You may not be thrilled to have “aged into” Medicare, but there’s a silver lining! Medicare offers significant support for communicating about your healthcare wishes and managing your end-of-life options.
Medicare also covers the cost of health services meant to improve quality of life when a cure is no longer possible: hospice care during the last six months of a terminal illness, and palliative care, to help manage a serious or terminal illness with a longer term prognosis. As important – but not well used – is the fact that Medicare covers advance care planning discussions with your physician as part of your annual wellness check.
Advance care planning is something every adult is encouraged to do and complete while in good health, ideally well before a health crisis or terminal diagnosis. Often advance directives are prepared and health proxies determined at the same time as your estate planning documents and power of attorney and executors are finalized. Preparing your advance directives offers the chance for you to have invaluable conversations about your care management and end-of-life wishes with your loved ones as well as your physician, thanks to Medicare.
Medicare also requires hospitals and skilled nursing facilities to ask at the time of admission whether you have an advance directive and to note its existence in your medical record.
Without your documentation, providers who do not know you will be making health care decisions for you.
Palliative care is a notoriously underutilized health service that focuses on managing pain and symptoms caused by chronic and debilitating illnesses. Under Medicare, palliative care is available to you whether or not you have a terminal disease, although it is most commonly used when you have decided to stop treating a terminal disease. Palliative care can increase your quality of life enormously. Because you’re no longer in such distress, palliative care also helps relieve the distress felt by your family and friends. Medicare covers the costs of palliative care, so you should ask your doctor about it in order to take advantage of the relief it can offer you as soon as possible.
Hospice is a combination of comfort care services including nursing care, palliative medicines, counseling for you and your family, and a supportive and knowledgeable resource for your immediate caregivers. The key benefit of hospice is being enabled to spend your last days in the surroundings of your choice – usually your home. If, like most of us, you want your death to be as peaceful and calm an event as possible, I encourage you to consider entering hospice as soon as your death becomes reasonably foreseeable rather than in a rush in the last few days.
Because Medicare covers almost all the costs of hospice, there is no reason to delay once your doctor certifies that you’re eligible. This typically happens once you’re within six months of death, an interval that can be extended if death does not occur within that period.
Where medical aid in dying (MAiD) fits in
If you live in California and are suffering from a terminal illness with a six months or less prognosis, the state’s End of Life Option Act enables you to request medical aid in dying from your physician. If you’re receiving hospice care, but the path towards death involves prolonged pain and suffering, you can choose to step off that path as long as you meet the legal requirements. To obtain medical aid in dying, you’re required to make two oral and one written request to your doctor; he or she confirms you’re within 6 months of dying; and a second physician must also confirm the attending physician’s opinion. After a 48-hour waiting period, your doctor is allowed to write your prescription for life-ending drugs.
Even if you’re eligible for and obtain a MAiD prescription, you’re free to make whatever end-of-life plans you wish, including when, or if, you ingest the medication. For some, knowing the medication is there if needed, offers enough relief to let death take its natural course. It’s important to note that aid in dying medication is not covered by Medicare.
Since 2016, Medicare has greatly expanded the range of end-of-life services it covers. These end-of-life services enable you to learn about and choose the care options you want, and to spend the last months of your life with your family and loved ones as comfortably as possible.
Note: Costs covered by Medicare may require a co-pay or deductible depending on the particular Medicare, Medicare Advantage, or Medicare Supplement plan you have. It’s well worth the time now to investigate what services are available and how you would want your care managed before facing a debilitating or terminal illness.
Adrian Byam, a member of EOLCCA’s Board of Directors, has been thinking about and researching end-of-life decision-making for the last decade. After retiring from a 40 year career as an entrepreneur and senior executive in the IT industry in 2012, he began a PhD program in neuroethics – a new field combining neuroscience and medical ethics – at the University of British Columbia (UBC). His thesis showed that the choices made by surrogate decision-makers for ICU patients often failed to meet patients’ values, and suggested new ways to ensure patients’ autonomy is truly respected. Our social and medical systems today rarely inform us about the choices available to us in the last stages of our lives. By working with EOLCCA, Adrian hopes to help his fellow Californians learn about the choices that are legitimately theirs, and empower them to exercise control over the last days, weeks, and months of their lives.
EOLCCA supports a strong team of experienced volunteers throughout the state, ready to help anyone, anywhere in California free of charge with information and support regarding all end-of-life planning and choices, including aid in dying through the California End of Life Option Act. You can find comprehensive information on our user-friendly website. To support our work, or request an educational presentation, please visit ways to help. Thank you for your support!