Tag: Advance directives

Prepare for surgery, heal faster
Judith Graham Reports for Kaiser Health News on new research revealing that older adults who prepare for surgery, heal faster and are discharged more quickly. They also are less likely to be rehospitalized. Some hospitals are taking the lead to help older patients best prepare for surgery.

More than anything else, you want to be sure pre-surgery that you really want surgery. Surgery is not risk-free, and many older adults end up in need of additional medical care post-surgery. Medicare data reveals that one in three older adults who are hospitalized are rehospitalized within 30 days of discharge.

If you do want surgery, there are ways you can minimize risks both during and after your hospital stay. Doctors at Duke, UCSF and Michigan are finding that older adults who exercise, eat a healthy diet and reduce their stress in anticipation of surgery, fare better post surgery than those who do not. Their aim is to highlight surgical centers that best help older adults to prepare for surgery.

Data from Duke University suggests that good preparation, including a thorough geriatric assessment, in advance of abdominal surgery significantly reduced the number of days older adults spent in hospital as well as their likelihood of readmission. The data also indicates that good preparation reduced the likelihood of patients needing home health care after discharge.

The Duke program, “POSH” (Perioperative Optimization of Senior Health,) spends time explaining to patients the benefits and risks of surgery. Patients are helped to understand the physical and emotional toll surgery can take on them and that it can lead to complications. Patients can then decide whether having surgery is in line with the quality of life they want.

Much of the advice given to patients who opt for surgery applies to everyone, regardless of whether they are getting surgery. Walk at least 20 minutes a day, do core-strengthening exercises every other day. Drink a lot of liquid. Do breathing exercises and take time to relax.

People taking medications need to beware adverse interactions with anesthesia. The POSH program advises people to stop taking benzodiazepines and antihistamines three days before surgery.

Questions patients should ask include:
- What choices do I have other than surgery?
- What are the risks and benefits of surgery or of making a different choice?
- Will surgery extend my life meaningfully?
- What will happen after surgery barring any complications? Will I be able to care for myself after surgery? If not, what kind of care will I need and how long will I need this care?
- Who should have a copy of my advance directive, appointing someone to speak for me if I cannot speak for myself after surgery?
Duke’s POSH program also offers advice that cannot be repeated too often regarding the value of having a health care buddy—someone to be with you during your hospital stay and after discharge–exercise, healthy eating and a good night’s sleep.

Here’s more from Just Care:
February 6, 2018
Why you should ask your loved ones about end of life care
Few of us think to ask loved ones about their end-of-life preferences. We may assume that the people we love don’t want to discuss these issues. But, it’s important that we understand and respect their views about the kinds of medical interventions they would want and who they would want to speak for them if they were unable to speak for themselves. So, please consider talking with your loved ones about end of life care, both your own desires and theirs.

Beyond talking about end of life wishes, make sure that your loved ones put their wishes in writing in what are called “advance directives.” Advance directives are documents that detail a person’s end-of-life wishes. There are two important documents: a living will, which concerns treatment preferences if serious interventions are needed to keep you alive, and a health care proxy or power of attorney, which names a person to speak on your behalf if you are unable to speak for yourself. You can download these legal documents for free here.

Without a health care proxy, a trusted family member may not be able to speak with your doctor on your behalf. Federal law protects your privacy. But, as a result, your wishes may not be honored. That’s why a health care proxy is so important.

A recent meta-study in Health Affairs of 150 studies published between 2011 and 2016, covering nearly 796,000 adults, finds that only one in three adults have advance directives. Not even four in ten people with chronic conditions had health care proxies or living wills.

Here are six reasons why you and your loved ones should create advance directives. And, to learn more about advance directives, watch this Jon Stewart video with Dr. Atul Gawande.

http://www.cc.com/video-clips/hz2xb6/the-daily-show-with-jon-stewart-atul-gawande

The Daily Sho
Get More: Daily Show Full Episodes,The Daily Show on Facebook,Daily Show Video Archive

Dr. Atul Gawande’s book, Being Mortal: Medicine and What Matters in the End, offers the following advice.
- Ask your loved ones about their end-of-life priorities. Do it repeatedly over time since their views are likely to change. And, have them complete an advance directive.
- Find out what they consider their health condition to be.
- Understand what they would like to see happen if their condition worsens, what they are most afraid of and the tradeoffs they would want to make.
People at the end of life who know about hospice care often choose it because it focuses on alleviating pain and ensuring people’s comfort. In many cases, Medicare pays for hospice care at home. To read a piece Dr. Gawande wrote about a friend at the end of life, click here. For help finding care at the end of life, visit the eldercare locator.

