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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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Roberto Cadalso
January 12, 2011 at 9:39 am

I've had end of life conversations with my parents and extended family and my partner.

Let us talk about the importance of our decisions till the end.

I thank Obama and our Leaders for doing this.

P. Hulbert
January 11, 2011 at 3:27 pm

I am a senior citizen and have worked in healthcare, as well as facilitating a cancer support group for eleven years and have been a telephone support volunteer for 18 years for those affected by cancer. It has been my experience that many have prepared for end of life with advanced planning, whatever one wishes to call it. And, many senior citizen organizations and physicians have provided educational information regarding the California Healthcare Directives.

Many of us consider this to be more a discussion of quality of end of life rather than a "death panel."

January 10, 2011 at 5:30 pm

This is just another slippery slope that, if acted upon, will eventually end in genocide of the elderly. Repeatedly, I have seen doctors who do not truly have their patient's best interests at heart and, really only say what everyone wants to hear for the main bottom line. And, now they have more authority? This could easily end up being Germany all over again. It really is not that far of a leap.

January 10, 2011 at 3:43 pm

Listening to these conspiracy theory nutbags is getting old. "The government wants to take over our minds!" They weren't so vocal when the administration they voted for was in office. Guess what? 99% of the federal workers are the same ones that were working there under the previous President. How come they weren't cruel, faceless bureaucrats then?

By the way, your so-called death panel provision was first proposed by a Republican senator from Georgia, Johnny Isakson. But as soon as the teabaggers got wind of it and distorted it with their flat-earth, anti-fact minds, and labeled it the death panel provision, Isakson wimped out and voted against the legislation.

Do you want to pay the health care for people who smoke and eat too much and get diabetic and have to have hip replacements and by-pass surgery but can't afford it? Of course you don't. How about your neighbor's 100 year old grandmother with terminal cancer who wants "everything done" including $250,000 for a bone marrow treatment (and she never worked so didn't really pay anything into Medicare)? Of course not. So now you have just rationed health care.You see, when you speak without thinking, everything isn't so black and white. And when you just throw out phrases like "Obamacare" it just shows how ignorant you really are.

Thoughtful Doc
January 10, 2011 at 1:28 pm

This issue has nothing to do with "Obamacare" but rather acknowledging that end of life planning is valuable and time consuming. Many senior citizens die lonely, uncomfortable and often painful deaths in a hospital because no one took the time to understand their wishes or to explore end-of-life care options with them. Does this discussion belong at a routine physical for a 35 year old? A healthy 70 year old? No. But for those truly at the end of life, let's not deny them the peace of mind and comfort they deserve. Of course families should be involved in this discussion, but many times the wishes of the patient and those of the family are quite different. Families may act in direct opposition to a loved one's wishes at the end of life for many reasons. It is also appropriate to involve an attorney, but make no mistake, precious few attorneys will rush to the ER or ICU on Christmas Eve to have a painful conversation with a grieving family. Death is a reality and should be planned for thoughtfully.

January 07, 2011 at 1:31 pm

@Concerned - I like the idea of an attorney or otherwise impartial attendee at these conversations. And the conversations are optional, offered by the doctor and paid for by Medicare if the patient chooses to do it at their annual visit.
Having been through a situation that divided the family because my sister did not make her wishes known to the entire family, I totally support making seniors aware and offering the chance to discuss their wishes and get them documented. Otherwise, emotions and differing belief systems will make an already stressful time much more so.

January 07, 2011 at 11:39 am

well many times "family members" will say things like "we do not want to talk about this MOm your not going to go anywhere for a long time" or sometimes famly members will pull in different directions making the decision for the senior an impossible task trying to please everybody else. So If this topic were to be discussed with a "nuteral party" like your doctor or a counselor it may be easier for the senior to make an educated decision that suits their "own needs" instead of trying to appease their battleing adult children.

helene rosenberg
January 06, 2011 at 5:17 am

I am disgusted with the Obamacare mess. They said there wouldn't be "death panels" and here they are. I am perfectly capable of deciding about my end of life planning and don't need a ridiculous doctor who has ten seconds to deal with me talk about ending things. Obamacare run amok. I thought this wasn't going to happen? Next thing you know they will be reducing medicines for seniors who "should be dying, but need a little help getting out quickly to make room for the next generation."

They start with discussions and end with force. I know when I will have my plugged pulled and I don't need a government bureaucrat meddling in my end of life planning, thank you.

I watched my mother die and believe me I would rather have a knowledgeable doctor who knows morphine well than a stupid discussion during my physical. My doctor should be focused in his three minutes he has with me on my living -- my quality of life, my exercise routine, my nutrition, my sleep patterns. I can think of so many more things I want him to focus on rather than my death. This is going to go the way of sex education in the schools -- idiotic teachers telling first graders about penises who don't know the first thing about sexual education. Or let's talk about drugs when they don't know anything about it.

HHS is a bureaucracy that is perfectly incapable of managing their way out of a paper bag. They certainly can't use taxpayer money to engineer death panels. The results are predictably pathetic, stupid, inefficient and wrongheaded. Believe me. I worked there forever. Cheers.

Myrna E. Miller
January 04, 2011 at 6:13 pm

I think it is a great idea that this topic is being introduced to seniors at a time when they are able to exercise choices, and not on their death beds. Many people will not otherwise address the topic. However, it also will stimulate thought, or should make references to coordination plans within the family.
For example a husband and wife, or a husband for his wife may have pre-paid burial plots. However with one partner signing to 'donate all organs - including all skin tissue, or body to be donated to scientific research -- the plot may be paid for - but no longer needed. The DNR agreements all seem to be working, tested and tried for more than a decade, so this is just timely reminder to a group, at age 65 start of a "terminal" partnership we know as Medicare...

January 04, 2011 at 8:23 am

End of life planning is important, but I'm not sure it should be done in a physical exam setting. That is a discussion that a person should be having with their family members. I can just see court battles with grieving relatives saying "my loved one was coerced and pressured by her doctor to sign this!". That ends up being more risk and liability to doctors and MORE taxpayer dollars on court costs. While I think, it's something a doctor should offer to their patients, it should be with a caveat that a family member be present or an attorney. There are many other factors on end ofl ife that are important to consider, like financial. Making sure wills and beneficiary designations are current! Again, this a discussion every senior should be having, but a family member or attorney should be more involved.