• Desperate Families Search for Affordable Home Care (Reed Abelson, The New York Times and KFF Health News, The High Cost of Dying DYING BROKE series, 12-4-23) Facing a severe shortage of aides and high costs, people trying to keep aging loved ones at home often cobble together a patchwork of family and friends to help.
• Dying Can Cost Loved Ones $20,000 Before Lost Wages And Worse Health, New Report Says (Deb Gordon, Forbes, 1-16-23)
"On average, survey respondents reported that they paid $3,584 to the funeral home (lower than the 2021 national median cost of $7,848 reported by the National Funeral Directors Association). Burial plots cost respondents an average of $1,841. Smaller expenses, such as catering, officiants, flowers, music, and invitations can add more than $1,700 combined, making the funeral the single biggest expense associated with a loved one's death.
"But the costs don't end with the funeral. Survey respondents reported paying an average of $4,384 to deal with financial matters, such as hiring accountants and paying bills.
Respondents spent nearly $5,000 on legal matters, including lawyer fees and costs associated with selling off assets. Disposing of real estate can add another $4,000."
• “The High Cost of Dying”: What Do the Data Show? Anne A Scitovsky, Milbank Quarterly, 12-2005) It is not surprising that “the high cost of dying” has led some people to question whether resources are being “wasted” on the dying (especially if the latter are very elderly) and could (or should) be more productively allocated to other patients, or even to other socially desirable ends such as education or housing. High medical care costs at the end of life become “the high cost of dying” and the source of concern over “wasting” scarce resources on the care of hopelessly ill patients. The policy implications of this interpretation of the data, though rarely stated explicitly, are clear: If we want to stem the rise in medical care costs, medical care expenditures at the end of life provide an excellent target for cost-containment efforts. A consensus has gradually developed about the ethics of forgoing treatment for such patients for whom care is, in some real way, futile. But no such consensus exists for patients who, although very sick, might still be helped by various diagnostic or therapeutic procedures and whose days might be prolonged. Thus, if we ask whether the costs of care for this group are excessive, we face new ethical problems of major proportions.
• The Cost of Dying (Empathy, 2024) Get the report here
• The Cost of Dying: Average Cost of Funerals and Cremation Fees (Self) This detailed piece is about the true cost of dying across the U.S. based on official data. Funerals and cremations are expensive--often surprisingly so. How much do people have to spend to say goodbye to their loved ones (by state). Which states cost the most to die in? Which cost the least? What are the most expensive states for funerals,for cremation? What were costs of burials and cremations in 2020 vs. 2022. What is the average cost of a funeral service? The average cost of dying in the U.S. in 2022 was $7,028 based on a blended average cost of burials and cremation services, calculated by the percentage of these end-of-life services performed across the country. Across all states, funerals cost an average of $8,526, while cremations cost $7,573. Hawaii is the most expensive state for funerals ($13,439) and cremations ($11,212). Mississippi is the most affordable state for funerals ($6,144) but Wyoming has the lowest cost for cremations ($5,219).
"Average service fees alone are a staggering $2,195 to start, however, the casket fee is what drives the price of funerals much higher than cremations. The average price of a casket according to the NFDA is $2,500, compared with $295 for an urn for those who choose to be cremated."
• What to Know About Home Care Services (Reed Abelson, NY Times, 12-4-23) Finding an aide to help an older person stay at home safely takes work. Here’s a guide.
• The Hidden Costs of Dying in America (Kendra Madsen, Tincture, 7-2-19) The National Funeral Director’s Association estimates median funeral costs, such as viewing services and cremation, hover at $7,360. While cremation is generally less expensive than burial, the Consumer Price Index indicates that over the last thirty years, all funeral expenses have risen more than 200%. Being armed with information about costs can help you and your loved ones make the best, most-compassionate decisions for your family. It can also ultimately save you money. In this case, knowledge isn’t only power — it’s also the peace of mind that comes with knowing you won’t leave financial burdens behind.
• The Economics of Dying -- The Illusion of Cost Savings at the End of Life (Ezekiel J. Emanuel, and Linda L. Emanuel, New England Journal of Medicine, 2-24-94) The unlikeliness of substantial savings in health care costs does not mean, however, that there are no good reasons to use advance directives, fund hospice care, and employ less aggressive life-sustaining treatments for dying patients....Our alternatives for achieving substantial savings seem limited to major changes in the financing and delivery of health care, difficult choices in the allocation of services, or both. Whatever we choose, we must stop deluding ourselves that advance directives and less aggressive care at the end of life will solve the financial problems of our health care system.
• Advance Directives: What You Need To Know (Jennifer Lagemann, Forbes, 10-25-22) Only one in three U.S. adults has an official plan in place for end-of-life care. Formalizing these details when you’re able to do so can make a world of difference for you and your loved ones down the line. Research shows advance directives can “get prematurely misinterpreted as a DNR order, and DNR orders can get misinterpreted as do-not-treat orders.” The goal is for the health care team to make decisions that honor what a person says they want. Each type of advance directive serves a unique purpose and is implemented in certain situations.
POLSTs (aka MOLSTS) are implemented once both the patient and their health care provider agree and sign off on a medical treatment plan as it relates to the person’s current health status.
Living wills go into effect when the person enters any of the conditions listed in their living will document. At this point, the document becomes operative and is followed by all care team members, explains Dr. Mirarchi.
Meanwhile, a health care power of attorney can be utilized at any point in a person’s life when they aren’t able to make a health decision for themselves, be it due to an acute health emergency or progression of a chronic illness.
And DNR orders become active when a person stops breathing or their heart stops beating, at which time the care team isn’t allowed to perform CPR to resuscitate them. See website section on Advance directives and living wills for more information on those options.