Here’s more from Just Care:
August 13, 2017
What care do you want if you become seriously ill? Talk to your doctor
One fourth or so of Medicare annual spending–about $33,500 a person–goes to the cost of care for the 1.8 million people over 65 who die each year. The cost of their care is high largely because they often have complex conditions, and two-thirds of them die in the hospital.What care do you want if you become seriously ill? Medicare now covers advance care planning to ensure that older adults have their care wishes honored in the days, weeks and months before they die.

Medicare will cover the full cost of a visit with your doctor to discuss your end-of-life wishes as part of your Medicare annual wellness visit. If you do a separate trip to the doctor, traditional Medicare covers 80 percent of the cost. If you’re in a Medicare Advantage plan, call the plan to find out your out-of-pocket costs. Here are six reasons why you and your loved ones should do advance care planning and create advance directives.

The data suggest that most people do not plan ahead–through advance care planning–and do not understand their care options. For example, most people prefer to die at home if they are terminally ill. But, they often have not had the chance to decide their care wishes or to share them with trusted family members, doctors or others in their social network. And, they end up dying in the hospital. So, ask your loved ones about end of life care.

Hospitals and nursing homes are required to ask patients on admission whether they have advance directives–living wills and health care proxies–under the Patient Self-Determination Act of 1991. These care facilities must keep a record of whether patients have advance directives in their files. But, patients are not required to have them.

About 40 percent of people over 65 have not done advance care planning and do not have advance directives. Each state has its own law regarding advance directives. To find out how to get advance directives for your state as well as information on how to complete them, check out Just Care’s get help page here.

Medicare also covers hospice services, including pain management, palliative care to offer comfort, pain and other symptoms management for people with complex and chronic conditions, and up to five days of respite care for caregivers. Hospice services are usually available in patients’ homes. Today, more than four in ten people with Medicare elect hospice care, more than double the rate from 2000 (23 percent).

Here’s more from Just Care:
- For your peace of mind and for the people you love, plan in advance for your care
- Get the preventive care you need, Medicare pays for it
- Why you should ask your loves ones about end of life care, Atul Gawande video
May 18, 2016
Honoring a wish to die in peace

It’s critically important that you share your end-of-life wishes with your doctors and the people you love. It is equally important that you complete and sign a written health care proxy and living will so that when you cannot speak for yourself, your end-of-life wishes will be honored.

The experience of Luz Salazar Garcia speaks volumes. In 2003, at 76, Garcia had advanced diabetes that robbed her of her eyesight. She also had advanced glaucoma, high blood pressure and neuropathy. Her husband and daughter became her caregivers 24 hours a day at her Los Angeles-area home.

Two years later, Garcia was hospitalized with kidney failure, breast cancer and multiple other conditions. Garcia was ready to die, and she let her family know. But, a doctor persuaded her husband that he should try to keep her alive through kidney dialysis. Against Garcia’s wishes, the doctors went ahead with dialysis.

Garcia was enraged. She shouted to make her wishes known. And, she resisted the efforts to treat her. She kept removing the oxygen mask. She died shortly thereafter. She spent her final moments struggling to stop the treatment, not in peace as she had wanted.

The lesson is clear that without a written directive, doctors and family members may intervene in your care in ways you would not want. To learn more about Luz Garcia’s story and end-of-life educational initiatives, click here. Here are six reasons why you and your loved ones should create advance directives, as well as a helpful toolkit of advance care planning resources that includes Spanish and Chinese translations. And, here’s a short Jon Stewart video with Atul Gawande explaining why you should ask your loved ones about their end-of-life wishes.

January 19, 2016
7 questions you should answer before you turn 65
Everyone has lots of questions about their health and financial security as they age. Here are seven questions you should answer before you turn 65 with links to simple information to help you decide what to do:

1. Do you need to sign up for Medicare? Medicare provides health insurance for people 65 and over and people with disabilities, regardless of income. Whether to enroll in Medicare depends on whether you have employer coverage and what kind you have. (If you have employer coverage through your job or your partner’s job, click here to learn more.) If you do need Medicare:
- Enrollment in Medicare Part A, hospital insurance, and Part B, medical insurance, is generally automatic if you have signed up for Social Security. Part A is free if you or your spouse has paid into Medicare for at least 40 quarters. You pay the Part B premium unless you qualify for Medicaid. You need Medicare Part B if your employer coverage is no longer primary once you turn 65. (To avoid penalties for mistakenly turning down Part B, check with Social Security at 800-772-1213; you can also contact your local area agency on aging at 800-677-1116.)
- Understand your supplemental coverage options and how to choose among them. Medicare only covers about half of your health care costs. If you enroll in traditional Medicare (see below), you will want additional coverage, supplemental coverage, to fill gaps and limit your out-of-pocket costs. For an explanation of your options, click here. If you enroll in a Medicare Advantage plan, you cannot buy insurance to cover your deductibles and copays and other out-of-pocket costs.
2. Should you enroll in traditional Medicare or a Medicare Advantage plan? It depends on the kind of coverage that’s important to you and whether you want as much choice of doctors and hospitals as possible. It also depends on how much you are willing and able to pay to get the coverage you need. Most people choose traditional Medicare because of the enormous choice of doctors and hospitals it offers anywhere in the country. (Note: Some insurers are involuntarily enrolling people in their Medicare Advantage plans when they turn 65. Make sure you’re not involuntarily enrolled.)

