As I grow older and think about my own health and well being and the inevitable and eventual decline, I think about what I want for care and services and how I want to live. Most data shows that nurses and doctors are more reality oriented when it comes to their own desires and options in their later years. Perhaps it is because they have seen so much over the years.

The brutal reality is that most seniors have not made decisions ahead of their healthcare need and talked about it with their physician and loved ones. The other reality is that too many seniors end up spending their last days in the hospital with extensive and often very uncomfortable treatments and procedures that offer no hope of a better life. These same individuals often die an uncomfortable death in a strange hospital environment rather than at home in their own bed. Five percent of Medicare patients who die each year consume a third of the Medicare dollars in their final month of life when there was no reasonable chance for them to recover. I believe that is because we do not like to talk about the possibility and inevitability of death.

I propose that all seniors when they sign up for Medicare consider what they want in their coming decade or two of life. Each visit to their primary doctor should include at least a mini discussion of what their healthcare future looks like and what complications could interfere with it. Most American seniors have at least one chronic illness. As the chronic illnesses are acquired, we have to take a more measured look at the consequences of our decisions today.

Each time an older person is sent to the Emergency Room we need to recognize that unless we advocate and speak up for the decisions we want, we may lose some of the choices that we really care about. A large part of that focus is to remember that we always have options and choices and the ER physician should be making us aware of those options.

In our financially driven and hurry up world, many times our primary physician does not make the time to have an in-depth discussion with us regarding our thoughts and theirs about our future. As consumers and patients of the medical system, we owe it to ourselves and to our families to have that discussion with our physician no matter how reluctant either of us are.

So, with the New Year upon us, I ask you to think about it.