Category: Death Education

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Medicare, Medicaid and Long-Term Care

What the programs cover, and what they don’t

by Tamara Lytle

What role does the federal government play in assisting Americans in need of long-term care? The answers, which lie primarily within two programs — Medicare and Medicaid — may may surprise you. Here is a breakdown of the services they do and don’t offer.

Does Medicare cover the costs of long-term care?

No. This is a common misconception. As a reminder, Medicare is strictly a health insurance program that covers costs related to illnesses and injuries (and, to some extent, their prevention). As such, it will help pay for up to 100 days of rehabilitation or skilled nursing care after a major health issue, based on a doctor’s recommendation. But longer stays, such as a permanent move into a nursing home, are not covered.

What about Medicare Advantage?

You can check to see if there’s a Medicare Advantage plan in your area that offers limited caregiving assistance. You may be able to find one that provides meals or pays for installation of grab bars, says Howard Gleckman, senior fellow at the Urban Institute. A small number of so-called special needs plans offer some in-home support services. If a Medicare Advantage plan has a five-star rating, you may switch to it outside of the annual enrollment period.

What about Medicaid?

Medicaid does pay for long-term nursing-home care, but only for people with very low income and modest savings who can no longer handle basic daily tasks like dressing or feeding themselves. Gleckman says a good rule of thumb is that if you have less than $750 in income per month and less than $2,000 in financial assets (not counting a home), you likely qualify for Medicaid.

This excludes a large number of people who draw Social Security, given that the average monthly benefit check is more than $1,600. Remember that Medicaid is meant to help just the very poor. Most middle-class people and even low-income people do not qualify, although sometimes people use up their savings and spend so much of their income on care that they do become eligible.

But also note that the Medicaid program is a partnership between the federal government and each state, meaning criteria for who qualifies and what benefits are available can vary based on where you live. Some states provide some benefits to people with low incomes who are over the basic qualification limit, but they are expected to pay for part of the care.

What about care services at home?

It’s important to distinguish between medical care and daily care needs like bathing, eating, moving about and such.

As noted, Medicare will pay for assistance like physical therapy or skilled nursing care, whether in a facility for short periods or at home, where there is no specific time limit, while a patient is recovering from an illness or injury. A supplemental Medigap policy may help with some at-home medical care costs, Gleckman says.

“But for people who are unable to care for themselves at home and don’t have a family member to help manage their daily activities, Medicare doesn’t fill that gap,” says Tricia Neuman, head of the Kaiser Family Foundation Program on Medicare Policy.

Medicaid is another matter. If you meet its stringent requirements, some recipients can get coverage for aides to help with activities like dressing and toileting, says Sara Rosenbaum, a law professor at the George Washington University Milken Institute School of Public Health. But even those benefits only go so far. “Medicaid is not going to provide anything remotely like 12 hours of help,” Gleckman notes. And again, benefits — and funding levels — vary by state. Oregon and Minnesota, in particular, have robust programs to help people live at home or in the community instead of in nursing homes.

Veterans should check with the U.S. Department of Veterans Affairs, which has some programs for those needing ongoing care, including a foster care program through which veterans live with families who can help them. For broader background on long-term care, visit longtermcare.acl.gov. The Area Agencies on Aging are a good clearinghouse for information on nonprofits or other community resources. Go to eldercare.acl.gov.

What if I just need a break as a caregiver?

Some state Medicaid programs pay for adult day programs that offer medical services. And some Medicare Advantage plans are beginning to offer coverage for adult day care and other breaks for family members, says Robert Saunders, senior research director for health care transformation at the Duke-Margolis Center for Health Policy. “There are more options now than there used to be.”

In end-of-life situations, Medicare will pay for respite care in hospice. That palliative care coverage is available when someone is considered to be in the final six months of life.

Complete Article ↪HERE↩!

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‘We Have to Make a Concerted Effort to Be Less Alienated from Death and Dying’

A conversation with Anita Hannig, author of ‘The Day I Die: The Untold Story of Assisted Dying in America’

By Richard Harris

Like taxes, death is still a certainty. But in America, the end of life isn’t what it used to be.

Today, one in five Americans lives in a state that permits medical aid in dying, sometimes simply called assisted dying. The idea is terminally ill individuals who have six months or less to live can apply for a medically assisted death to limit their suffering. And if they meet the criteria, they can have some say when they will take their last breath.

