Medicare - Living Wills - Controlling Costs and Suffering
I've read that a third or more of Medicare costs are in the last months of life. I lost my mom to breast cancer in 2004 and my dad to complications following a massive stroke in 2009. In my mother's case, she chose to discontinue chemotherapy because it wasn't working anymore and she was tired of trying different things to no avail. She was an agnostic. She didn't think she was going to die and go to heaven. She knew she was going to die. The cancer was in her bones, all over her body. She told me she wanted to be cremated and under no circumstances should she be given a feeding tube. She received hospice care in her home starting in August 2003. They took care of her pain and provided me a lot of advice and support. Thank goodness for morphine and methadone. I moved in with her and could afford to pay for a nurse's aide to stay with her when I had to be away. It was rough, but we had a lot of good times during those last months. The cancer spread to her brain and she started having trouble with her memory. Sometimes she recognized me, sometimes not. She did eventually lose her appetite, but I respected her wishes. I didn't force feed her or have a feeding tube put in. She slept more and more over a few days time and died in January of 2004.
In my father's case. he was 75 and was in the hospital for atrial fibrillation. He had already had a couple of moderate strokes and a doctor told him and his wife that he should fill out a living will because he was at high risk for a major stroke. He didn't and he had a major stroke while he was still in the hospital for the A fib. That was Sept 2008. The doctor that told him to fill out a living will told his wife that he was never going home. She refused to believe him and called him Dr. Doom. I won't bore you with all the complications and surgeries and transfers and negligence, but when it was all over, he spent his last month in the ICU on a ventilator, with a 7" bedsore and his kidneys failing from sepsis. Dr. Doom was right. He never left. And it was really difficult for his wife to have to make the decision turn off the ventilator. I can't imagine what the bill to Medicare was for that 4 months of care, but I've got to wonder if my dad would have preferred to die at home, in his own bed. Considering that Dr. Doom said my dad was never going to recover, I've got to question the wisdom of all those surgeries. If he had just been sent home, his wife would have been able to be by his side as much as she wanted and he could have had in home hospice care. I don't know how aware he was during those last months. I try not to think about it. And I can imagine the bill to Medicare was insane.
So what if, during the Medicare enrollment process, it was REQUIRED that a person fill out a living will? If they was anything and everything done to extend their life, that's fine. But I think a lot of people wouldn't want to end up like my dad and to make their loved make the kind of decisions his wife had to make. We're all going to die and if you make it to 65, you're going to die under Medicare. If current and new Medicare recipients filled out living wills, it could save hundreds of billions of dollars over ten years, and the suffering it would prevent, well, you can't really put a price tag on that.
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