Small Document, Big Impact – November 2018
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It wasn’t that long ago that companies realized that rewarding healthy behavior among their employees paid off in big ways. Healthier eating and exercise meant fewer sick days, increased longevity, and higher productivity. So, companies instituted perks and bonuses for employees who took better care of themselves; this, in turn, took better care of the company. This long-view of employee health and behavior can now be applied to a part of life that few companies talk about; the end of life. It may surprise you to learn that how an employee prepares for death can have far-reaching implications for your business. I am not talking about after a person dies, I am talking about the months or weeks leading up to death. I will explain by way of example, then I will end with a few steps you, and your company. can take to better prepare.
The story comes from the small town of La Crosse, Wisconsin. Just shy of 52,000 people, La Crosse spends less on end-of-life care than any other city in the United States. Why? Largely because of the work of Bud Hammes, Medical Ethicist with La Crosse’s Gunderson Health System. Part of Bud’s job is to help patients and families deal with end-of-life issues; and a big part of that process is making sure that the patient’s wishes for meeting the end are honored. The way to do this is to make sure the patient has an Advance Care Directive, also called a Health Care Directive.
Most people think that all they need regarding their death is a last will and testament. Wills dictate what happens after a person dies, but what if you have an accident that leaves you unable to speak for yourself? Now your family must decide about issues like life support, pain management, and emergency resuscitation. With different views about personal, spiritual, or religious beliefs, these issues can be difficult to resolve among family members. In fact, more families have been torn apart by not have a Health Care Directive than by not having a will. If you die without a will, the state will step in and mediate the process. Without a Health Care Directive, there is no right answer to “How long do we maintain life support?”
Having a Health Care Directive includes choosing a Health Care Agent. This is the person who makes sure your end-of-life wishes are followed. Most people assume the best person for this role is a spouse or partner, but that isn’t always best. When tragedy strikes, emotions run high, and burdening a spouse with making life-and-death decisions might be too much to ask. The best person for the job is someone who can navigate family members who might disagree, as well as work with health care professionals about your care.
Bud Hammes knew this, so he trained other health care professionals to make conversations about end-of-life planning more comfortable. The momentum grew to include the entire community. Now, it isn’t uncommon in La Crosse to hear people chatting over coffee and asking, “Got your HCD done?” The result is, while the national average for Health Care Directive participation is about 30%, La Crosse has a 96% participation rate. The outcome is that La Crosse also spends less money on end-of-life care than any city in the country. Hammes didn’t begin his campaign with cost savings in mind, but doctors do report that a good deal of health care spending is done in the final year of life; and a good deal of that spending is during the patient’s final days. Sadly, much of that spending is against the patient’s wishes. Without a Health Care Directive, physicians must make decisions on the spot, with no input from the patient. I spoke to an ER doctor who said it wasn’t uncommon for him to resuscitate a patient, only to have the patient be angry to be brought back. Those who know the end is coming would like to meet it on their terms.
And, it is easy for younger employees to think this is only an issue for older folks, but anyone can be in a car accident and be left unable to speak for themselves. In fact, a 24-year-old member of my company completed a Health Care Directive as part of our initiative. A few days later, he was coaching a youth hockey game and tripped on the ice. He was rushed to the emergency room to check for a concussion, and the first thing the admitting nurse asked was whether he had a Health Care Directive. None of us will get out of this life alive, and everyone should meet the end on his or her own terms.
How does this affect your business? Just like employees engaging in healthy behavior affects the company’s long-term bottom line, so does planning for end of life. Of course, it is easy to see how eliminating the cost of unwanted procedures, medications, and hospital care would affect a company’s cost for employee benefits, but it goes further. Studies have shown that when employees deal with the end-of-life of a family member, if a Health Care Directive is not in place, the employee’s work life is greatly affected. Lost hours, and loss of productivity at work are all the result of not having one simple document.
The good news is, Health Care Directives are free, and easy to complete. Unlike a will, attorneys are not needed to complete an HCD. You can download the form online, fill it out, and hand it to your doctor. It then becomes part of your medical record, so your wishes can be honored if you can’t speak for yourself. Here is what I encourage you to do: 1) Assign someone in your company to be the Advance Care Director. Many hospitals have this role; someone in your company should champion the process. 2) Make having a Health Care/Advance Care Directive an expectation of employment. While you can’t, and shouldn’t, force someone to take part, people do respond favorably to a culture of expectation (as they learned in La Crosse). 3) Make the HCD a living document. Don’t just stick it in a drawer and forget about it. Discuss it with loved ones so they know about your wishes, but also review your HCD every now and then to see if your feelings and wishes might have changed.
Americans are not alone in avoiding conversations about death, but we are adept at it. Take the simple steps to get your employees ready, and comfortable, with the end. You may not see the financial benefits right away, but they are there. And, you will see immediate benefits that go much deeper.
Stevie Ray is a keynote speaker and trainer, bringing his program, “The Roadmap to Influence” to organizations nationwide.