It’s been nearly 25 years since the country’s first assisted death law — Oregon’s Death With Dignity Act — went into effect. And since then, eight other states — Washington, Vermont, California, Colorado, Hawaii, New Jersey, Maine and New Mexico, as well as Washington, D.C., have enacted their own versions. What all jurisdictions with medical aid in dying have in common is the requirement that the patients must be of sound mind, have less than six months to live and they must be able to self-administer the lethal medication, prescribed by a physician, to end their lives.

Eleven other states have introduced medical aid in dying bills during the 2021-22 legislative session. It’s a growing movement that’s largely under the radar, much as death is in this society.

Assisted death is “not the path of least resistance. For many it’s the path of most resistance.”

In the latest survey by Susquehanna Polling & Research, two out of three voters (67%) said if they “had an incurable, terminal illness, still had a sound mind but less than six months to live and met the legal requirements,” they would want the option of medical aid in dying.

As the baby boomers age, medical aid in dying is expected to be an even bigger issue in the years ahead.

Anita Hannig, associate professor of anthropology at Brandeis University in Waltham, Massachusetts, says assisted death is “not the path of least resistance. For many it’s the path of most resistance.”

Indeed, the assisted dying laws in the ten U.S. jurisdictions are among the most restrictive in countries with such laws. That hasn’t stopped opposition from some religious and right-to-life groups, among others.

For her new book, “The Day I Die: The Untold Story of Assisted Dying in America,” Hannig spent hundreds of hours over five years on the frontlines of assisted dying in the Pacific Northwest, including witnessing several deaths among those who availed themselves of the law.

Next Avenue: You’ve taken a very deep dive into assisted dying in America, a world few families have experienced. As a cultural anthropologist, you’ve gone from researching birth and the beginning of life in Ethiopia to the opposite end of the life cycle. Why the shift?

Anita Hannig: I was showing a film called ‘How to Die in Oregon’ in my Medicine and Religion class at Brandeis. It’s such a lovely documentary about the law in Oregon and about all those assisted dying volunteers who go and help people die. And I was immediately hooked and thought, wow, birth and death are like bookends. You have home births and home deaths. And so I was curious to go over to the other side. I was very surprised by what I found.

You must have a unique perspective on birth and death as an anthropologist studying assisted dying and as a new mother who also lost a child during an earlier pregnancy.

Definitely. We’re so used to thinking about birth and death as opposites when they’re actually very similar. One of the main figures in my book, a former nurse and longtime assisted dying volunteer in Oregon, Derianna Mooney, taught me that birth and death are both sacred transitions — from one state of being to another, from nonbeing into being and being into nonbeing. And culturally we revere one, but we shun the other.

“I think part of the issue is that we have all the technology now, but our ethical and moral compass hasn’t really caught up with how we should use it.”

As a new mother, I can see people’s eyes light up when they watch us stroll by with our oversized pram. There’s so much positive attention. And all of this has to do with the fact that we love the beginning. It holds so much promise.

And yet we’re so afraid of the end. Similar to a birth, people do need help at the end of life. I love when Derianna says, “You’re going to the gate with them and you are letting them go, but you’re nurturing them through the gate.” What a beautiful vision.

One of the vexing issues surrounding death in our country especially is the role high-tech medicine plays in extending life — even when a longer life doesn’t always promise more quality. Is the assisted dying movement a sign that technology is frequently not making our final years better?

Yes. I think part of the issue is that we have all the technology now, but our ethical and moral compass hasn’t really caught up with how we should use it. And it’s not just in the United States. My 87-year-old grandmother, who passed away in Germany in March, underwent radiation for her breast cancer when she was two weeks away from dying. I’m flabbergasted when I think about why we offer this extremely invasive treatment to somebody who is close to dying. Thankfully, she was soon admitted to a beautiful hospice by a lake to spend what became her final days.

I got interested in this topic when a friend’s husband, suffering from Parkinson’s and no longer able to feed himself, was forced to starve himself to death since he lived in Maryland, a state without a medical aid in dying law. For people consigned to such a horrific death, can a doctor truly say they are following the Hippocratic Oath that tells physicians to do no harm?

That’s exactly the conclusion that a lot of doctors who help patients die come to because in that case doing nothing — such as not helping somebody die — is doing harm. Physicians who are at the forefront of assisted dying say their task is to prevent suffering. And how you prevent suffering in many of these cases is to help somebody die. I always come back to this question: Who is telling these patients that they need to hang on? For what? For whom? Sometimes they themselves are ready to go, but they want to stick around for the family or because there’s a societal expectation to fight.

