October 4th, 2011
04:00 PM ET
It's something no one wants to think about, but a reality if worst happens: What do you want to happen if you are on the brink of death and can't communicate?
A new study in the Journal of the American Medical Association finds that advance directives are linked to less Medicare spending, lower likelihood of dying in a hospital, and higher usage of hospice care in areas of the U.S. that tend to spend the most on end of life care generally. Advance directives, also called living wills, are documents that specify what kind of treatment you do or don't want to be given in various situations when your life is on the line.
"It absolutely highlights some of the reasons why you should both talk to family, friends and physicians about the type of care you might want to receive, should you be unable to make your own decisions," said Lauren Hersch Nicholas, lead study author and health economist at the University of Michigan.
The study looked at information from 3,302 Medicare beneficiaries from a nationally representative study at the University of Michigan called the Health and Retirement Study. Participants included in the end-of- life research died between 1998 and 2007.
Researchers conducted interviews with next-of-kin about experiences at the end of life, and whether the people who died had advance directives.
They found that in regions of the country where there tends to be a more aggressive treatment style for end-of-life care, Medicare spending was about $5,600 less per person who died with an advance directive. There was no significant spending difference found in locations with low to average end-of-life expenditures. Most participants with advance directives specified that they wanted to limit treatment.
For people in high-spending regions with advance directives specifying limitation of treatments at the end of life, 41% received hospice care, compared with 24% among people without these documents.
How much weight an advance directive carries differs by state. You can explore your state's regulations and fill out a state-specific form at Caringinfo.org, run by the National Hospice and Palliative Care Organization.
Previous research has supported the idea that if doctors spoke with their patients about end-of-life wishes, millions of dollars could be saved in health care costs - specifically, more than $76 million per year could be saved if half of the people who die from cancer annually had end-of-life conversations with their doctors, according to a March 2009 study in the Archives of Internal Medicine.
Having these kinds of talks with anyone is difficult, but organizations such as Engage with Grace are trying to make them easier for you and your family. Check out this article and these videos for more information about how to ensure that your loved ones have end-of-life plans in place.
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