-“Advance Planning for Your End-of-Life Care - Best for Yourself and Your Family”
By Saghir Aslam
Rawalpindi, Pakistan
(The following information is provided solely to educate the Muslim community about investing and financial planning. It is hoped that the Ummah will benefit from this effort through greater financial empowerment, enabling the community to live with dignity and fulfill their moral obligations towards charitable activities)
A newly available health benefit encourages discussion.
Millions of Californians are newly eligible for a health care benefit that could determine the treatment they receive in their final days and most don’t know it.
Medi-Cal, which covers more than 13 million Californians, and Medicare, with more than 5 million California enrollees, now pay for “advance care planning” discussions with doctors.
Advance care planning isn’t about long-term care options, such as nursing homes or assisted living.
It’s about “your wishes for your care if you are not able to speak for yourself”.
If you are incapacitated, if you need someone to speak for you, who do you want to speak for you? And what would be your medical wishes?
If, for instance, you have a stroke that leaves you unconscious and unable to communicate, with little hope for improvement, would you want to be kept alive with a feeding tube or ventilator?
“These decisions may have consequences for the quality of life you have for the rest of your life. They may also have consequences for whether you live or die”.
In other words, they are important. But many doctors and patients don’t yet realize that talking about these decisions- and possibly putting them into writing- is a covered benefit.
Starting in October, Medi-Cal- the state’s version of the federal Medicaid program for low-income residents- began covering advance care planning discussions between doctors (or other qualified providers) and patients (for a family member). Any Medi-Cal recipient can use the coverage regardless of age.
Medicare, the federal health insurance program for people 65 and older, and for people younger than 65 who have certain disabilities, started covering the discussions Jan. 1. Medicare does not limit the number of discussions per patient each year. Some private insurance plans cover these discussions and some don’t.
Both Medicare and Medi-Cal will cover the conversations even if patients don’t end up completing an “advance care directive” as a result. That’s a document that formalizes your wishes, which should be shared with your family and doctor.
I believe that anyone over 18 should have this discussion and complete an advance directive. But don’t expect your doctor to initiate the conversation. “Many physicians may not be very comfortable having this conversation”.
A poll of more than 700 doctors, released in April, found that nearly half of them feel unsure some or much of the time about what to say when discussing end-of-life care with patients. (The poll was commissioned in part by the California Health Care Foundation. California Health line, produced by Kaiser Health News, is an editorially independent publication of the California Health Care Foundation). I and my wife are members of Kaiser and certainly believe in this and have already communicated our health wishes with Kaiser. I feel each and every one of us should do this as soon as possible. I have seen multiple cases, some my very good friends that wish their sick relatives in coma had done this to save him/her and family from this misery.
“There’s an art to having the discussion. There is an art to recognizing when people are uncomfortable”.
Because many doctors don’t know about this benefit- or may feel uncomfortable broaching the topic- most people should start by having a conversation with family and loved ones.
“It’s difficult to discuss, but when you have done it, it’s a comfort. As I stated earlier in this article I have done it and I am truly delighted that my family will not have to go through this misery when we are not able to communicate with each other. Just staying alive with tubes (machines), it is painful for the patient but extremely difficult for the loved ones. It’s something I don’t wish on anyone.
A variety of forms and templates are available. You can use “POLST” form, which is a medical order that must be completed and signed by a healthcare professional. It is typically for seriously ill or frail patients, whereas an advance care directive is a legal document for people of any age or condition.
Use “Five Wishes” form, which can be personalized and is available online for $5 at AgingWithDignity.org. Other options for advance directives can be found at CaringInfo.org or at this AARP site: bit.ly/28TtVVy. (A lawyer can help you prepare an advance directive, but you usually don’t need an attorney to get it done.)
After you have filled out your advance care directive, discuss it with your doctor; don’t forget to give your doctor a copy.
“The role of the physician is really to provide information, not to persuade one way or to other”.
Most are open to the discussion, and their responses are mixed. Some older or sicker patients tell they don’t want any extraordinary measures if they’re incapacitated. Others, who are younger and healthier, say they would probably want medical intervention if they might have a chance to thrive afterward.
“Most people don’t to be kept on life support indefinitely. They really don’t want that”.
(Saghir A. Aslam only explains strategies and formulas that he has been using. He is merely providing information, and NO ADVICE is given. Mr Aslam does not endorse or recommend any broker, brokerage firm, or any investment at all, nor does he suggest that anyone will earn a profit when or if they purchase stocks, bonds or any other investments. All stocks or investment vehicles mentioned are for illustrative purposes only. Mr Aslam is not an attorney, accountant, real estate broker, stockbroker, investment advisor, or certified financial planner. Mr Aslam does not have anything for sale.)
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