Advance directives decrease family confusion on health care decisions

According to a recent study conducted by researchers from Harvard University and Dartmouth Medical School, one-fifth of Medicare nursing home patients suffering from advanced Alzheimer's and other forms of dementia were placed in hospitals and nursing homes during the last few months of their lives for questionable reasons.

Interestingly, the study found that questionable transfers were most common among patients who were black or Hispanic, as well as patients who did not have an advance directive. In light of this, there is all the more reason to make an advance health care directive part of your estate plan.

In making their findings, researches looked at Medicare records from 2000 through 2007 and identified transitions of care labeled "burdensome." These included moving patients in the last several days of their life, moving them on multiple occasions during their final months, or moving them to a nursing home after hospitalization.


Out of the nearly 475,000 patients studied in the research, 19 percent of them were transferred for questionable reasons. Patients who had been dubiously transferred were more likely to have a feeding tube inserted, to end up in intensive care during the last month of their life, and to have a severe bedsore and to be admitted to hospice within three days of death.

According to the researchers, one factor in the dubious placements may have been money. Because Medicare pays nearly three times the typical daily rate following a hospitalization, there is plenty of room for questionable motives in making such transfers. Some have noted that the increased likelihood of questionable transfers may also be a result of poor planning.

Experts have suggested that avoiding these kinds of transfers may be prevented by getting the patients involved in planning their care while they are still able to do so; making sure nursing home staff and attending physicians understand the family's goals for care of the patient; considering hospice care earlier in the process; and seeking advice from experts.

An advance health care directive would be a great way of planning such matters early on. It may be hard getting the conversation on such matters started, but it is well worth it.

Source: Associated Press, "Dementia patients suffer dubious hospitalizations," Marilynn Marchione, Sep 30, 2011.

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