Discussing Advance Directives with Seniors
March 31, 2021
Medicare makes Advance Care Planning more common with physicians
Seniors, just like the rest of us, don’t want to fret about worst-case scenarios. And who can blame them for wanting to spend their time enjoying life rather than worrying about the difficult decisions that may come in the future?
More frequently, however, seniors are discussing this important issue with their providers, thanks to coverage by Medicare which reimburses physicians for 30 minutes of advance care planning with patients. As we approach National Healthcare Decisions Day on April 16, this month is the ideal time to review these vital documents.
Particularly for older adults, advance care planning (or advance directives) can help ensure that their health care wishes are met even in moments they can’t communicate their desires. In addition to protecting both patients and their providers, advance directives also take the burden of difficult decision-making off of already stressed loved ones.
Reviewing advance directives
Since 2016, Medicare has rewarded patients who have a voluntary consultation on advance directives with a health care professional. Medicare beneficiaries pay nothing for this planning when it’s part of a yearly wellness visit with a provider that accepts assignment.
Medicare pays for advance care planning as either an optional part of a patient’s Medicare wellness visit or as a Medicare Part B medically necessary service. Medicare doesn’t place a limit on the number of times this service can be provided, as long as the patient’s change in their advance care wishes is documented.
For anyone with an advance directive, regardless of age or health, these documents should be updated any time there’s a significant change in their lives. This might be a new health diagnosis, a change of marital status, or the loss of a loved one. Even folks who haven’t experienced one of these changes recently, it’s still important to review their advance directives every few years, as thoughts and feelings about end-of-life decisions change as we age.
Types of advance directives
Living wills and health care proxies (durable power of attorney) are the most common types of advance directives. And while the two are similar, they have different roles. Both, however, ensure that providers are able to make the health-related decisions their patients want, even when those patients can’t speak for themselves.
A Living Will is a written legal document used only for end-of-life decisions, typically in the case of late stage terminal illness or those who are deemed permanently unconscious. It clearly denotes what sort of life-prolonging measures a patient wants to establish. It also states under what conditions an attempt to prolong life should be stopped. Items like tube feeding, dialysis, ventilators, resuscitation and palliative care are addressed, as well as a patient’s wishes for organ donation.
A living will shouldn’t be confused with a Do Not Resuscitate (DNR) order, which instructs health care providers not to perform CPR on someone who has stopped breathing or whose heart stops beating in any situation.
A Health Care Proxy is the second primary type of advance directive. When patients are incapacitated and unable to express their wishes, a trusted person is able to make medical decisions on their behalf. These decisions could range from simple treatments and therapies to end-of-life decisions in situations that are not covered in the living will. Health care proxies are most commonly spouses, parents, children, or close friends.
Talking with seniors
Because end-of-life decisions can be a delicate topic, the American Medical Association suggests normalizing the process, and discussing advance care planning with every patient. The AMA educational module on End-of-Life Care helps providers facilitate these discussions.
Every state has different requirements for creating an advance directive. For patients who prefer to work on their own, AARP offers links to free forms available to create an advance directive that complies with the laws of your home state or territory.
As a partner to healthcare providers serving older adults, Oasis Senior Advisors is here when you need us. If you have a patient who needs help planning for the future, no matter what their future entails, Oasis will provide the right resources at the right time. One call to Oasis provides many solutions for seniors and the providers who serve them every day.