3. Should you sign up for a Medicare Part D prescription drug plan? In most cases, yes, if you need drug coverage. But, you should understand the limits to that coverage and when your drugs will be covered. Here are six tips for keeping your drug costs down.

4.     What about Medicaid? Medicaid can pick up many of your health care costs that Medicare does not cover, including your Medicare premium, if your income is low. Whether you qualify for Medicaid might depend on where you live. You can have both Medicare and Medicaid. Here’s how they work together. And, here’s what you need to know about the ways Medicaid can help you. Even if you don’t qualify for Medicaid, here are five programs that lower your costs if you have Medicare.

5. When should you sign up for Social Security benefits (if you have not already done so) and what will your  Social Security benefits be when you retire? You should understand the benefits and risks of claiming Social Security early.

6.     Are you prepared if you need long-term services and supports? Today, two in five people with Medicare needing these services do not receive them.
7. Do you have a living will and medical power of attorney, Advance Directives? You should. Get help from Caring Connections.
October 3, 2015
Medicare proposes to pay for advance care planning

In a newly released proposed rule, Medicare is proposing to pay for individuals to talk to their doctors and care teams about their health care wishes as part of their advance care planning. Medicare already pays for advance care planning under people’s Welcome to Medicare visit. But, the agency wants to give people additional opportunities and greater flexibility to have a conversation about end-of-life decisions with their doctors.

For their peace of mind and for the comfort of their family, an increasing number of people are planning ahead for their care and creating advance directives even before they enroll in Medicare. Some are ready to discuss end-of-life planning with their doctors when they first enroll in Medicare, and others would prefer to wait. People also might want to start the conversation at the onset of a serious illness or as an illness progresses.

Making decisions about the kind of care you would want when you cannot speak for yourself takes some serious thinking. There are a number of factors to consider, including Medicare coverage options and who you would want to make decisions on your behalf. The proposed rule would allow Medicare to cover patient conversations with providers about the kind of care patients desire—from every treatment possible to minimal intervention–along with a range of other issues, when the patient wishes to have them.

In May 2015, 66 organizations sent a letter to Sylvia Burwell, head of the Department of Health and Human Services, urging that Medicare pay for advance care planning discussions with medical providers. “Published, peer‐reviewed research shows that ACP [advance care planning] leads to better care, higher patient and family satisfaction, fewer unwanted hospitalizations, and lower rates of caregiver distress, depression and lost productivity.”

And, there is a bi-partisan Senate bill, the Care Planning Act of 2015, from June 11, 2015, that would authorize Medicare to pay physicians to counsel patients on end-of-life decisions.

A proposal to cover advance care planning was taken out of the Affordable Care Act before it was passed, after Sarah Palin called these voluntary discussions to plan for end-of-life care “death panels.”

July 22, 2015
Making medical decisions for someone you love: Your rights

You shouldn’t have to pull strings to be able to make medical decisions on behalf of the people you love if they are unable to make them for themselves. And, it should be easy if you’ve been named their health care proxy. But, without a written health care proxy, it could be hard to make medical decisions for the people you love or even to speak with their doctors about their medical conditions.

If there’s no legal document naming you as the health care proxy, sometimes called an “advance directive,” whether you have the right to act on behalf of someone you love depends on state law, even if you’re the caregiver. Some states allow next of kin to act on behalf of a patient who is unable to make medical decisions. However, if the next of kin disagree on the treatment, you might have to go to court to settle the matter.

If there is no health care proxy, in many cases the doctor and hospital staff end up responsible for making medical decisions. Click here to learn about advance care planning and how to get a free health care proxy document for you and the people you love. For sure, advance care planning is important for end-of-life care.

And, if you’d like to learn more about why you should have an advance directive, click here.

