To Die at Home

Don’t get me wrong.  I’m not criticizing nursing homes.  They have a real place in our healthcare system.  For some people a nursing home is the best alternative. Like my mom; she’s in one right now.  She needs to be there.  If she can get her stronger we’ll take her back home, but for the time time being the nursing home is her only good option.

But, when  I come to the end of my days if at all possible I’d like to die at home.

Whether I can do so will depend on my physical condition and my financial condition: can I afford to pay for in-home care?  But it will also depend on whether I’ve done planning ahead of time to make it happen.

Let me share a story that’s really been bothering me.  One of my farmer clients, let’s call him Bob, was in his eighties.  Bob was very successful. He had a big, debt-free farm and a loving family.  He was a little hard of hearing, but otherwise his health was pretty good.  He was sharp and fun to talk to.

Then one day he had a stroke and ended up in a nursing home.  He hated it, especially the constant noise and lack of privacy.  He wanted to get out and go home.  But, despite his millions, he couldn’t.  And I couldn’t help.  We had done his basic estate planning, but it didn’t help.

At that point Bob had lost control of his life.  His family had assumed control.  That’s exactly what Bob had said should happen if he became disabled when we did his estate planning.  And Bob’s family loved him and wanted to do what was best for him.

The healthcare professionals told the family that the nursing home was the best place for Bob.  (And, anyway, that is where “everyone” who needs a high level of care ends up, isn’t it?)

And it takes a lot of work – and money – to get a family home set up to take care of an invalid.  Handicap accessible bathroom, hand rails, a hospital bed.  Home healthcare people.   Where do you even find someone to do such work?  There are a lot of moving parts.   What would it cost?

 So, Bob’s family never seriously considered doing what Bob told them he wanted as he lay in the nursing home bed.  Even though there was plenty of money to pay for twenty-four hour care and to retrofit the home for his care.

The lawyer in me has to point out that the heirs were in a conflict of interest situation: every extra dollar spent on Bob’s healthcare reduced their inheritance by a dollar.  But I don’t want to point fingers.  Except at Bob and – myself.

Bob couldn’t die at home because he had not done the planning ahead of time – while he was still in control. When we were doing Bob’s estate planning, he said that he didn’t want his money to be “wasted” on a lot of medical expenses.   But I wish I had prodded him.  I’ll bet he also would have said that he would like to die at home if he could – and that it was okay to use part of his ample estate for that.  If we had put a specific plan in place and he had discussed it with the family, I’m sure they would have agreed and followed his wishes.

Not everyone will have the same viewpoint, and many won’t have the financial means to die at home if that is medically possible.

But it all starts with planning.  I’m making this part of our estate planning process.  I’m working with another family right now who want to make sure they can die at home.  I owe it to them, and I owe it to Bob.

Keith