Can Medicare Advance Directives Be Simple?

(Via KevinMD.com) Consider Medicare enrollment with the end in mind. In case of emergency, do seniors prefer medical care or holistic care? Might they designate a medical power of attorney or a merciful power of attorney? Do they oblige CPR or sign a DNR order?  The JAMA Network just published Death and End-of-Life Care in Emergency Departments in the U.S. This retrospective cohort study concludes that, robust systems of emergency care must not only offer life-prolonging interventions but also identify patients and families for whom end-of-life care is necessary or preferred.  The frequency with which these scenarios arise suggests a significant public health impact from policies and resources to support delivery of this care in the ED.  Registration clerks quickly identify seniors by their Medicare numbers. Could this number enlist seniors’ advance directives? Could advance directives be as simple as A-B-C?  At enrollment, Medicare could offer three advance directives with goals of care:

Directive A: CONSENT to treat — inpatient medical treatment

Directive B: CONSENT to comfort — homebound holistic care

The above study points out that “among ED encounters for patients older than 80 years of age, nearly 1 in 12 will die within one month of that encounter. These patients may exhibit identifiable trajectories of dying that offer an opportunity to avoid unwanted aggressive care or hospitalization at the end of life.  To read the complete article, click here.