How the House Health Bill Could Affect Granny

Why you shouldn’t wait until age 65 to talk about end-of-life healthcare

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A provision in the House's healthcare reform bill would add coverage of a voluntary consultation about end-of-life care to a Medicare recipient’s benefits once every five years. The clause would require Medicare to pay doctors for their time helping patients to make a living will or appointing a health proxy. End-of-life care consultations would also be covered by Medicare whenever a patient undergoes a qualifying event, such as the diagnosis of a life threatening or chronic illness, admission to a long‐term care or skilled nursing facility, or a hospice program.

But many palliative care experts say that you shouldn’t await the fate of the House bill or even until qualifying for Medicare at age 65 to start a discussion about the types of healthcare you want or wish to avoid under various circumstances. “If you are over the age of 18 you should spend some time introspecting and thinking about the end of life and record it in advanced directives,” says David Feldman, assistant professor of counseling psychology at Santa Clara University and coauthor of The End-of-Life Handbook: A Compassionate Guide to Connecting with and Caring for a Dying Loved One. Advance directives are legal documents that specify your treatment preferences. The most common forms typically include a living will explaining your healthcare instructions and a healthcare proxy or durable healthcare power of attorney that designates a person to make medical decisions for you if you no longer can.

But simply filling out the proper paper work isn’t enough. Advance directives need to be properly distributed and should be accompanied by a discussion about your end-of-life wishes with your family members, physician, and a nearby hospital. “You don’t have to be dying for these questions to have value and be important,” says Ira Byock, director of palliative medicine at the Dartmouth-Hitchcock Medical Center and author of Dying Well. “You just have to be mortal.”

Check out these tips for Planning Your End-of-Life Care.