At the beginning of your book, you almost took my breath away when you were helping one of the volunteers opening the capsules of Seconal and pouring powder into a bowl in one room while the patient, Ken, was waiting in the next room to receive the lethal medication. What were your thoughts as you prepared the medicinal mix that you knew would end a man’s life?

It’s a really good question. Anthropologists have a tool in our toolbox called “participant observation.” And that means you’re never just an impartial observer because your presence alone already changes what’s happening in the room. In order to really relate and put ourselves and the reader into the shoes of these people, you have to bring yourself into the situation wholeheartedly and authentically. And often that means becoming a participant in what is happening.

It’s an extreme privilege to be invited into that kind of intimate space. So, it would have felt very off- putting to just be sitting in the corner taking notes. Everybody in the room is carrying this person over the threshold together. And so you just kind of take your cues from what’s happening.

You don’t want to feel like a voyeur?

Exactly. You want to be in the moment and going through all the emotions other people are going through. It’s a different way of being present that allows you to faithfully experience the death alongside the people whose loved one is dying.

But this must have been a difficult moment for you. In your book, you described “a heavy sense of transgression rise up inside” of you as prepared the lethal medication.

You know what I think it is? It’s the feeling of internalizing some of the stigma that we carry and some of the taboo with which we treat death. And so being part of somebody’s death in this participatory way makes you ask, ‘Am I doing something wrong? Am I, in some bizarre way, enabling that person to die?’

But even if I hadn’t been there, things would have gone probably in a very similar way. I think it’s the cultural baggage that we feel around what it means to hasten the end of your life. Everyone there knew this is what Ken wanted. He chose this with one-hundred percent of his cognitive abilities. His wish was to be delivered from this world and you are enabling that transition.

Among the deaths you researched but didn’t witness was that of Louis, who was an outlier. His experience turned into a nightmare for the person who supervised his assisted death. Louis actually woke up after taking the lethal medication. What happened?

“Everybody in the room is carrying this person over the threshold together.”

Medicine is a human art and as an art, is prone to failure. And it just goes back to the ways the laws are written. They insist on self-administration. But when you are limited that way, you’re going to run into a bunch of problems such as people with gastrointestinal issues who can’t quite absorb the medication. And then you have people who can’t physically self-administer, like a lot of folks with ALS or other illnesses that affect their mobility or their hand range or who can’t drink something on their own or push the syringe on their feeding tube.

And people are getting a little more innovative with things like rectal catheters now, but there’s still a requirement that this has to be an act of volition — you have to be the one to push the plunger on your feeding tube or catheter, what have you. And in almost all other countries, you don’t have that requirement. A doctor can administer if you’re unable to administer yourself.

So after immersing yourself in this world of assisted dying for five years, what‘s your takeaway from this experience?

As a society, we have to make a concerted effort to become less alienated from death and dying. Of course, one could ask how alienated are we when the biggest newspaper in the country, the New York Times, can post images of corpses in Ukraine on its front page? But that doesn’t create closeness or connection. That just creates more fear.

Ideally, I think everybody should have to take a class on death and dying that could cover estates, hospice, and what life-extending procedures there are. In my death and dying class, I talk about people in South Korea who fill an entire gymnasium with coffins and the public comes in and gets inside the coffin to simulate what it would be to die. And they come out of this experience with a totally new zest for life.

This is what contemplating our mortality can do for us. It can take away some of the fear and some of the surprise when a loved one passes away because you will have thought about it in advance. I’m not saying assisted death is the way to go for everyone. We really need to pay more attention to end-of-life issues and prepare for the inevitable and have all of that be less stigmatized.

Book over of "The Day I Die" by Anita Hannig. Next Avenue, medical aid in dying

As the country’s pandemic death toll inches toward one million, has America’s attitude toward death changed at all?

Certainly it’s brought death into the lives of lots of people but not in a way to make them feel more connected to death. Many people weren’t able to see their loved ones in assisted living homes or couldn’t go to the funeral or they weren’t allowed to be present at a nursing home.

When I see the way that we’re tumbling back into life as it was before the pandemic, I don’t know that we’ve really thought critically about death. We just have this big fear-based relationship with death and it’s not lifting the curtain, really. I think people are thrilled to have escaped the pandemic. They see themselves on the other end of that mostly unscathed.

They dodged a bullet?

That’s exactly what it is. But I don’t think it’s made us really contemplate our mortality that much more.  

So what will give you a signal that something has shifted in the American attitude toward death?

