Planning Brings Peace of Mind.

From financial planning to health care directives, don’t leave end-of-life matters to chance

When people first contact Brent Kimbel, a certified financial planner with Ameriprise Financial, they’re generally concerned with issues such as their children’s education. “They’re generally not looking for end-of-life planning. They’re concerned with their first day of retirement, not their last,” he says. “That’s the value of good financial planners. They can say, ‘We also need to look at the horizon.’”

His practice specializes in assisting public service employees. “They have a unique set of benefits, and they’ve come under a lot of strain lately with pay cuts and having to pay higher premiums. There are more demands on their dollars,” says Kimbel.

He’s finding people want to have long and confident retirements, a change from past generations. “My grandparents and their contemporaries generally worked almost up to the day they passed away, but Boomers and younger generations don’t want to do that,” he says. “They’re living longer and they want to retire earlier—and something that big doesn’t happen by accident.”

 It requires financial planning, begun as soon as possible. “You can start as soon as you finish school and get your first paycheck. The earlier you plan, the cheaper it is,” says Kimbel.

A good financial planner will help you prioritize. “You can take one thing at a time: your kids’ education, any debts, insurance, early retirement and later-in-life retirement,” Kimbel explains. “It can be overwhelming if you look at the whole picture, but it doesn’t all have to be done in one day.”

He and his associates help people evaluate their options. “For end-of-life planning, some people might want to save money and self-insure, where others might want to transfer the risk to an insurance company. We look at both scenarios and they can choose.”

Kimbel advises building a relationship with your financial planner. “Over the years your life will change and your planner will understand how those changes affect your finances.

“Financial planning gives people peace of mind about the quality of health care they’ll get late in life,” he notes. “Also, people don’t want to be a burden to their spouses or children, and planning can minimize that concern.”

He’s pleased that awareness of the need for financial planning has grown. “People are starting to take the bull by the horns. I’m not sure exactly why, but younger generations tend to do more planning than Boomers, and women than men.”

Advanced Directives

People are also realizing they need to plan their end-of-life health care, and even their death experiences. “It used to be a taboo subject, but people are getting more comfortable talking about it,” says Tom Moreland, president and CEO of Saint Jude Healthcare.

“Even the churches, until about five years ago, didn’t want people to talk to parishioners about it,” he adds. “Doctors at one time weren’t asking the questions and explaining how important end-of-life care is.”

Karen Carrig, president and CEO of Rainbow Hospice Care, has seen a vast improvement in patients and families approaching end of life more openly. “The more people hospice is able to serve and the more people speak about the care they’ve received, the lower that barrier is. Advanced care planning gives you an opportunity to talk to your loved ones about what you want.”

Society needs to embrace the concept of death being a part of life, not a medical failure. “Many people aren’t afraid to die, but they’re afraid of dying,” says Carrig. “And advanced care directives can prevent suffering. If you don’t want futile care in the intensive care unit, you need to let your loved ones know. They need to understand what you do and don’t want.”

Anyone over age 18 can have an advanced directive, and Dena Green, medical director at Agrace HospiceCare, believes all adults should have one. “We hold community seminars to help make that point,” she says. “It’s so helpful when patients with life-limiting illnesses have their wishes written.

Rainbow Hospice Care helped develop “Consider the Conversation: A Documentary On A Taboo Subject,” that the Wisconsin Medical Society is using statewide to promote advanced directives. “They’re far better created at the kitchen table than in the emergency room,” Carrig warns. “Often by the time a person gets a terminal diagnosis, it’s a very emotional time and it’s very difficult to start planning.”

It’s hard for people to think about their mortality, Moreland acknowledges. “But I think it’s actually harder when you’re older, when it’s staring you in the face.

“I developed mine at age 30,” he continues. “I know what I want. Also, in terms of a medical power of attorney, I wanted to make sure it’s somebody who knows my wishes and my church’s guidelines.”

Many people appoint their spouse and then their children as surrogates, but Moreland recommends against it. “If they have to make decisions and you haven’t clearly written your wishes, they can be emotionally shocked and in crisis, and may not follow your wishes because it’s too hard for them to stop treatment. It’s best to have someone close enough to know you, but not so close that emotions can interfere.”

His organization uses “Five Wishes,” available at agingwithdignity.org, to help people plan. “It covers things like who you want in the room and if you want music playing. It’s legally recognized in 38 states.”

