Advance Directives Allow Choices and Support Medicare Savings

All the hoopla about “death panels” during the 2010 battle for healthcare reform spooked too many older adults into thinking they would be deprived of curative healthcare because they were older and the care too costly.

That talk has died down for the most part; however, the idea continues to haunt many when they think about end-of-life choices and hope their wishes will be honored and not limited to palliative care alone.

The results of a recent University of Michigan study, published in the Journal of the American Medical Association, show promise that advance directives and other end-of-life care choices have not had an impact on the quality of care provided. Nor have older Americans been denied curative care if they desired it, according to the study.

In regions of the country where curative care is the norm, the cost of medical care has surprisingly declined (and Medicare savings have increased) because of growth in the number of patients choosing palliative care instead of more costly aggressive care. The Michigan study showed that patients in those regions with advance directives received quality comfort care according to their final wishes. Many died at home instead of in hospitals, as was their wish.

The study’s results may encourage people to strongly consider their quality of life concerns and make their end-of life choices known to their families and their healthcare team. Even many study participants who chose treatment-limiting instructions also allowed for limited trials of intubation (inserting breathing or feeding tubes) and mechanical ventilation if needed. But their instructions also made it easier for their proxy (appointed person who has the legal power to make healthcare decisions if you cannot) to stop the treatments if they weren’t effective.

End-of-life care decisions require careful consideration; they can be as specific as you want or need them to be. Although impossible to address every scenario, it’s imperative to discuss the scope of your wishes with your family; your spokesperson and your healthcare team so that your intentions can be met. For instance, do you want everything possible done or do you want quality of life and freedom from pain and suffering (palliative care) if there is no hope of a cure?

If you would like to help people make important decisions in their healthcare, consider any of the online healthcare degrees.