Medicare does not pay for some services dying people need, such as long-term care in nursing homes or home health aides at home. Services provided by a hospice program are the exception in that they are usually quite comprehensive. However, hospice programs mostly provide services in the home, not all people qualify for a hospice program, and doctors are often reluctant to certify the 6-month prognosis required for hospice coverage.
The family should investigate the cost of care for a family member's serious illness. Information about coverage and regulations can take substantial and diligent work to obtain. Consulting the doctor and care team and often involving the local Area Agency on Aging (visit the National Association for Area Agencies on Aging at www.n4a.org) or a social worker from a hospital or health plan are good places to start.
Family members often provide most of the care at the end of life for free, but they should explore how professional caregivers can help them so that the burdens are tolerable. There may be costs of giving up employment as well as expenses of drugs, home care, and travel. The family should talk openly about costs with the doctor, insisting on reasonable attention to costs and planning ahead to limit or prepare for them.
Planning for the dying person's estate is advisable. Although discussing property and financial issues is hard to do when death is impending, it is usually a good idea. Doing so often reveals things that could be signed or arranged by the dying person, easing the burden on the family. Some attorneys specialize in elder care and can help people deal with financial and legal concerns.
Last full review/revision October 2007 by Joanne Lynn, MD, MA, MS