For an insurance agent who sells long-term care insurance (LTCI) agent — or an agent who takes a comprehensive approach to selling life insurance or major medical coverage — final care planning is part of a day’s work.
Doctors barely have time these days to tell seriously ill patients what their life expectancy is, let alone spend much time talking about how patients can go out their own way, avoid getting unwanted care, and minimize any burden they might impose on their loved ones.
Insurance agents, meanwhile, make a specialty of helping clients think hard about death. Agents are often the ones who tell consumers about the critical importance of getting wills, setting up health care powers of attorney, and making the financial arrangements needed to support their plans.
Now health care policymakers are trying to catch up with agents and have the medical community helping with improving end-of-life planning services and expanding consumers’ access to those consumers.
The Committee on Approaching Death — an arm of the Institute of Medicine (IOM), an official government health policy advisory board — recently talked about efforts to improve end-of-life care public education efforts in Dying in America, a major report on the state of end-of-life care in the United States.
Here are 10 facts you can use when thinking about how to talk about this difficult subject with your own clients.
1. Members of the IOM committee think insurers can and should have a role in sponsoring and organization end-of-life planning education campaigns.
The IOM panel suggested that insurers could make good sponsors of outreach campaigns, and they cited Excellus BlueCross BlueShield — the parent of MedAmerica –as an example of a company with a great end-of-life planning program.
2. Many Americans have no idea how caring for frail older people or people with serious illnesses actually works.
The IOM panel said many Americans know too little about the topic to understand what policymakers might think of as basic terms.
When researchers asked ordinary people how they refer to “loved ones who care for [people] at the end of their lives,” half had no answer. Just one-quarter replied with the term “caregiver” or “caretaker.”
3. Even people who know a little about the idea of caregiving may have no idea how patients can make their wishes unknown in the event that they are so ill or so seriously injured that they cannot talk to their doctors.
States use many different, conflicting terms to refer to the designated agent who has the official authority to make decisions about an individual’s end-of-life care. Terms used include “agent,” “surrogate,” and the individual who has “health care power of attorney.”
About 30 percent of consumers who participated in one survey had no idea what to call “a person they designate to make health care decisions on their behalf,” and 32 percent responded with the word “family.” Just 15 percent used the term “power of attorney.”
4. Even many doctors would just be winging it if they tried to talk to patients about end-of-life planning.
The IOM panel said many medical officials confuse “palliative care” — care that focuses on easing pain — with end-of-life care or with hospice care.
A hospice program can provide palliative care but may not always need to do so, the panel said.
5. Whether Americans know about the concept of end-of-life care planning or not, many fail to plan.
One-quarter of Americans ages 75 and older who participated in a Pew survey said they had given their preferences for end-of-life medical treatment little or no thought.
In response to another survey, 76 precent of Americans ages 65 and older said they had talked to their children about what to do with family belongings if they were incapacitated or dead — and only 63 perent said they had talked to children about what to do if they are unable to make decisions about their medical care.
6. The idea that most Americans want doctors to do everything possible to keep them alive, whatever the cost, is probably wrong.
In response to three surveys the researchers cited, consumers said their top end-of-life care concern was worry about how the cost of care would affect the family of the patient.
7. Doctors are about as well-equipped to discuss the cost of end-of-life care as the typical insurance agent is to talk about the latest advances in molecular biology.
In 2011, Regence reported that only 16 percent of the physicians they surveyed said they had any training in connection with health care financial issues or how to talk about those issues with patients.
8. Despite all of the controversy about the possibility that an end-of-life counseling provision in the Patient Protection and Affordable Care Act (PPACA) might lead to death panels, many Americans seem to think paying physicians to provide end-of-life care planning advice is a good thing to do.
The Regence Foundation found that 81 percent of the Americans it polled thought Medicare should cover physician assistance with end-of-life care planning for people with serious illnesses.
See also: End-of-life talks not supported by Medicare.
9. The idea that choosing cheaper, simpler care typically shortens a patient’s life may be false.
The IOM researchers said they have seen no evidence that end-of-life care planning shortens patients’ lives. In the real world, the IOM panel said, relying on less aggressive care may help a patient enjoy a longer life as well as a more comfortable life.
See also: Study: Intense Care Management Cuts Costs.
10. Support for the concept of physicians helping some patients end their lives may be stronger than you think.
The term “assisted suicide” is more controversial than the concept of doctors helping terminally ill patients die, the IOM panel said. “When Gallup conducted a survey in May 2013, only 51 percent of the respondents supported doctors’ helping a terminally ill patient ‘commit suicide’ if asked by the patient,” the panel said.
But 70 percent ofthe Gallup survey participants supported doctors helping a terminally ill patient die when the survey team referred to that allowing doctors to “end a patient’s life by some painless means” if the doctor was asked to do so.
Image: AP photo/Scott M. Lieberman