That people don’t automatically associate the topic of death with fear. And when people begin to realize what I witnessed and write about in the book — some of the empowerment that can come from determining the end of your life and even some of the joy. I hope I’m not out of line to call it joy. When I think of the deaths I witnessed, they weren’t unambiguously sad. There were also serene and heartfelt moments, some laughter and families felt at ease because their loved one wanted to die and they were helping them.

And those who chose to end their lives wanted their death to resonate beyond themselves and their families. Jean, one of the people whose death I witnessed, unbelievably spent the last few minutes of her life promoting her chosen way to die. I still remember her words:

“There are all these baby boomers who will want a better way to die. Our society doesn’t recognize that yet. They will someday.”

Complete Article ↪HERE↩!

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These are the best and worst U.S. places to die, report shows

  • Your end-of-life experience may be very different depending on where you live, according to a Policygenius report.
  • The report ranks the best and worst U.S. places to die based on funeral costs and services, green burials, palliative care, Medicare providers, at-home deaths and probate shortcuts.

By Kate Dore, CFP®

Your end-of-life experience may be very different depending on where you live, according to a Policygenius report that ranks the country’s best and worst places to die. 

The report gave each state and the District of Columbia a numerical score based on seven factors, including funeral costs and services, green burials, palliative care, Medicare providers, at-home deaths and probate shortcuts.

“I think the big takeaway of this project is to get people thinking about the costs associated with the end of life,” said Logan Sachon, senior managing editor of research at Policygenius. “Because some of them can be mitigated through planning.”

“If you look at the top 10 and bottom 10, there aren’t any specific things they all have in common,” Sachon said. “They are each kind of unique in their own way.”

Indeed, Vermont, ranked as the No. 1 place to die, was among the most expensive for funeral costs but scored highest for palliative care, which focuses on pain relief, management and emotional support.

Florida, known for its high population of retirees, came in last place, with the fewest Medicare providers per capita, and scored low for at-home deaths and palliative care.

The best places in the U.S. to die

  1. Vermont
  2. Utah
  3. Idaho
  4. Ohio
  5. South Dakota
  6. Maine
  7. Colorado (tie)
  8. Illinois (tie)
  9. New Hampshire
  10. Washington

The worst places in the U.S. to die

  1. Florida
  2. Alaska
  3. Texas
  4. Hawaii
  5. New York
  6. Georgia
  7. New Jersey
  8. North Carolina
  9. South Carolina
  10. Connecticut

It’s never too early for older Americans to prepare for end of life, Sachon said.

While the Covid-19 pandemic has boosted awareness about the need to be proactive, 67% of Americans still don’t have an estate plan, according to senior living referral service Caring.com.  

Experts recommend an advanced directive, also known as a living will, covering your medical care preferences. You’ll also need a health-care proxy or power of attorney, naming someone to make medical decisions on your behalf if needed.

Estate planning

The report also focuses on each state’s probate process, which determines the cost and time it takes to settle your estate.

As of June 2021, only 17 states and the District of Columbia have an estate or inheritance tax, according to the Center on Budget and Policy Priorities.

With different laws in every state, a local estate planning attorney may share some options to protect your assets and carry out your wishes, depending on where you live.

There’s no federal estate tax on wealth below $12.06 million for individuals in 2022, and with proper planning, married couples can transfer their unused exemption to their surviving spouse, effectively doubling it to $24.12 million.

However, this reverts to an estimated $6 million exemption in 2026 when provisions from the Tax Cuts and Jobs Act sunset.

Complete Article ↪HERE↩!

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‘I Prepare Wills for a Living, and Here Are 4 Things I Wish Every Family Would Talk About in Times of Health’

By Erica Sloan

As a thing that most people try to avoid, death isn’t a common topic of conversation. After all, discussing it requires confronting its inherent inevitably—but avoiding discussions surrounding it doesn’t just bring blissful ignorance, either. In fact, this tactic can leave your loved ones in the lurch when death does arrive. That’s why estate-planning attorneys suggest considering in advance how you’ll discuss your plans for death with your family, and above all, making a point to do so.

Death comes along with an emotional and logistical cascade of concerns for those close to the person who passed. While working with a palliative-care professional or death doula once death becomes imminent can certainly help with the emotional side of things, creating an estate plan ahead of time mitigates stress related to the logistics. “This is why we always say every adult should have a will,” says estate-planning attorney Rosalyn Carothers, JD. “For one, that allows you to direct what happens to any of your assets, and two, you’re making it easier and less expensive for your family members to help, as you’d have seen fit.”