While it was hard to write his advanced directive, afterward Moreland felt a sense of peace. “It was a relief to know my wishes will be honored. I’ll get to die the way I want just like I got to live the way I want.”

Rural Hospice Collaborative

Since 2010, Rainbow Hospice Care has participated in a collaborative with Home Health United and Beloit Regional Hospice that facilitates continuing care for rural residents discharged from Madison hospitals. It enables the region’s nonprofit hospices to work together and find synergies. Agrace HospiceCare is a new participant Carrig calls the “urban partner.”

The organizations had informally shared information and decided to formalize the arrangement. “We contractually came together to hire one person to facilitate all discharges from Madison hospitals,” explains Carrig. “The three primary partners all serve mostly rural populations and a lot of patients seek tertiary care in Madison. We often get referrals for patients coming back to their communities, and the hospital discharges can be complicated.”

Whether they’re moving to in-home or inpatient hospice care, patients may need supplies the partners don’t stock, or family members may need specific training. “If we have someone in the hospitals meeting with patients and family members, the coordinator can help plan and make the transition smooth,” Carrig says. “It can be a scary time and we try to bring the fear factor down.”

The partners work closely together to ensure patients have the right level of care. “It can be very challenging,” says Lynne Willer, vice president of clinical services at Home Health United. “Having providers collaborate helps patients understand their end-of-life care alternatives and helps them feel more comfortable.”

The collaborative also aims to streamline processes and reduce paperwork. “We try to all use similar forms and not burden physicians with excess paperwork,” Willer says. “Our care-consent form went from four pages to one, and it still meets all requirements. We try to standardize processes and not reinvent the wheel.”

The three rural nonprofit hospices are relatively small organizations serving similar populations. “We can pool our resources—educational programs, contract staff—achieve economies of scale and get the word out about hospice,” says Mary Ann Miller, executive director of Beloit Regional Hospice. “We have the same mission.”

As does Agrace HospiceCare. “Although their service area is primarily urban, they have a lot of expertise to share with us,” Carrig says.

“We’re learning so much from one another and it’s been wonderful to be part of this group,” she enthuses. “It’s not just the practical standpoint of having someone in the Madison hospitals; we’re still learning new things about caring for patients. Compassion without competence is chaos, and I feel like we give each other more competence every day.”

Patients Live Longer

Studies show hospice patients live a month longer, on average, than people with the same condition who do not receive hospice care, reports Agrace’s Green. “As people become more knowledgeable about their health care options, they want more control over end-of-life care. That’s something hospice can offer as an alternative to hospitals, focusing on comfort and an interdisciplinary approach: physical, spiritual and emotional whole-patient care.

“It’s better if patients have increased awareness and understanding about death and dying, including grief and loss,” she continues. “We make the experience as comfortable as possible.”

Agrace is Madison’s only nonprofit, community-based hospice and it works closely with its Rural Hospice Collaborative partners who also bring compassion, comfort and dignity to patients in the area. Agrace serves more than 600 patients every day. “We have strong support from the community—we built both of our centers with community resources,” says Green.

It’s important to know hospice care is covered by insurance, whether it’s Medicare or most private policies, she notes, “although we wouldn’t turn anyone away if they couldn’t pay, and we offer of bereavement support for anyone in the community, even if they didn’t use hospice care.”

Catholic-based Care

Saint Jude has offered hospice care in Madison since 2010. “Madison is Wisconsin’s second-largest city, and it has a lower number of hospice providers than some cities of 50,000,” says Moreland. “The more choices people have the better. I talked to a patient this morning who had interviewed all three hospices, and that’s the right thing to do.”

Saint Jude is Catholic-based first and foremost. “We adhere to the ethical and religious directives of Catholic care, and that’s important for many people,” Moreland says. “We have a vice president of admissions whose goal is to make sure our care is always in line with the church’s teachings.

“In the simplest form, the teachings say it’s benefit versus burden,” he adds. “If the burden is larger than the benefit, follow the benefit, whether it’s pulling a feeding tube, stopping hydration or giving palliative care with morphine.”

Only about 30 percent of Saint Jude’s staff is Catholic, but all have grasped the teachings. “It’s very close to the nursing code of conduct,” says Moreland. “And we really pride ourselves on providing more benefits than Medicare requires, in particular our music and massage therapies. They’re not reimbursed, but we offer them anyway.” 

-Judy Dahl

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