Benjamin Franklin famously wrote that “nothing can be said to be certain, except death and taxes.” And yet the inherent optimism of human nature causes us to avoid talking about the inescapable truth of death. Studies have repeatedly shown that while we widely recognize the value in end-of-life consideration and planning, we do not take much, if any, action to ensure personal desires will one day happen.
A 2013 national survey found 90 percent of Americans believe it is important to have end-of-life care discussions with their families, yet fewer than 30 percent had actually done it. Another 2014 study reported only 26 percent of Americans surveyed had completed an advanced directive, like a living will -or other legal documentation of one’s end-of-life wishes. Another study confirmed again that while 63 percent felt it was very important to communicate their funeral wishes to family members prior to death, just 21 percent had done so.
And since we are not taking action in either family conversations or legal documentation, individual wishes are not being realized. Seventy percent of Americans state they would prefer to die at home, although only 25 percent actually do.
In addition to the gap of unmet patient wishes, unnecessary end-of-life care also comes at a high financial cost. The United States spent $646 billion on Medicare in 2015, and it is estimated 28 percent of that was spent on patients’ last six months of life. Patients also pay high healthcare costs at the end of life; a Mount Sinai School of Medicine study found average out-of-pocket expenses for Medicare recipients during the five years before their death were around $39,000 for individuals and $51,000 for couples where one spouse died. Twenty-five percent had bills exceeding their total household assets, and 43 percent exceeded their non-housing assets.