The Need For Advanced Care Planning

By Susan

The New York Times  reports, “The Obama administration, reversing course, will revise a Medicare regulation to delete references to end-of-life planning as part of the annual physical examinations covered under the new health care law.” According to the Times, “The move is an abrupt shift; coming just days after the new policy took effect on Jan. 1. … While administration officials cited procedural reasons for changing the rule, it was clear that political concerns were also a factor.”

I’m not writing this to make a political statement. The issue of Medicare compensating physicians for the time taken to talk with patients about end-of-life choices and planning, however, has received significant press—again—in the past week, and I need to speak up. As an impassioned hospice professional, I am deeply disappointed that this kind of planning between a patient and physician will not be encouraged and reimbursed by Medicare. However, my message is not about politics, Medicare or hospice. It’s about YOU and the people you love.

You see, the fundamental issue remains: advance care planning allows a person to make his or her wishes and care preferences known before being faced with a medical crisis. Advance care planning is simply smart life planning—and can be one of the greatest gifts a person can ever give to loved ones.

This is a deeply personal issue for me, and a tribute to my parents. Here’s the thing: they planned for the ends of their lives. They planned openly, lovingly and legally. Their advance directives and durable powers of attorney for health care were not only in order, but in the hands of family members and appropriate health care providers. And, they were backed up with years of casual, comfortable talk about what they would want, and why.

My mom suffered a massive brain hemorrhage; my dad, a heart attack in the late stages of Parkinson’s disease and dementia. In spite of their end-of-life preparation, many of our decisions during those last days and hours were very grey and difficult. So, please don’t think I’m suggesting that the planning makes all of this easy; it doesn’t. But, I can’t imagine what these family crises would have been like without the guidance my parents had provided. In our situations, hospice care ensured that they both died comfortably and peacefully; their planning ensured that we were also comfortable and at peace with the responsibilities that rested upon us.

Whatever one’s politics, advance care planning is NOT about limiting or rationing care. It’s not about hastening death. It’s not about saving money or taking away an individual’s choices.

Advance care planning IS about examining options, planning and communicating the choices that YOU want—either to limit treatments, accept all treatments or something in between.

To carry out a loved one’s wishes at the end of life is a profound act of love. But, how can you do it if you don’t know what someone wants; if you haven’t talked; if you haven’t planned?

Information that can guide you in understanding various care options at the end of life is readily available through resources such as these:

Advanced Health Care Planning Resource Guide for North Dakotans (and others) available through Hospice of the Red River Valley: or 1-800-237-4629.

About Hospice of the Red River Valley
Hospice of the Red River Valley is an independent, not-for-profit hospice serving all, or portions of, 29 counties in North Dakota and Minnesota. Hospice care is intensive comfort care that alleviates pain and suffering, enhancing the quality of life for patients with life-limiting illnesses and their loved ones by addressing their medical, emotional, spiritual and grief needs. For more information, call toll free 800-237-4629, email or visit