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Study supports doctor-led approach to end-of-life care planning

By Hook Law Center

The end of a person’s life is a time of intense transition and difficult choices. Although nothing can fully prepare an individual or a family for the gravity of the decisions that need to be made, end-of-life care planning can help ensure that a dying individual’s wishes about his or her care are followed.

Traditionally, family conversations have led this process. Relatively few Americans have written advance health care directives. A recent study suggests that incentivizing physicians to discuss end-of-life care could boost participation in end-of-life care planning dramatically.

In the study, palliative care specialist Dr. Joshua Lakin and a team of his colleagues at the University of California, San Francisco (UCSF) Medical Center instituted an incentive program to improve documentation of patients’ advance care decisions.

The researchers developed a standard form, which was placed in patient’s electronic medical records. The form documented preferences, including whether the patient would like to be resuscitated, intubated, receive a feeding tube or receive all care in the case of major health decline. The forms also had room to list the patient’s health care agent and that person’s contact information, as well as a space for “expressed wishes” and any existing living will or health care directive.

Medical residents would receive a monetary bonus if, as a group, they completed preference forms for at least 75 percent of discharged patients during at least three out of the four quarters. Email alerts were sent to residents if they fell behind.

In July of 2011, 22 percent of the patients had documented preferences. By October of that year, 90 percent of patients had documented preferences, and the number stayed that high.

Although family conversations about end-of-life care remain important, this study suggests that in the future, a doctor-led approach may help ensure that these tough decisions are made and documented.

Posted on Friday, January 23rd, 2015. Filed under Long-Term Care.

The effect of procrastination and debt on retirement planning

By Hook Law Center

The desire to create a comfortable, secure retirement is almost universal. Unfortunately, procrastination and debt can have a devastating, though not irreversible, effect on these efforts. While Americans can now anticipate longer-than-ever retirements with ever-higher costs of care, they tend to be less prepared for retirement than in decades past.

Procrastination can affect one’s retirement plans dramatically. The earlier people start saving for retirement, the less they need to save, and the more they will have when retirement comes. For example, to have the same balance at 65, a person who starts saving for retirement at 40 will need to save more than three times as much each month as a person who started saving at 25. Every year of procrastination can impact the security of one’s retirement.

Sadly, such procrastination is quite common. The savings rate in the United States hit a low point in February 2013 at just 2.6 percent — compared to a high of 11 percent in 1973. The majority of Americans have less than $25,000 in savings and investments, and 28 percent of Americans said they were “not at all confident” that they were saving enough for retirement.

Debt also threatens security during retirement. Levels of credit card debt, student loans and mortgage debt are all on the rise, including among people of retirement age. From 1989 to 2010, debt among people 75 and older increased by 978 percent, and debt among people aged 65 to 74 increased by 384 percent. Some older individuals must tap into their retirement funds to pay down credit card and other debt, which means that those funds will not be available later on.

Many Americans have so much debt that they are unable to retire when they would like to. Others are less secure in their retirement because of debt.

Debt and procrastination can have a devastating impact on retirement planning, but it is never too late to start working towards a good retirement. As the saying goes, the best time to start was yesterday, and the second best time is now.

Posted on Thursday, January 15th, 2015. Filed under Estate Planning.
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