“If you indicate clearly [to family members], ‘Here is my plan,’ then everyone can get on the same page, and it’s harder for someone to feel like they’re getting cheated.” —Patrick Hicks, JD, general counsel at Trust & Will

But, because of the inherent sensitivity of a will—deciding who gets what and what goes where—creating one only gets you halfway to solid death preparations. Learning how to discuss your plans for death with loved ones is the other half, both so that they know exactly where to find all the relevant documents in the event of death, and also so that they can help ensure your wishes are carried out effectively, without confusion, disagreement, or unwelcome surprises. “If you indicate clearly, ‘Here is my plan,’ then everyone can get on the same page, and it’s harder for someone to feel like they’re getting cheated, so to speak, when push comes to shove,” says estate planning attorney Patrick Hicks, JD, general counsel at Trust & Will.

Below, estate-planning attorneys share the key elements of end-of-life planning to talk about explicitly with family members, so that everyone knows what to expect should the unexpected occur.

What to discuss with family about end-of-life issues, according to estate planning attorneys

1. End-of-life wishes

A handful of both pre- and post-death desires fit into this category—which covers what you’d like to happen in the event that you’re incapacitated or terminally ill (the details of which can be legalized in a living will) and how you’d like your body to be handled should you pass (like your preferences for burial or cremation, for instance). “You really want to let folks in your life know, ‘Hey, if I’m in this circumstance, do this or don’t do this,’ regarding life support, in particular, so that loved ones feel like they are intimately aware of what you would’ve wanted,” says Carothers.

Even if it’s all legally delineated in your estate plan, talking about these desires openly can spare the people in your life who survive you from some very difficult conversations, says Hicks. It’s also worth mentioning that, in the same conversation, you should tell loved ones exactly where they can find the documents detailing these wishes, so that there’s no need to search for them if and when the time comes.

2. Who will handle what when death nears

Once you start considering your plans for death, you’ll quickly run up against what Carothers calls the “who’s its” and the “what’s its.” This refers to “who” in your life is going to handle “what,” logistically speaking, when you’re about to pass and afterward—which is another big source of potential death-related conflict that can often be avoided with a conversation.

The most contentious roles to consider are who you’ll appoint as your financial and health-care agents under your powers of attorney, or the person (or people) you’re choosing to handle your finances and taxes and your medical decisions, respectively, whenever you become unable to do so. “Sometimes, people don’t want to speak to their kids or siblings about this because they don’t want to hurt anybody’s feelings,” says Carothers. “But, it’s better to let these loved ones know upfront who you’re choosing for what and why.” That way, there’s less chance of a dispute after the fact.

The same goes for clarifying whom you’ll be naming as the executor of your estate (once you have a will in place or while you’re creating one). This is the person who will settle your accounts, manage your personal assets, and disseminate the right assets to the designated beneficiaries of your will after you pass. Talking about this with family members lets everyone know whom they should turn to for any will-related matters post-death.

3. People to call in the event of an accident

Chances are, you may not even know exactly who among a parent or sibling’s friends or acquaintances you should contact directly should they become incapacitated or die. And if you do, it’s even likelier that you don’t have their contact info handy. “Nowadays, everything is just saved in everybody’s cell phones, but what happens if you lose a loved one’s phone in an accident or you just can’t unlock it?” says Carothers.

That’s why she suggests everyone keep a list of the few close friends whom they’d like to be contacted should something happen to them, along with their contact information, and inform loved ones where they can find it in the event of an accident. Also on that list should be the name and contact info of your accountant and homeowner’s insurance agent, if either or both applies, adds Carothers, since these are usually the most important people to reach in any situation where someone is nearing death.

4. Sentimental assets

Surprisingly, it’s often the sentimental pieces of property that tend to create the most tension among a decedent’s family members, says Hicks. “With valuable assets, a lot of the time, it gets quickly resolved, either according to the specific plan in place, or in a way where things get divided equally,” he says. “But it’s the things that don’t have a lot of economic value, but that have sentimental value which are typically not accounted for in a will, and then get fought over.”

That could mean a family photo album, an antique, a special piece of artwork, or any other kind of family heirloom that can’t just be cut up into parts and divided equally. “Not having a conversation upfront about who’s going to get which of these items often leads to disputes and disagreements,” Hicks says. Talking explicitly about sentimental pieces in advance can certainly get ahead of these potential arguments, though Carothers also suggests checking to see if your state allows you to file a memorandum along with your will that can include a written file of all these items, listing the person’s name to whom each should go.

Complete Article ↪HERE↩!

