Photo from Huffington Post
Marjorie never felt alone at her nursing home. Although her husband died last year, and her children couldn’t be there a lot of the time to visit her, she seemed content. Her ability to speak clearly and her memory were diminishing and most people couldn’t understand what she wanted or needed, but somehow she always felt like her voice was being heard. It was through a doula, or as she put it five years ago, a “guardian angel,” named Cara, that she found comfort, compassion, advocacy, and motivation.
When she was diagnosed with Lewy Body Dementia, Marjorie’s doctor initiated an end-of-life conversation with her. He stressed how important it was for sick people to have companionship to help them find comfort during a time when they need it most. The talk compelled Marjorie to think of another challenging time in her life when she felt comfort, and she recalled the doula from her labor and delivery. She did research and came across an article in the New York Times titled, “In Death Watch for Stranger, Becoming a Friend to the End,” by N. R. Kleinfeld, and she realized there are doulas out there that can help her during this time of her life, as well.
While she still had her wits about her, she indicated in her Advance Medical Directive that she would like to have a doula, should she be in a position where she needs someone to provide end-of-life compassion and support. If it weren’t for the doctor initiating the conversation, and Marjorie planning in advance with an experienced elder law attorney, she would have never had Cara there as her “guardian angel.” In addition, without Medicaid Planning, she would have never been able to afford the $14,000 a month nursing home bill, without depleting her hard-earned assets.
In ancient Greece, the word doula was used to describe a household servant. It is most often used to mean an individual trained to provide comfort and support to women during labor and childbirth. More recently, it has been associated with those trained to provide support at the end of life. Now, hundreds of individuals facing the end of life are not alone as a result of a relationship with an End-of-Life Doula. To learn more about end-of-life doulas and how to find one, visit the International End-of-Life Doula Association Website.
The End-of-Life Conversation
A landmark report titled “Dying in America” was released last year by the Institute of Medicine. It found that few people make their wishes known and too many deaths are filled with breathing machines, feeding tubes, powerful drugs, and other treatments that fail to extend life and make its final chapter more painful and unpleasant. The report found that end-of-life counseling, in conjunction with incapacity planning documents, can discern the type of treatment patients want in their last days, with options ranging from care that’s more focused on comfort than extending life to all-out medical efforts to resuscitate a dying patient.
Medicare just announced that beginning in 2016, doctors may be compensated for end-of-life advice to patients. Some doctors already have such conversations with their patients without billing extra. But an opening to roughly 55 million Medicare beneficiaries could make such talks far more common.
Supporters say counseling and planning in advance would give patients more control and free families from tortuous decisions. They suggest that patients should make their wishes known about end-of-life care at different stages of their lives, as early as when they get a driver’s license.
Comment period for the proposal closes on Sept. 8, 2015. Coverage would begin in 2016. You can read the proposal here.
Important Incapacity Planning Documents
Once an end-of-life conversation occurs, and important decisions are discussed, it is important to work with a qualified elder law attorney (preferably a Certified Elder Law Attorney) to ensure that the Incapacity Planning documents listed below are in place. Doing so is the best way to ensure that your wishes are met should you become unable to make important decisions for yourself. Incapacity planning documents include an Advance Medical Directive, a Financial Power of Attorney, and a Revocable Living Trust (RLT). Read more about these documents in this recent blog post.
The Time to Start Elder Law Planning is Now!
What if you’re like Marjorie in our example, and you want a doula to be by your side for comfort and compassion, in your time of need? What if you were in a coma and you want all life saving measures to be taken, or for the plug to be pulled? To ensure your wishes are met, it is important to start your planning now, so you are prepared in case a crisis occurs. If you have not done Incapacity Planning or Estate Planning, or if you have a loved one who is nearing the need for long-term care or already receiving long-term care, please contact Farr Law Firm, P.C. as soon as possible to make an appointment for a consultation:
Fairfax Elder Law: 703-691-1888
Fredericksburg Elder Law: 540-479-1435
Rockville Elder Law: 301-519-8041
DC Elder Law: 202-587-2797
About Evan H Farr, CELA, CAP
