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Dan's new book for millennials, Wealthier: The Investing Field Guide for Millennials will be published in May 2024 and available on Amazon.
Here’s a worst-case scenario, which isn’t all that uncommon.
Following a severe illness, injury, or surgical procedure, an elderly person requires prolonged care in a skilled nursing facility. They also undergo multiple hospitalizations, including ICU stays. Total end-of-life care expenses could easily exceed $300,000.
Even without extended stays in a nursing home, the cost is significant. Healthcare expenditures in the last year of life average $80,000, and $155,000 in the last three years.
What value does the patient often receive?
Research has shown that aggressive interventions and prolonged hospitalizations at the end of life don’t necessarily lead to better outcomes. Patients who receive palliative and less aggressive end-of-life care often have improved quality of life.
Another study found that aggressive healthcare measures at the end of life were associated with decreased quality of care. In contrast, early palliative care referrals meant less intensive care, improved outcomes, and significant cost savings.
The DNR ‘Gap’
Consider this situation, which was conveyed to me recently.
An 85-year-old woman with cognitive decline and a standard do not resuscitate (DNR) order still underwent emergency brain surgery following a stroke, which ultimately led to a coma and her death a few days later.
This situation highlights the limitations of standard DNR orders, which typically only address the use of cardiopulmonary resuscitation (CPR) in the event of cardiac arrest. A standard DNR doesn’t guide other medical interventions, like surgery, ventilation, or feeding tubes, which may be considered in severe illness or injury cases.
In this scenario, the decision to perform emergency brain surgery on the 85-year-old woman was made to save her life, but was this intervention aligned with her overall goals of care and quality-of-life preferences, especially given her age and preexisting cognitive decline?
Despite the availability of advance directives, many patients still receive aggressive, life-sustaining interventions that may not align with their preferences or improve their quality of life. I call this the “DNR gap.”
It arises when a patient's severe condition doesn’t meet the specific criteria outlined in their advance directive. In these cases, doctors may feel compelled to provide burdensome treatments, even if the prognosis is poor and the interventions are unlikely to extend life or improve its quality meaningfully.
The Role of POLST Forms
Physician orders for life-sustaining treatment (POLST) forms potentially offer a powerful tool to help bridge the DNR gap. These legally binding medical orders provide specific instructions for a patient's end-of-life care and are designed to be more detailed and actionable than standard advance directives.
POLST forms cover a range of medical interventions, including CPR, artificial nutrition and hydration, intubation, and comfort measures.
By clearly outlining the patient's preferences, POLST forms provide healthcare providers with unambiguous guidance on proceeding in emergencies or when patients cannot communicate their wishes.
One study found that patients with POLST forms had lower ICU admission rates and shorter hospital lengths of stay than patients without these directives. Based on observational studies, those with POLST forms are “less likely to die in the hospital or receive high-intensity treatments compared with those who do not.”
Some states prohibit a provider from completing a POLST form unless the patient is seriously ill or extremely frail, so be sure to check the laws of your state.
Wealthier:
The Investing Field Guide for Millennials.
Why have so many financial advisors agreed to review an advance copy of Wealthier: The Investing Field Guide for Millennials. It empowers millennials to be responsible DIY investors and financial planners. You can see some of their reviews here.
Wealthier will be published in May 2024.
Here’s what one advisor said: "Saplings grow into trees. We need to help the next generation of investors get to where they need our services."
For more information, visit the website for Wealthier:
To review Wealthier send an e-mail to: [email protected]
The Need for Improved End-of-Life Care
Despite the availability of tools like advance directives and POLST forms, end-of-life care in the United States remains fragmented and often fails to prioritize patient autonomy and quality of life. Improving end-of-life care will require a multifaceted approach that includes:
1. Promoting widespread use of POLST forms and educating patients, families, and healthcare providers about their benefits and limitations.
2. Advocating for legislative changes to strengthen the legal enforceability of advance directives and expand the range of medical scenarios they can address.
3. Encouraging ongoing conversations between patients, families, healthcare providers, and financial advisors to ensure that end-of-life preferences are clearly understood, documented, and financially anticipated.
4. Providing education and training for healthcare providers on respecting patient autonomy, delivering compassionate end-of-life care, and considering the ethical implications of aggressive interventions.
5. Increasing access to high-quality palliative and hospice care services can improve the quality of life and reduce the burden of aggressive treatments for patients with advanced illnesses.
6. Supporting research and public discourse on expanding end-of-life options, including exploring the legal and ethical frameworks for physician-assisted death in cases of severe suffering or terminal illness.
Your Role
You play a crucial role in helping your clients plan for these challenging end-of-life scenarios by encouraging them to create comprehensive advance directives, discuss their values and preferences with loved ones, and consider the potential costs and benefits of different levels of care.
By facilitating these conversations and promoting a holistic approach to end-of-life planning, you can help your clients make informed decisions that prioritize their well-being and minimize unnecessary suffering.
Dan coaches evidence-based financial advisors on how to convert more prospects into clients. His digital marketing firm is a leading provider of SEO, website design, branding, content marketing, and video production services to financial advisors worldwide.
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Advisor Perspectives welcomes guest contributions. The views presented here do not necessarily represent those of Advisor Perspectives.
Here’s what one advisor said: "Saplings grow into trees. We need to help the next generation of investors get to where they need our services."