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Post-retirement — a plan to die

By Jennie L. Phipps ·
Monday, January 3, 2011
Posted: 2 pm ET

When you next go to the doctor's office for your annual Medicare-paid-for physical or if you just turned 65, your Welcome-to-Medicare physical -- a new benefit this year, thanks to health care reform -- the doc may want to talk about your death. Don't get scared. It's happening to everybody eligible for Medicare.

Beginning this year, Medicare will reimburse docs for the time they spend initiating an end-of-life planning discussion. The doc will ask you to sign an agreement in advance about what you want to happen if your heart stops, you can't breathe without a breathing machine, and/or you are otherwise in a vegetative state and aren't likely to rally. You'll also be asked to state whether you want to donate organs and other tissue after you die.

Proponents of this new aspect of retirement planning say it will provide opportunities for people to talk about a tough topic while they are still able. The discussion with the doc is confidential. You don't have to share it with anyone, although legal experts say that storing a copy of this agreement someplace where family can easily find it when it is needed can save everybody a lot of grief.

It also could save taxpayers a lot of money. A 2009 study published in the Archives of Internal Medicine found that late-stage cancer patients who received end-of-life counseling incurred 36 percent lower health care costs in their last week of life compared to patients who didn't make choices in advance. This isn't a small amount of money because more than 25 percent of the annual Medicare budget is spent on end-of-life care for the 5 percent of beneficiaries who die each year. Moreover, higher costs were associated with the worst quality of death -- more pain and indignity, the study found.

I cringe when I think about life ending this way. I'd prefer to go to bed feeling good and just not wake up. But it's a fact of retirement that many of us won't be that lucky, so let's have that end-of-life talk.

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Ginny Levsen
February 26, 2011 at 6:51 pm

My husband, Hal, had a major stroke on June 3, 2010. He was left unable to speak, read, write, or use the right side of his body. He still had that heart-warming smile and comprehended conversations and what was going on around him, indicating his responses with various facial expressions and the use of his left hand. Hal was a robust former fighter pilot, top level manager for a Fortune 500 company, and die hard golfer. He was truly enjoying life right up to the moment of his stroke. It is amazing how one second can change so many lives. He died at home on August 26th.

Had he not had a living will, Hal would have died in a hospital hooked up to medical equipment, which was NOT the manner in which he wanted to die. Making the decision to bring him home, knowing he was going to die within a week or two, was the hardest and most painful decision I have ever made. Knowing with certainty that this was what he wanted helped make the decision more palatable. His look of relief and happiness upon his arrival home reinforced the wisdom of his decisions and mine prior to his stroke.

In the years before his stroke, I had nagged him about writing a formal will and a living will. (Strange name for a will that determines how you want to die, isn't it?) After haggling with a man who did not want to confront his own death all those years, he finally recognized the importance of planning for his death (and to keep me from nagging him, at least on those issues). Both of us wrote wills and living wills as well as legally creating general powers-of-attorney, medical POA's, and financial POA's.

I had always thought the spouse had the power to make all medical decisions for her spouse if the latter was incapacitated. And she does in most states but without a medical POA, that can be a slow process and one complicated by well-meaning family and friends. The medical POA helped facilitate those processes on Hal's behalf. The financial POA ended up being the most important piece of paper I have ever had (along with his DD 214 for those who must deal with the military). Accessing his IRA's and stocks and bonds, providing me with much needed and easily accessible money while he was still alive and immediately following his death, would have been a nightmare, in spite of his having a general POA. I strongly encourage everyone to include the financial POA, along with the general POA, as a part of their "death packet."

NOTHING can ease the pain of losing a spouse but having the legal documents laying out Hal's wishes related to his dying and his death has at least made the necessary actions that Hal's death requires easier for me to implement. I wish no one had to go through what I am going through but if a spouse hasn't legally expressed his or her desires through legal documentation, the surviving spouse is left with additional decisions and problems on top of trying to deal with the emotional chaos. I have talked to several widows whose husbands did not create a "death packet" and I am so thankful to Hal that I do not have to deal with the problems they are encountering. Grieving is an incredibly difficult journey all by itself. It doesn't need additional baggage.

P. Powers
February 21, 2011 at 9:44 am

The hype has been to say that this coverage is forcing people to make end of life planning. As the rule reads, it is just to pay for the process. My husband, an R.N., has witnessed many families keep 90+ grandma alive even when she is suffering and does not know what is going on around her. The nurses privately tell each other that they hope that their families do not make them suffer. Then there are doctors will put a 90 year-old on dialysis when kidney function is going. If you want to pass on with dignity and your wishes met, do make a plan with your doctor. My dad did and it was so much easier on us. Don't take away that need for thoses that can't afford it.

Jim Griswold
February 18, 2011 at 4:11 pm

I, too, have made my intentions known to my wife. I discovered that when I told my sons that they were surprised, and if the choice had been up to them and not me, extraordinary measures would have been taken to keep me alive "at any cost" - their words, not mine. I am so glad we told them not to go to extremes. If there is a reasonable chance we will survive with some degree of quality of life, then don't pull the plug. Otherwise, see you on the other side.

David Winstead
February 11, 2011 at 5:01 pm

I have had that discussion and thought at the time i wonder if this discussion will come back later and haunt me as they use my reply to determine whether or not I get a new heart, etc? Will they go into my records and say here is a guy who doesn't care if he live or dies why should we let him live, all because I said do not keep me alive if that inevitable time comes. In reality I said do not revive me if on life support, as I don't want to be burden on anyone. I did not say I am ready to go.

February 01, 2011 at 11:24 am

Being a long way from Medicare I still had that conversation with my doctor when I turned 50. It was initiated by her, I was uncomfortable at first, then realized it was in my best interests to have a will, a power of attorney, and all of my wishes in writing. I hope to never need it, but it is there, just in case.

Thanks to that conversation I prepared for the inevitable, which I should have done all along, I just never knew.

Information is a good thing, it allows us to make informed decisions. Why there are people that fight against being able to make an informed decisions is a mystery.

These people are the ones who don't get their voice heard when they can't speak for themselves.

January 13, 2011 at 4:16 pm

Cutting to the chase, it is up to the individual whether he or she is at all interested in having the conversation. That is choice, not coercion. I have already made clear to my wife and adult childen what my wishes are should I be in a terminal condition where there is no reasonable belief that I can be helped. Succintly put, I have asked them to pull the plug. It will be a judgement call in many cases as not all situations are black-and-white. Nevertheless, we have all seen situations where the patient was comatose, unable to breath without a machine, taking nutrition through a tube with little to no expectation of improvement. How long shold this continuje? I casn't and shouildn't be able to vote on anyone's case other than my own or a family member whio has given me the right to do so, but I would vote for ending the suffering as quickly and painlessly as possible. Let me die with a modicum of dignity.