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Sun Dec 9, 2012, 08:22 PM

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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Arrow 8 replies Author Time Post
Reply Medicare - Living Wills - Controlling Costs and Suffering (Original post)
TexasBushwhacker Dec 2012 OP
NMDemDist2 Dec 2012 #1
Ruby the Liberal Dec 2012 #2
Auntie Bush Dec 2012 #3
TexasBushwhacker Dec 2012 #4
Auntie Bush Dec 2012 #5
TexasBushwhacker Dec 2012 #6
Lone_Star_Dem Dec 2012 #7
TexasBushwhacker Dec 2012 #8

Response to TexasBushwhacker (Original post)

Sun Dec 9, 2012, 08:52 PM

1. i think that's an excellent suggestion

some folks just refuse to look at their final days and what it will be like to poked, prodded and invaded all in the name of 'medicine'

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Response to TexasBushwhacker (Original post)

Sun Dec 9, 2012, 08:55 PM

2. That is an excellent idea. nt

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Response to TexasBushwhacker (Original post)

Sun Dec 9, 2012, 10:24 PM

3. (((( Death panels!!! Death panels!!!))))) I can already hear the Rethugs screaming!

I think that's an excellent idea...reminds me to make a Living Will myself Gotta do that!
Thanks for the reminder. Wouldn't want my children to have to go through that...nor would I like to spend my last days like that either.

Sorry all that happened to you. Thanks for posting.

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Response to Auntie Bush (Reply #3)

Sun Dec 9, 2012, 11:59 PM

4. But it would reduce, if not eliminate, the need for "death panels"

In my mother's case, it was her choice to discontinue treatment. Her oncologist was surprised she didn't want to continue with the poisons and feeling shitty all the time, because when cancer comes back, when it has metasticized, it's terminal. They had stopped it in her bone marrow, but it was still all over in her bones. She had almost died in 2001 from a bad response to chemo and was in the hospital for 6 weeks. She had to go to a nursing home for a week to do some physical therapy because she had lost so much muscle mass. Her roommate was a woman who had a stroke and was in a permanent vegetative state. She had an IV for hydration and a feeding tube. Her son came to see her every day and she had already been there for over a year. That's what prompted my mother to say "NO FEEDING TUBE". The mother of a former boss had a stroke and she was in a similar situation. I remember he approved the feeding tube because he said "I just can't starve my mother to death". So people really need to make these kind of decisions BEFORE they become ill.

Another thing is I think they need to be very frank with seniors about their "odds" when it comes to surgeries and such. Neil Armstrong died at 82 of complications following coronary bypass surgery. All I could think was why the hell were they doing such an invasive surgery on an 82 year old? How much did they think it would extend his life, because in fact, it shortened it? It may be that he knew all the risks and wanted to go for it, but I also know that surgeons like to cut. Now when I had gall stones, the surgeon that was assigned to my case said she was going to have to schedule my surgery later because a gall bladder surgery on a 90 YEAR OLD MAN had taken longer than anticipated. I thought, wow that's risky and was she worried. She said that for a 90 year old, he was in great shape and the gall stones were causing him a lot of pain, so that gall bladder had to come out. The only difference was that she had to do it with a big incision instead of a laproscope. It gave me a lot of confidence in her though, that she felt comfortable operating on a 90 year old man. But that's not coronary bypass surgery!

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Response to TexasBushwhacker (Reply #4)

Mon Dec 10, 2012, 01:55 PM

5. I thought that's what Obama suggested...making plans ahead of time with your Dr. to make out

Living Wills. That's when the ReThugs (Palin) started crying "Death Panels."

I'M ALL FOR LIVING WILLS!

I know a 93 year old that got colon cancer and they operated. Fools! She was one of those success stories where the operation was successful...but the patient died.

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Response to Auntie Bush (Reply #5)

Mon Dec 10, 2012, 09:44 PM

6. I think the death panels were the advisory panels

that he was suggesting that could make recommendations to improve care and/or control costs. I think the 93 year old with colon cancer is a perfect example. Exactly how long did they think they were going to extend the life OF A 93 YEAR OLD? In fact, they shortened it, but Medicare still got the bill. Colon cancer can be very slow growing. It's more likely, at age 93, that she would die WITH colon cancer than OF colon cancer.

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Response to TexasBushwhacker (Original post)

Mon Dec 10, 2012, 10:12 PM

7. A good suggestion. That way no matter what the person's wishes are followed.

I also think it's a good idea for each of us, no matter our age, to do the same on our own. Different people have different desires when it comes to our end of life care. If we want our personal choices to be respected, we have to accept ahead of time that we may not be in a state of mind to make them know when the time comes.

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Response to Lone_Star_Dem (Reply #7)

Mon Dec 10, 2012, 10:44 PM

8. Absolutely, and mention organ donation as well

Even though their internal organs probably wouldn't be suitable for donation, they may still be able to use their skin for burn victims and corneas. Younger people can donate everything, but family members can feel uncomfortable talking about donating things like skin, so you really have to get specific. Here, you have to say you want to donate your organs or they assume you don't. In Italy, with all those Catholics, it's the opposite. The default is donation. If you don't want your organs donated you have to register that. Consequently, Italy has a lot more organs available for donation, per capita, than the US.

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