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Medicare needs to change to serve those at the end of life

Updated: Feb 10, 2023

Reforming Medicare enrollment and simplifying Advance Directives are passions for Dr. Kevin Haselhorst. In this podcast he argues that most Advance Directives are confusing for caregivers and families and he cites well-documented research to substantiate that point. Dr. Haselhorst does believe Advance Directives are a critical tool for patients and healthcare, however, they need to be simplified. He suggests two strategies for simplification.


First, have a patient select one of three treat options for end-of-life care:

  • Proactive inpatient hospitalization

  • Comfort care in the home

  • Palliative care in the outpatient setting

Second, make completing an advanced directive mandatory at enrollment with Medicare and require Medicare recipients to review the directive annually as part of the annual Medicare Wellness visit.


The podcast provides several patient care examples to illustrate why Dr. Haselhort’s recommendations are advisable. He invites patients to assume much greater responsibility for their own end-of-life care. In essence, he is suggesting we need to engage individuals into becoming more informed about their end-of-life choices. Making the three simple choices he suggests would be powerful, but these choices are only feasible if the individual understands the implications of those choices.


My book, The Journey’s End, makes similar recommendations. The book outlines many of the challenges making the implementation of these recommendations feasible. As Dr. Haselhorst acknowledges, one of the biggest challenges is that the vocabulary for all these choices is confusing and inconsistent. The Medicare insurance world, the clinical world and the legal world each contribute to this confusion.


The Journey’s End helps patients become informed about these choices and offers health reform recommendations to make their implementation feasible. If you’re interested in reading more on this topic, my book is available for pre-order. Use code RLFANDF30 for 30% off.

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