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Knowing Someone Has Your Back At The End Of Your Life

By Sara Zeff Geber, PhD

While we were celebrating Passover and Easter with our loved ones and family, National Health Care Decisions Day came and went. It was on Saturday, April 16. It was designated to remind us that no matter our age, planning for the inevitable day when we cannot make our own health care decisions is more than a good idea; it is essential. Not planning for that inevitable event is like flying a plane that you don’t know how to land. The only people who don’t need a plan are those who meet their demise like my father: standing and talking to a friend one minute, and in an instant was lying on the floor – dead. If you are sure that is your fate, then don’t waste your time doing any planning. However, be advised that the ultimate result of not providing end-of-life instructions is that when you find yourself in the hospital toward the end of life (as many people do), the hospital ‘care protocol conveyor belt’ takes over and you will be hooked up to whatever life-support is available to keep your body nourished and your heart pumping.

What Do People Want?

Let’s look at some facts and some history about end-of-life care. Studies on end-of-life preferences demonstrate quite clearly that the vast majority of people want to die at home. However, because of a lack of willingness to talk about preferences for end-of-life care and advance care planning, over one-fifth of patients still die in the hospital. If your wish for the end of your life is an extended stay in an acute care unit of a hospital, hooked up to machines designed to keep you alive, then by all means ignore all of these statistics and opportunities to make other choices. My friend Mitch, a retired ER doc, told me how frequently he watched as family members argued about whether to keep their elder relative alive through extraordinary measures (feeding tube, mechanical ventilation, urinary catheterization, dialysis, etc.) or to let them die a more natural death. Often these well-meaning relatives were confused about what the elder wanted, or remember hearing it differently than another relative. In the end, and in the absence of written instructions, the final decision was almost always “keep her alive.”

End-of-Life Care Will Cost You

For those who still are not convinced that planning is the best way to ensure an end-of-life experience that is under your control and as comfortable as possible, you may also want to consider the cost implications of hospital care versus palliative or hospice care at home.

End-of-life costs for people with chronic diseases can be $57,000/yr. and up. Medicare will generally pick up most of that, depending on medigap coverage, pre-approvals and cooperating providers, and how long you are expected to live, but one study found that out-ot-pocket expenditures for end-of-life treatments and care are still averaging close to $12,000., with a range that goes up to close to $100,000. in the final year of life.

Medicare has covered hospice care since 1983 and usage of this benefit has slowly been increasing. In 2018, for example, 50.7% of those who died had taken advantage of hospice care for their final weeks or months of life. The savings associated with using hospice, rather than in-hospital care or a nursing home is estimated to be $117.-$400. per day.

The best-known way of creating an advance directive (also known as a healthcare proxy or power-of-attorney for health care decisions), is to work with an attorney who specializes in estate planning. They will suggest that you create a full set of end-of-life documents, which usually includes a will, a power-of-attorney for financial decisions, an advance directive, and possibly a trust. They will give you a worksheet and have a series of discussions with you about your preferences for end-of-life care and who you would choose to make decisions for you about your health and finances if you could not make them yourself. In addition to denial about the urgency of creating these documents, the cost of a complete estate plan can range from $1000-$8000., depending on how complex it needs to be.

Quick and Easy Advance Directive Online

If you are now convinced that advance care planning is important and necessary but you aren’t ready to do the full estate plan, there is a way to produce and file just the advance directive document, online – and it’s free! Since 2009, Vital Decisions has worked with individuals through health insurers to set up their wishes, should they be unable to communicate their wants at the end of life. Today, in addition to their insurance partners’ clients, they also offer a free program for the general public. It’s called My Living Voice and it guides you through three stages of preparing an advance directive: 1) setting a healthcare proxy 2) Talking through values 3) Goals of Care and Treatment wishes. So check it out, in honor of National Health Care Decisions Day, and give your loved ones the peace of mind of knowing what you want at the end of your life. Plus, it will give you peace of mind that you have communicated your final wishes to those who will be making decisions for you when you cannot.

Complete Article ↪HERE↩!

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Don’t leave your health decisions to chance

It’s easy to put off making important decisions in life, especially health care decisions. They can be uncomfortable and complex. Yet taking time to discuss and document your health care wishes can bring peace of mind and lead to better health outcomes in the future.

By William Creech

It’s easy to procrastinate

There are so many things to do every day, an almost-limitless amount of “low hanging fruit” items to cross off the list. It’s easy to put off thinking about your health care wishes.

There are many more enjoyable things to plan and ponder, while considering your health care wishes can feel like a chore. When given a choice between planning a vacation or outlining your end-of-life wishes, it’s easy to pick the more fun, less distressing task.

