Making end-of-life care comfortable and effective is always at the forefront of the minds of the elderly and their loved ones as they approach this emotional time. "Will my loved one be comfortable? What can I do to be present? How much time do we have? Is there more we could do? What will happen when it is all over?" are questions that come into the minds of loving caregivers.

How can I pay for end-of-life care?

One question many seniors and their loved ones are asking too late, though, is this: "How can I pay for end-of-life care? How much will my passing, or the passing of my loved one, cost?"

Those answers are all in the choices. In fact, the choice is fairly simple: receive end-of-life care in a facility or receive it at home. Most seniors (90%) would prefer this care at home, yet many of them still end up in facilities when they pass on. Not only is this environment often less comfortable and friendly (think stark white walls and cafeteria food instead of family photos and home-cooked meals), but it is also much more expensive.

Especially as baby boomers begin to transition into old age, this choice is becoming more and more relevant, since these costs are largely paid for by Medicare. This program has, for more than five decades, provided the elderly and disabled with health insurance and enabled people to get care, but it is in danger of losing its funding if many baby boomers are too expensive to care for as they age. One way that seniors can help is by choosing to receive end-of-life care at home rather than in a hospital.

The Costs

Aging at home saves money in many ways, but it largely comes down to labor and hospital bed time. Having a nurse visit a home once a day, or even allotting this labor to a family caregiver, means money is saved; taking up a bed at home is far cheaper than a room in a hospital. Medicare then does not have to cover these costs. There is a cost, though, that can often not be measured in dollars. This choice typically means more time and energy from family caregivers as opposed to palliative or hospice care. It also means space must be found in a safe, healthy environment outside of a hospital. For some families, these factors make end-of-life care at home prohibitive or impractical. However, as with many things related to aging, this can be helped by early decision-

...anticipated needs should be approved by a doctor before proceeding with moving someone into the home.

A huge financial and logistical cost associated with aging at home is equipment. This may be simple (a bedside commode, for example) or more complex (a breathing machine or heart monitor). These items may be covered by Medicare in part or entirely, or maybe only with a doctor's recommendation. All such anticipated needs should be approved by a doctor before proceeding with moving someone into the home. Setting up this equipment and maintaining it should be done by a professional, and this is often the most intimidating thought: "How will I make sure that my loved one is getting the right care if I am not a doctor? This is why doctors must be involved in making the decision for someone to spend the end of life at home and also aid in the transition into the home.

The Benefits

Not only does end-of-life care at home frequently save money, but it also means more flexibility. Hospitals often have strict visiting hours or numbers of loved ones that can visit at a time; homes do not have such limits, allowing large families or social groups to gather and visit a loved one. There is also the comfort of home, which often allows patients to be more at ease and to feel safe; many patients associate hospitals with sickness, surgery, or dying, but spending time at home means that they can experience family and friends, happy times, and celebrations instead.

The benefit of saving money during end-of-life care should not be overlooked. The consequences of Medicare losing funding could be disastrous; either it will be discontinued, leaving many elderly and disabled Americans without health insurance or under-covered by health insurance, or it will have to restrict benefits, leaving many Americans with bills they simply cannot pay. Rather than leaving behind debt or chaos, most seniors would rather leave behind a legacy of love and community, and as such they may want to consider end-of-life care at home rather than in a hospital or other healthcare facility.

Sources

Boards of Trustees, Federal Hospital Insurance and Federal Supplementary Medical Insurance Trust Funds. (July 28, 2014). 2014 Annual Report. Centers for Medicare and Medicaid Services. Available at https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/ReportsTrustFunds/downloads/tr2014.pdf. Retrieved on March 4, 2015.

Kaiser Family Foundation (KFF). (November 5, 2015). 10 FAQs: Medicare's Role in End-of-Life Care. Available at http://kff.org/medicare/fact-sheet/10-faqs-medicares-role-in-end-of-life-care/#footnote-153315-3. Retrieved on March 4, 2015.

National Institutes of Health (NIH)'s National Institute on Aging. (January 22, 2015). End of Life: Helping with Comfort and Care. Available at https://www.nia.nih.gov/health/publication/end-life-helping-comfort-and-care/finding-care-end-life. Retrieved on March 4, 2015.

Taylor, Erin Audrey. (July 30, 2015.) Medicare at 50: How Reforming End-of-Life Care Could Benefit It For Years to Come. U.S. News & World Report. The Rand Blog. The Rand Corporation. Available at http://www.rand.org/blog/2015/07/medicare-at-50.html. Retrieved on March 4, 2015.

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