It's late December... That means it's time for me to ruin your holidays.
Readers have accused me of putting too much of a damper on the joyful season. That's because I always encourage folks to have the hard discussions while all the family is together. And by hard discussions, I mean end-of-life planning.
It's shocking… But over and over, the medical establishment is denying people the right to die peacefully or with dignity. The facts about the end of life are alarming. Medicare spends more than a quarter of its funding on people in their last 12 months of life. And about 41% of people in their last three months of life receive a "burdensome intervention." These are things like tube feedings, emergency-room visits, and resuscitation.
Where is the comfort... dignity... or even common sense?
We've written several times about making sure your estate is in order, including things like living wills and health care proxies. We want to cover these more in depth in a later issue, so keep an eye out for that.
But there's a lot more to end-of-life planning than just the paperwork. And because emotions run high at the time it happens, I encourage you to take some time to plan ahead. Don't put that stress on your family. Even if they balk at having these conversations, take the time to go through the following six questions.
1. Have you considered nursing homes and assisted living centers? If so, be sure to look at the fine print. When my stepmother and I were moving my dad – who suffered from dementia – into an assisted living home, no one explained the sit-and-pivot rule to us. (To stay at the assisted living home, my dad had to be able to sit up in bed on his own and pivot on his feet on the floor to get in and out of a wheelchair.) We thought a place with a dementia center would naturally be prepared for someone like him. As a result, we kept him home too long to qualify – due to the sit-and-pivot rule – for the sort of care an assisted living center provides… It's a rough way to find out on the day you bring your loved one in for admission.
And be sure to look online at the federal government's website on nursing homes: http://www.medicare.gov/NHCompare. The site allows you to compare ratings and locations among thousands of nursing homes. For a U.S. government site, it's surprisingly useful and full of information to help you decide what's best for your situation. My stepmother was able to find a place half the distance from home, but higher-rated than the other choices farther away.
2. Have you thought about where you want to die? At home? The nursing home? Don't forget about hospice care, which provides pain medication, but nothing else. It involves no treatments, no tests, no interventions in your last months of life – aside from pain management. And you can receive hospice care in your home or at a facility equipped to help make you comfortable. This is how I'd like to go – at home with little pain.
And if you consider a hospice facility, we've had experience with a few hospice centers in Baltimore and can say they are all clean, quiet, and provide a wonderful level of care for their patients. And being in a center often helps take some of the burden off the family as well. But everyone's decision is personal. If you expect to care for a loved one through this last stage of life, please ask him or her now.
3. What's covered by insurance when someone is dying? Once you or your family member is in a nursing home, who pays for a hospitalization? What will be your out-of-pocket expenses for each major decision? If you had $250,000 to leave to your daughter, but you were in your last year of life, would you want to pay for treatment out of pocket or forgo it and let your child get the money? It doesn't seem like a big deal now. But you and your daughter should talk about it. Imagine if you discovered she felt the exact opposite… you should know these things before you're in the midst of it and don't have any control to take your time and consider what is best for you.
4. Who will be in charge of your finances when you can no longer manage them? This applies not just to after your death, when someone will have to pay the bills and file all the tax forms. It also applies to a time when you may not be able to make decisions clearly.
Make sure you designate someone to act as your financial power of attorney and take the time to get them up to speed. They'll need to know your passwords and how to access your accounts. Create a list for them of your financial accounts, like checking and savings accounts, retirement accounts, 401(k)s, IRAs, credit cards, etc. (We have a great list in our essay, here.) Also make sure they understand how you intend to pay for end-of-life care.
5. Have you addressed your spirituality? Whatever your beliefs, make them known to your family and loved ones. Do you want your priest coming by? Do you want music? Do you want to give or get forgiveness from anyone? You need to discuss these topics and make a plan for them… and make sure your family knows about the plan.
6. What kind of memorial would you like? Pre-paying for a funeral might seem morbid, but it's a practical investment. It's even more prudent when you realize that funeral costs have increased 230% from 1986 to 2017… that's more than double the increase in commodities (up 95% in that same period).
And according to the National Funeral Directors Association, the average cost of a funeral with viewing and a burial is $7,360 (using 2017 data, the latest reported). So, if you pre-plan and even pre-pay, you can ensure folks will respect your wishes. You can plan everything right down to which songs will accompany the service and who will deliver the eulogy.
I hope these six topics open up a dialogue with at least yourself and your closest family and that today's issue has added a little something to your life. I truly hope that as you contemplate yours or another's mortality now or in the future, you can talk about it safely with friends and loved ones. Begin the dialogue this week and continue it into the New Year.
What We're Reading...
- Something different: Where'd this new clock on my desk come from?
Here's to our health, wealth, and a great retirement,
Dr. David Eifrig and the Health & Wealth Bulletin Research Team
December 20, 2018