You also may procrastinate because you believe these decisions can wait for a more appropriate time in the future. Unfortunately, the right time and circumstances never seem to line up.

Documentation of your wishes

Thinking through and documenting your health care wishes tells your family and health care team what kind of care you want if you are too ill to express your wishes yourself. This could occur if you’re terminally ill, seriously injured, in a coma, in the late stages of dementia or near the end of life.

Some decisions that you should document include when you want to be resuscitated by CPR, when and for how long you want to be placed on a mechanical ventilator, or if you want to be fed through a feeding tube.

Record your wishes in a legal form called an advance directive. This document isn’t just for older adults. Anyone over 18, regardless of state of health, can complete an advance directive. It’s only activated if or when you are incapacitated and cannot make health care decisions.

One type of advance directive, a power of attorney for health care, is preferred because it makes your care wishes known and designates a person to make decisions for you if you cannot speak for yourself. This person is called a “health care agent.”

When selecting your health care agent, remember this story:

Two leaders pondered a difficult decision and were united in their approach. But soon, the second leader started to second guess the decision. The first leader said to the second, “Now is not the time to be a fence straddler.”

As you select your health care agent, pick a person you trust to follow your wishes and hold firm to the decisions.

You can update an advance health care directive or power of attorney for health care at any time, such as after a new diagnosis, a change in marital status or if your thoughts about end-of-life care evolve.

Get better outcomes

Procrastinating health care decision-making is a serious matter, so the sooner you begin, the better the potential outcome.

In some cases, life can be prolonged using advanced technology like ventilators, vasopressors and surgery. It’s great to be an educated health care consumer and understand the available treatment options, but it’s also important to remain objective, and listen to and heed the advice of your health care team.

If your health care team is unsure of your wishes, they may insist on prolonging care or performing invasive treatments on your behalf. These actions can have serious negative side effects and result in low quality of life.

Documenting your wishes early ensures that you will get the medical care you want and need while avoiding unwanted heroic measures that may be harmful. It also relieves unnecessary suffering, and eases your family and friends of decision-making burdens during moments of crisis or grief. What a gift this is for them.

Tips for difficult decisions

These conversations and decisions are not easy, but they are important.

Here’s my advice on tackling difficult decisions with your family and friends:

Don’t kick the can down the road.

Sometimes getting started is the hardest part. Years ago, I drove a vehicle with a manual three-speed transmission on the column. Unlike the automatic engines found in cars today, you could give this car a small push downhill to start the engine. In the same way, some people just need a little push to get started.

Perhaps you feel the day will never come that you face a serious injury or illness or that you will die in your sleep. But nearly every family is affected by a serious illness or injury at some point. If decisions are put off and not documented, a well-intentioned but uninformed family member could make decisions that don’t align with your wishes. I have found this to be the case on many occasions. A rolling snowball in the form of unmet health care decision-making can lead to a big mess that can become a proverbial avalanche if left unheeded.

Don’t decide to do nothing.

Inaction is still an action. If you refuse to make difficult decisions in health care, you are still deciding, but it’s much riskier. It’s like gambling on a roulette wheel. You don’t know where the ball is going to stop. Instead of taking action to improve your odds, you are just hoping for a good outcome.

You take control by expressing your wishes and choosing a responsible health care agent in an advance directive. These actions guide your roulette ball by adding flappers on the wheel that align with your desires. Doing so can make the difference between comfort or chaos for you, your health care team and your family.

Keep points simple yet specific.

As you complete your advance directive, you will be advised to consider all options. This can feel overwhelming. The key is to keep it simple because there is no way you can cover every possible scenario.

Too often, advance directives are too generic or too detailed. I recommend a happy medium where some key themes are outlined and cover a myriad of scenarios. Keep it simple when you can.

Let professionals guide you.

When you are ready, find a health care professional to guide you through completing an Advance Directive booklet. Social workers and chaplains in health care organizations, along with faith leaders, community service workers in local communities and volunteers, are trained to assist you. Your primary care provider also can assist. These professionals will help you work through the decisions, but they won’t tell you what to do.

Advanced planning and outlining your wishes before you need the care gives you the opportunity to communicate your wishes with your family. Talk with them about your advance directive and health care wishes, along with your rationale behind the decisions. Give a copy to your health care agent and health care team.

It’s prudent to be a well-informed patient as you outline your health care wishes. They are not only life decisions, but also they’re life-altering.

