Medicare End of Life Counseling: Do You Have a Plan? Many African Americans Do Not
For many years, patients, families and health care advocates have urged that doctors in Medicare be reimbursed for end of life counseling. Unfortunately in 2008, the GOP’s Vice Presidential candidate, Sarah Palin, derailed any hope of a reasonable debate by claiming such conversations would lead to “death panels.” Thankfully, time and truth have put an end to the political posturing and Medicare will now reimburse doctors for conversations with patients about whether and how they would want to be kept alive if they became too sick to speak for themselves.
According to Kaiser Family Foundation polling, public support for the move is huge; however, many Americans haven’t had end of life counseling with their doctor.
“Even though 89 percent of respondents said doctors should have this conversation with patients — and just 9 percent said they shouldn’t — only 17 percent of people reported having done so. And 4 in 10 of those who haven’t yet had the discussion said they didn’t want to. That’s despite the survey also showing that 84 percent of people would be comfortable talking to their doctors about the topic.”
Additionally, Kaiser found that communities of color are even less likely to have dealt with end of life issues:
“Studies have found that about 4 in 10 Americans ages 65 and older do not have advanced directives or have not written down their own wishes for end-of-life medical treatment. Additionally, demographic differences appear to play a role in the likelihood of having advanced directives. Specifically, African Americans and Hispanics have advance directives at lower rates compared to whites, as do people with lower incomes and lower levels of completed education. Researchers have identified several factors that contribute to these differences, including cultural and religious differences, communication challenges between patients and medical staff, distrust of medical care systems, and awareness of advance directive options.”
Research on how to reverse the trend of less end of life engagement in the African American and Hispanic community is limited. However, as of January 1 this year, Medicare will cover advance care planning as a separate service provided by physicians and other health professionals. Advocates hope the new provisions will open the door to increased usage of the new benefit across the nation.