Traverse City Record-Eagle

January 20, 2013

In the end, we all face reality


---- — My mother is 88 and she is dying.

Over the last few months, she has been hospitalized several times and has been in a rehabilitation center to regain strength, only to return to the hospital instead of returning home.

With each successive hospitalization, her ability to recover has diminished to the point where her physicians have indicated that there is nothing else medical science can do for her. So we now wait the moment when her earthly vessel gives up her spiritual energy and she reenters the cosmos from once she came.

She is tired and she is ready. The spark that once was in my mother's eyes has gone out and I know she, too, recognizes that the end is near. She isn't being stoic or hysterical; she is being my mom — pragmatic and a realist.

As my mom readies herself for her end-of-life journey, my brother and I are facing the realities of the cost of dying. We, too, are pragmatic and realists.

Figures recently released by the National Center for Policy Analysis indicate that senior citizens within the last 24 months of life can expect to generate more than $50,000 in medical, funeral and burial costs. Government programs such as Medicare and Medicaid will pick up about 65 percent of the cost of my mom's care with her supplemental program covering quite a bit more:

n Medicare averages spending $28,616 on medical bills for seniors in the last two years of life.

n Medical costs paid by Medicaid and private insurance average $4,006 and $3,720, respectively.

n The deceased and their families can expect out-of-pocket medical expenses of $5,723.

n Funeral and burial expenses average another $8,000.

I don't know the cost of my mom's final medical expenses and may never know because I won't see all the bills, but I do know that hers may not be as dramatic as above because we (my brother, mother and I) had those hard-to-have discussions and made the hard choices before they needed to be made. We knew my mom's feelings, as we had previously filled out the proper forms and executed all the legal documents, filed them with the doctors and hospital and instructed her physician that no "heroic measures" were to be performed. Now our goal is to enforce those wishes and make sure my mom is kept pain free and comfortable in the time she has remaining.

One of the biggest issues facing this country is the high cost of medical care and how to make those tough choices when it comes to allocation of care. I believe that it is incumbent upon the patient and family to make those choices before they are driven by pure emotion. Reality is that my mom will not get better nor will she benefit from additional treatment; it's a question of quality versus quantity.

In an end-of-life study done by the Dartmouth Atlas Project, they found that chronically ill Medicare patients were spending fewer days in the hospital and receiving more hospice care, but at the same time there was an increase in the intensity of care for patients who were hospitalized. Despite that shift, those patients had significantly more visits from physicians, particularly medical specialists, and spent more days in intensive care units.

"In addition to its effects on patients' quality of life, unnecessarily aggressive care carries a high financial cost," said Dr. David Goodman, lead author of the study and director of the Center for Health Policy Research at Dartmouth's Institute for Health Policy and Clinical Practice. "About one-fourth of all Medicare spending goes to pay for the care of patients in their last year of life, and much of the growth in Medicare spending is the result of the high cost of treating chronic disease."

I know that physicians are trained to save lives, but my mother's time here is near its end. I will miss her. I am already grieving.

Try as we might, ultimately we all succumb to the ravages of old age. My mother will die in dignity, surrounded by those who love her — not IV bottles and tubes.

Fred L. Goldenberg is a Certified Senior Advisor and the founder of Senior Benefit Solutions, LLC, a consumer and financial services organization in Traverse City. If you have any questions or comments about this article or any senior issue, he can be reached at 231-922-1010 or