Providers who coach patients on advance directives can positively impact health-care costs and quality in their community.
More than 7,500 baby boomers age into Medicare each day, and by 2030, almost one in five Americans will be 65 or older – up from about one in eight today. While most aging adults have opinions about artificially administered nutrition and hydration, hospice treatment, burial wishes and more, a good majority of them have not prepared their end-of-life care decisions.
The New York Times has reported that fewer than 30 percent of American adults have signed advance directives stating their health-care wishes. Patients cite scarce information and limited access to legal aid as top reasons for lacking an advance directive, but the law directs that responsibility to the health-care system.
History of Advance Directives
In 1990, Congress passed the Patient Self-Determination Act. It requires health-care institutions and providers to tell adult patients at the time of admission about their rights under state law to make decisions about medical care. These rights include the ability to craft an advance directive—an umbrella term including living wills that state a patient’s wishes about medical care and a power of attorney that designates someone to carry them out if the patient cannot. In most states, these rights apply to competent adults who are 18 years or older.
According to some experts, health-care facilities and providers often address end-of-life care, especially advance directives, in a merely obligatory way. Yet research shows that when providers have meaningful and effective conversations with patients about end-of-life care, outcomes and health-care quality improve.
The High Cost of Averting Advance Directives
The negative consequences of millions of adults foregoing advance directives are numerous for the health-care system and its patients. High health-care costs and family hardship and are among the main concerns.
For example, when an individual does not have an advance directive, the cost of dying skyrockets. According to the Agency for Healthcare Research and Quality, one-quarter of all Medicare spending annually – $139 billion – goes toward care for just 5 percent of beneficiaries who die each year. Other research suggests that $1.7 billion in annual health-care expenses could be saved if all adults had an advance directive.
Advance directives also help to avoid unwanted, futile medical intervention that can cause languish for loved ones. Research reveals that spouses are twice as likely to die after their partner’s death if end-of-life care is not planned.
Impacting the Future of Health Care
Some health-care organizations, knowing that physicians are pressed for time, have designed programs where nurses, social workers, chaplains and others receive training as advance care planning facilitators to help patients and families discuss and document end-of-life wishes. Other facilities employ nurse-care managers to help manage both Medicare and commercially insured patients with terminal illnesses, using telephone consultations with patients, doctors and families to ensure advance directives are in place and complied with.
No matter what steps your organization takes, well-designed communication regarding advance directives can help patients face the complex issues in modern medicine and encourage them to take charge of their end-of-life care. Such actions can reduce health-care costs while preserving patient dignity and quality of care.