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Can Medicare advance directives be simple?


It’s important to have the end goal in mind when you think about Medicare enrollment. Do elderly people choose conventional medicine or alternative therapies when faced with a medical emergency? Is it possible that they might name a compassionate or medical power of attorney? What happens if they refuse CPR or a do-not-resuscitate (DNR) order is signed

Using their Medicare numbers, registration staff may swiftly determine who is an elderly customer. Will this amount be enough to enlist seniors’ living wills? Would an ABC approach work for advance directives?

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Medicare enrollees may be given the option of selecting from three different care goals advance directives:

A. Authorization to Treat; Hospitalization

B Directive: Consent to Comfort, Holistic Care for the Homebound

Choose against medical advice and use these outpatient palliative care services (Directive C)

A woman of 86 years old comes to the ER complaining of severe pulmonary edema. A DNR is an advance directive since the nurse handed it over. Is there any hope for her condition to improve? Do you have the woman’s power of attorney? There are more questions than answers in these times of crisis, and the goal of care should be to prevent legal action.

Seniors were aware that they would require a vent during the COVID pandemic, but they were not equipped to say no. Can you tell me how many people who wanted a peaceful death at home ended up in the intensive care unit instead? Is there any way to foresee this “pandemonium” at the time of Medicare enrollment? Is it too much to ask that Medicare recipients, in addition to naming a contact person to reach in case of an emergency, also sign an advance directive outlining their preferences for such situations?

According to the aforementioned research, “about 1 in 12 among ED encounters for patients older than 80 years of age will die within one month of that interaction.”

These individuals may follow predictable patterns of dying that could help them avoid unnecessary interventions like intensive care or hospitalization in their final days.

Patients in this category are routinely admitted to the hospital and given life-prolonging treatments.

Medicaid does not cover hospice care, but Medicare does, and hospice care is a limited Medicare benefit. “directs the Secretary of Health and Human Services to notify the public of the ability to execute advance directives and a patient’s right to participate in and command health care decisions,” as stated in the Patient Self Determination Act of 1990. Medicare’s hospice benefit requirements take precedence over patient choice.

Medicare is required by law to tell enrollees about their advance directive options. A group calling itself the “Coalition for Medicare Advance Directives” has proposed drafting legislation to make advance directives a standard part of the Medicare registration process. This eliminates the need for patients to be confused about their advance directives and instead focuses on the treatment aims at hand.

If 1 in 12 people over the age of 80 with a serious disease attend the emergency room in the next year, how many of those people would prefer to forego the ED and die peacefully in their own homes instead? How many people would choose to age with remarkable dignity and opt for Directive B (permission to comfort) instead of Directive A (consent to treat)? While most people would prefer Directive B, they are hesitant to make the “give up” decision because of Medicare’s limited coverage of human (holistic) services.

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The prognosis of any serious illness can be estimated. All medical choices involve a balancing act between patient preferences and overall quality of life considerations. One’s perception of quality of life when terminally sick may be tied to whether or not they are afforded the respect due to a loved one or a patient. Having “Real Serious Illness Conversations with Parents” is a prerequisite for signing an advance directive in conjunction with Medicare enrollment.

Not everyone benefits from holistic treatment. People who shun medical professionals and refuse hospital care are the target audience. The conventional approach to illness, which focuses on symptom management rather than a thorough diagnosis, would be upended by the holistic approach. Bring it in line with value-based medicine and the concept of aging in place.

The palliative care lane stands in stark contrast to the acute care and emergency room lanes, as well as the standard care and urgent care lanes.

As an example: A 67-year-old diabetic on dialysis with a leg infection presents to the ER. Could he be discharged after receiving an antibiotic injection and further infusions during dialysis? If he loses a leg or dies from sepsis, who is responsible? In his healthcare directive, he expresses a desire for autonomy and accepts responsibility for his medical care while requesting outpatient palliative services.

Because of their initiative and independence, people who take a holistic view of life are adept at dealing with the unknown. When faced with a life-or-death situation, they are prepared to act swiftly and decisively.

One 72-year-old female patient complained of dizziness and was found to have a total heart block on her electrocardiogram upon arrival at the emergency department. She was advised to get a pacemaker, but she flatly refused. She withheld treatment while knowing she was experiencing a medical turnaround. Her choice was already made at the time of Medicare enrollment, so there was no need for her to give it any further thought.

Medicare’s failure to enable seniors to pay for only what they want at the end of life is the primary reason why the United States is ranked 43rd in quality end-of-life care. By obeying the rules, Medicare will ensure that seniors are aware of advance directives and allowed to choose the choice that best suits their needs.


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