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Burlington, VT office 802.540.0529
Hanover, NH office 603.643.6072
Rutland, VT office 802.773.3822
Woodstock, VT office 802.457.9492

October 7, 2010 Newsletter Archive

A Story that Reveals a Flaw in our Healthcare System

Recently we read a story in the New York Times Magazine about one family's perilous journey navigating today's health care system. This story struck a chord with us because we work with a large variety of elders and their children. Moreover, the story was written by the couple's daughter who informed the story almost as a helpless bystander watching her parents' lives deteriorate.

The story was about a strong, smart and stubborn couple in their 80s who had lived "the American dream." He was a successful Wesleyan professor emeritus and his wife was an active and buoyant woman. They had two successful daughters.

Until their late 70s the health care system had treated them perfectly well. They were both hale and well and in general took care of themselves. Moreover, Medicare and Medicare supplemental policies had taken care of their medical expenses. For all purposes they were happy with the healthcare they had received for most of their lives.

Unfortunately, at age 79 the husband suffered a stroke and by mutual understanding the wife became his primary caregiver. It was a long rehabilitation, yet within the next few years the husband was beginning to make some strides toward recovery. However, the couple learned that he had a hernia which required surgery, and in the process of preparing for surgery doctors discovered some heart arrhythmia requiring a pacemaker.

Although the family requested information on alternatives to the pacemaker, the likelihood of recovery, quality of life, prognosis, etc., few answers were provided to them. In fact, though the husband and wife's primary care physician was wonderful in his explanations at every step, he was not consulted during this critical period. Feeling there were few alternatives, the wife submitted to implanting a pacemaker on her husband's behalf.

The story goes on to describe that a progressive form of dementia was one of the side affects of the husband's stroke. Eventually, the husband became, like so many later stage people with dementia, unable to communicate or act on his own. He became totally dependent on his wife for everything, from going to the bathroom to eating. His condition caused his wife exhaustion and resulted in her subsequent heart condition. Eventually, the only thing keeping the husband alive was the pacemaker which far outlived his mental capacity.

The stroke completely changed the lives of the couple because they went from being independent and virtually carefree to infirm and exhausted by the labors of caregiving. The article explains that in years past the stroke would have caused the death of the husband but, due to our medical system, the husband was able to survive. According to the author, "thanks to advanced medical technologies, elderly people now survive repeated health crises that once killed them, and so the 'oldest old' have become the nation's most rapidly growing age group."

The point of the article was to describe our current healthcare system and the breakdowns in communication. Here the family was led down a path which provided maximum revenue to the doctors, hospitals, and specialists involved, but did not take into consideration the patient's quality of life.

The modern healthcare system can work wonders and extend our lives significantly longer now than ever before; however, few people in the healthcare industry stop to consider how extending life can affect quality of life for the patient and the patient's family.

Further, the healthcare system is disjointed; an individual's primary care physician often has no involvement with treatment if the individual has a medical crisis. Having an Advance Health Care Directive and an agent who is your advocate — particularly one who is familiar and strong enough with your end of life wishes — and who can connect the broken links, is crucial, and can provide a family with options, alternatives, and the dignity we all deserve at the end of life.

Learning how to navigate the systems and their perils and the pitfalls before a crisis occurs is one of the most important steps you can take.

Why Use this Story?

Thinking about end of life planning is difficult enough. Choosing the appropriate agent, and then thoroughly discussing with and informing them about your wishes, is even more difficult. We often would like to ignore these conversations and hope for the best. Yet, as the above story illustrates, it may not be enough to have a perfunctory advance directive and never have the essential discussions with your agent and family members.

The very instructive "take away" from the above story is that really delving into your end of life wishes, and then selecting an advocate that can articulate your wishes, is critically important to both you and your loved ones' quality of life.

What Can You Do?

Navigating the terms of the advance directive can be difficult. Should you allow your agent to seek a Do Not Resuscitate Order or shouldn't you? Should you withhold hydration and nutrition, or just nutrition? Should you allow your agent to override your wishes if you are able to articulate them, even if your wishes may not actually be in your best interest?

How can you ensure that you understand these terms and what would be best for you?

Talk to your primary care physician. He or she should be able to consult you on what may be medically best or not such a good idea depending on your current health situation. You can ask your doctors to include your advance directive in your medical records as a standing order. This may help a variety of doctors to understand your wishes.

Speak to your spiritual leader.Often a minister, priest or rabbi can counsel you through difficult experiences. Many religions provide their own types of advance directives because that religion wants to make sure you stay within its proscriptions. As long as the advance directive meets the legal requirements of your state a religiously based advance directive should be fine.

Call our office. If you or a family member would like assistance in discussing, interpreting and completing an advance directive that can work in a crisis, please call our office at 603.643.6072 or 802.457.9492. Our Elder Care Manager has many years of experience counseling clients about handling end of life care matters. Call our office today to learn more.

Melendy Moritz PLLC is a client centered boutique firm. We focus on your unique needs by providing the individualized legal counseling and advising tailored to your specific situation.

We concentrate on the planning that matters to you.
Call us at 603.643.6072 or 802.457.9492


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