I realize what you’re about to read isn’t an overly happy or pleasant topic. In fact, to many, it’s downright scary. It’s something many put off — that is, until it’s too late. What I’m referring to is end-of-life care. And before you think this blog may not apply to you, remember this quote by Benjamin Franklin — “In this world nothing can be said to be certain, except death and taxes.”

Here’s the real deal.

• In 2014, about 8 of every 10 of the 2.6 million people who died in the U.S. were on Medicare, making Medicare the largest insurer of healthcare provided during the last year of life.
• More than 90 million Americans live with at least one chronic illness, and 7 out of 10 Americans die from chronic disease.
• Among the Medicare population, the toll is even greater: about 9 out of 10 deaths are associated with just nine chronic illnesses, including congestive heart failure, chronic lung disease, cancer, coronary artery disease, renal failure, peripheral vascular disease, diabetes, chronic liver disease, and dementia.
• While the cost estimates vary somewhat, nearly 25 percent of traditional Medicare spending for healthcare is for services provided to Medicare beneficiaries in their last year of life — most of which is actually spent during their last month of life. Much of this expense goes toward physician and hospital fees associated with repeated hospitalizations.

Aside from cost, several other factors contribute to difficult clinical and policy discussions about whether patients are getting the care they want or need as they approach the end of their lives. Research has found, for example, that most adults (about 90 percent) say they would prefer to receive end-of-life care in their home if they were terminally ill, yet data shows that only about one-third of Medicare beneficiaries (age 65 and older) died at home.

So what’s going wrong?

The focus needs to be on what those facing their own mortality want — not just which treatments will extend life. Dr. Atul Gawande, a well-known writer, public health researcher, and surgeon at Brigham and Women’s Hospital in Boston, believes if families and doctors learn to ask and then really listen to the answers to the five key questions below, care in this country would radically change and the subsequent cost of care would also change.

1. What is your understanding of where you are and of your illness?
2. What are your fears or worries for the future?
3. What are your goals and priorities?
4. What outcomes are unacceptable to you? What are you willing to sacrifice and not?
5. And as a question to ask later — What would a good day look like?

This conversation has to happen well before the end, and you need to ask repeatedly as people change their minds. Knowing the answers to these questions allows everybody to understand what the goal really is and what the person is really fighting for.

One way this can happen is by an advance directive. Advance directives are written instructions that are intended to reflect a patient’s wishes for healthcare to guide medical decision-making in the event that a patient is unable to speak for her/himself. But here’s a scary statistic. Studies have found that about 4 in 10 Americans ages 65 and older do not have advanced directives or have not written down their own wishes for end-of-life medical treatment. We need to be having these conversations. We live our lives on our own terms; why wouldn’t we want our end-of-life to happen the same way, if possible?

I’m going to end this blog with a personal example. When my cousins asked my aunt who was diagnosed with late stage cancer earlier this year what she wanted, she was very clear she didn’t want aggressive, invasive, or curative treatment that would prevent her from spending quality time actively enjoying her grandchildren. Instead, when it was time, they chose palliative care as an integral part of her end-of-life care. She recently passed away. While the loss is significant for those closest to her and only about nine months after my uncle passed away unexpectedly, there is solace in knowing her wishes were fulfilled.

At Holmes Murphy, we want to help manage healthcare costs and safeguard the human dignity of people as they age or face serious illness. One way we do this is by discussing this topic in our Health and Human Services vertical…particularly with hospitals, physicians, and aging services clients and prospects. If you’d like to talk with us about how we can help you, please reach out to us. I’m also including several links I think are beneficial when tackling this tough topic:

• 10 FAQs: Medicare’s Role in End-of-Life Care
• 1-in-4 Older Adults Have Not Discussed Advance Care Planning
• The Dartmouth Atlas of Health Care: End-of-Life Care
• Aging with Dignity: Five Wishes Online

Again, please reach out and let us know how we can help. Don’t wait!