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Americans are bad at talking about death, and it’s hurting the environment

The path to more eco-friendly burials starts with uncomfortable conversations about death

By Rachel Ashcroft

How often do you think about your own death? The answer is probably along the lines of “rarely, if ever.” Death denial is commonplace in the United States; indeed, in Western countries, people tend not to die at all, but “pass on” or “slip away” instead. Our own death, in particular, is something we try to avoid thinking about until we really have no choice in the matter.

This is perfectly understandable behavior. Thinking about death can be scary for many reasons, from fears about dying in pain to contemplating what happens after death. Longer lifespans and medical advances have made it easier to delay thinking about mortality. But death denial has many disadvantages, too. Avoidance can actually increase — not lessen — anxiety. We also risk leaving behind grieving loved ones who aren’t clear on our final wishes. Death denial is not just bad for individuals, either: There’s plenty of evidence to show that it is harmful to the environment, too.

Traditional funeral options are less than eco-friendly. In the U.S., some estimates suggest that cremation emits approximately 360,000 metric tons of CO2 each year. According to the Green Burial Council, heating a furnace at 2,000 degrees Fahrenheit for two hours produces roughly the same emissions as driving 500 miles in a car. Burials pose their own set of problems: Caskets and vaults use a large amount of natural resources. Casket wood alone requires the felling of 30 million board feet of wood in the U.S. each year, and thousands of tons of steel and concrete are used to construct vaults. Embalming fluid (which contains carcinogenic chemicals) can contaminate groundwater around cemeteries.

At a time when large corporations are regularly held to account for their green principles, the funeral industry is one of the few players to escape the scrutiny of its practices. A culture of death denial facilitates this situation. In a society where death is considered “morbid,” who wants to build their activism around something that most of us avoid discussing? Prominent figures like Greta Thunberg rarely venture into the murky world of deathcare. On Instagram, eco influencers are far more comfortable snapping pictures of avocado on toast than discussing the perils of embalming fluid.

Things weren’t always this way. In the early 1900s, Americans lived in close proximity to the dead and dying. Bedside vigils, in which the entire family gathered around a dying relative, were extremely common. Most people died in their home, leaving family members to prepare the body. Historians argue that this changed when end-of-life care moved to hospitals and funeral parlors began looking after dead bodies. Death became far less visible. When people today view an open casket, the corpse is altered so as to hide the physical effects of death. This evolution from death in close proximity to death being hidden and painted over has fueled a tendency toward death avoidance which, when compared to many other world cultures, is a complete anomaly.

Fortunately for our planet, change is on the horizon. Several environmentally-friendly deathcare options are springing up across the United States. From water burials to natural organic reduction or “human composting,” the green deathcare industry is taking root. But in order to fast forward the process of offering people legalized, eco-friendly deathcare choices, we have to talk more openly about death and dying to begin with.

In practical terms, avoiding death talk allows myths and assumptions about funeral care to flourish. Just over half of Americans choose cremation each year, partly due to a (false) perception that it’s good for the environment. Caitlin Doughty, a prominent mortician and “death positive” advocate, has also reported instances of bereaved families being informed that embalming is a legal requirement — it isn’t. No state requires embalming or even burial inside a vault. If you’ve lived your whole life trying to reduce your carbon footprint, understanding what is and isn’t legal can help make your death greener, too.

People often say they “want to be a tree” after they die. But when we don’t examine traditional deathcare closely enough, it’s easy to overlook the fact that ash from cremated remains doesn’t enrich soil, while traditional burial prevents bodies from mingling with the earth. Setting aside time to explore other funeral options reveals the different ways that our remains can help plants grow. “Green burial” generally describes an unembalmed body placed in a shroud or biodegradable coffin, which is lowered directly into the ground. This allows the body to decompose into the surrounding earth. No state laws forbid green burial, and a growing number of cemeteries are offering this service. Human composting uses a combination of microbes, oxygen, and organic matter to convert corpses directly into soil. It’s legal in Colorado, Oregon, and Washington, and bills are being considered in several other states.

There are some disadvantages to green deathcare. At the moment, price can be an issue. For society’s poorest, direct cremation (no viewing or visitation) costs as little as $1,000. Human composting, on the other hand, is priced between $7,000 to $10,000. There may also be religious issues pertaining to human remains; Washington’s legalization of human composting was opposed by Catholic groups who argued that composting didn’t show enough respect for the deceased body.

However, green deathcare will only become more affordable and widespread (for those who want it) if we learn how to talk about death in the first place. Of course, it can initially be uncomfortable to think about ourselves turning into ash or soil. But having as much information as possible about a topic is always empowering — even when it comes to your own death.

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