June 24, 2015
Older and living alone, the rise of elder orphans

Elder orphans, older adults living alone, should be among the chief concerns of health policy gurus and, for that matter, presidential candidates. They are single, divorced or widowed, and without children, or with children living far away. These older isolated individuals need both personal resources and community resources in order to age in place.

According to a new report out of North Shore-Long Island Jewish Health System, there are now more than 9 million elder orphans or individuals at risk to become elder orphans—roughly 22 percent of the older adult population. In 2012, there were 43.1 million adults over age 65, representing about 13 percent of the population, according to the federal Administration for Community Living.

Elder orphans do not have a health care proxy. They may be physically or cognitively impaired. They have no one to care for them, to act on their behalf, if they are sick or hospitalized, if choices need to be made about their current situation and the future. They often have little income and few assets. That puts them at great risk of not having their health care or life wishes honored. They often live in nursing homes, with no one to visit them or provide companionship.

If elder orphans cannot make decisions for themselves, the state appoint may conservators or guardians to be responsible for the elder orphans’ finances and persons. The elder orphans become wards of the state and lose all rights to make decisions for themselves.

The number of elder orphans is likely to grow substantially as the population ages. In 2012, about one in three Americans between the ages of 45 and 63 were childless and living alone, which is 50 percent more than in 1980. We need a strategy for helping them as they age; we need to plan ahead for the next likely larger generation of elder orphans.

By 2030, some estimate that more than 5 million people—of the estimated 70 people over 65, including 9 million over 85–will need to live in a nursing home or alternative care facility because they will not have anyone to care for them at home. It’s not even clear whether there will be enough nursing home beds for these elder orphans, if they wanted to enter a nursing home. Today, there are 15,700 nursing homes with 1.7 million beds and 1.4 million residents, according to the CDC.

May 27, 2015
Health caring for mom: Three ways to let your mom know you love her on Mother’s Day
Mother’s Day is the time to show your mom some serious love. But how? Most of us love flowers and chocolate. So, consider getting mom a little of both. What we really treasure, though, is the priceless gift of time together and conversation. And there are few things more important to talk about than your mom’s health. So here are a few priceless gifts for mom on her special day:
1. Make sure your mom is safe and healthy. Talk to her about all of the drugs she’s taking, both over the counter drugs and painkiller prescriptions. If your mom has a chronic condition like asthma or diabetes, find out whether her primary care doctor is doing a good job of coordinating her care. Click here to learn how your mom’s primary care doctor can help her. And, if your mom wants to stop smoking, lose weight or change another unhealthy behavior, here are some tips for motivating her to do so.
2. Talk to your mom about planning for her future health care needs. Who would she want to take care of her when she cannot take care of herself? Would she like to remain at home as long as possible? What are the tradeoffs she would like to make? And, make sure your mother has a reliable health care proxy and a living will. (You should have those too!) Click here for free help with these advance directives.
3. Double check that your mom is getting the preventive care services she needs. She should get regular pap tests, pelvic exams and breast exams. If she’s over 60, she should get a shingles vaccine. Medicare and most insurance cover all these tests in full. Next time she’s headed to the doctor, consider tagging along. Mom, like all of us, could use a health care buddy to ask the questions she might not ask.
These are important conversations. Most of us know we should talk to our mothers about their health, but we never quite get around to having the actual conversation. Why not use Mother’s Day as a reason to get serious about your mom’s health? Just talking to your mom about these issues can be healthy for her.
May 7, 2015
US ranks at bottom of pack of wealthy nations on health of older adults and affordability of care

A new Commonwealth Fund survey of older adults 65 and older in 11 countries reveals that, even with Medicare, affordability of care for older Americans is a serious issue. Older adults in the United States struggle more paying for care and are in poorer health than older adults abroad. Almost one in five older adults in the U.S. (19%) said that they had not visited the doctor or filled a prescription because of the cost.

The typical person with Medicare spends $4000 each year on out-of-pocket health care costs that Medicare does not pay for. Older adults in the U.S. also reported a harder time getting primary care and staying out of the emergency room than older adults in every other country except Canada and Sweden. Of equal concern, older adults in the United States reported the highest levels of chronic conditions, with 87% saying that they had at least one chronic condition and 68% saying they had at least two.

On a more positive note, older adults in the United States were more likely have spoken with a care provider about what they could do to improve their health. They also were more likely to have a personalized chronic care plan and to have engaged in end-of-life planning. End-of-life care planning by age 50 is especially important and relatively easy to do. Since we can’t know what health care needs we will have, if we want our wishes followed, it is critical to have advance directives, such as a health care proxy and living will, as well as a power of attorney.

If you like this, you might also be interested in this:
A free resource for getting Advance Directives

February 26, 2015