UPCOMING EVENTS

SEMINARS FOR SEPTEMBER 2016

MONROEVILLE / PITTSBURGH
Tuesday, September 13, 2016
2:00PM
Courtyard Marriott / Monroeville
3962 Wm Penn Highway
Monroeville, PA 15146
Between Sheetz and Eat ‘n Park
 
MURRYSVLLE / DELMONT
Tuesday, September 13, 2016
7:00PM
Holiday Inn Express
Delmont/Murrysville
6552 Route 22
Delmont, PA 15626
Behind Lamplighter Restaurant on Rt. 22
 
HARMARVILLE / PITTSBURGH
Wednesday, September 14, 2016
2:00PM
TownePlace Suites / Pittsburgh
2785 Freeport Road
Pittsburgh, PA 15238
Just off of Exit 48 of PA Turnpike
 
MONROEVILLE
Wednesday, September 14, 2016
7:00PM
The Estate Planning Centers
3824 Northern Pike, Suite 801B
One Monroeville Center
Monroeville, PA 15146
Just west of Red Lobster on Rt. 22
 
MURRYSVLLE / DELMONT
Saturday, September 17, 2016
10:00AM
Holiday Inn Express
Delmont/Murrysville
6552 Route 22
Delmont, PA 15626
Behind Lamplighter Restaurant
 

 
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Proudly serving clients throughout Allegheny, Westmoreland, Butler, Fayette, and Washington Counties; including Pittsburgh, Monroeville, Greensburg, Latrobe, Cranberry, Wexford, Sewickley and YOUR community.

Your Living Will: Improving Your Quality of Life

I am occasionally asked whether Living Wills really make a difference in how “quality of life” decisions are made as someone approaches the end of their days. A Living Will is an advance directive that a person prepares to specify how they would like medical treatment decisions to be made if the person is no longer able to communicate with physicians while at the end stage of a terminal condition, or permanently unconscious.  (Please do not confuse this with a Living Trust, which is a powerful estate planning tool for controlling your own financial affairs during your lifetime and after you pass on).  Some of my clients are initially concerned that their wishes might simply be ignored. I have discussed the matter with many clients and their family members, doctors and other health professionals, and the information from my investigation has always lead to the conclusion that the Living Will is important, it is followed, and it provides comfort and relief to family members who have to make difficult decisions when we are in a dire condition.
 
This conclusion was further supported by a recently released study in the Journal of the American Medical Associationi (Oct. 5, 2011).   The doctors who conducted the study examined the difference between end-of-life care for people with Living Wills, and those without. Based on the thousands of patients they reviewed, they concluded that when patients live in regions with “high spending” on end-of-life care had Living Wills specifying limitations on treatment, they: 
 
  1. had significantly lower end-of-life spending, 
  2. were less likely to have an in-hospital death, and 
  3. had significantly greater odds of hospice use than decedents without advance directives in those regions. 
 
The differences in care outcomes were less significant in regions which already had lower average end-of-life spending, presumably because of a regional pattern favoring less intensive treatment when the outcome is unavoidable.
 
I wanted to see where our region was positioned on the scale of high-spending versus low-spending on end-of-life care.  The researchers relied on the Dartmouth Atlas of Health Care data setii, so I examined that information. Our region in Southwestern Pennsylvania is consistently a high-spending area.  This is likely the result of the outstanding health care facilities we have available to us in Pittsburgh. While there is a time for a physician to throw everything they have available into prolonging a life, there is also a time for backing away and letting go.  It seems that overall our region is not as good at letting go, absent an advanced directive in a Living Will.  The good news from the JAMA study is that in an area like ours, the use of a Living Will is effective in decreasing the financial and emotional cost of unnecessarily extended end-of-life care, and decreasing the time spent confined to a hospital room while increasing the use of hospice services for a peaceful end in our own homes.  
 
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iNicholas, LH.  Regional Variation in the Association Between Advance Directives and End-of-Life Medicare Expenditures.  JAMA. 2011; 306(13): 1447-1453 (October 5, 2011).
iiThe Dartmouth Atlas of Health Care. Data by region. http://www.dartmouthatlas.org. Accessed October 8, 2011.