While you're healthy, make a living will

It's not an easy subject to discuss: Deciding the treatments and care you want -- and don't want -- in the final days of your life. But if you don't make those choices when you're healthy, the decisions will be made by others, and what they decide may not be what you would want.

One way to help ensure that your wishes are followed is by having a living will, or advance directive. This document tells your family and doctors which life-prolonging procedures you don't want if you become incapacitated. But what happens if you don't have an advance directive? A new study concluded that the type of treatments you get often depends on where you live.

Researchers at the University of Michigan found that in "high-spending" Medicare areas of the country -- and Long Island is near the top of that list -- Medicare beneficiaries without a living will were likely to spend their final days in a hospital.

Those with advance directives were more likely to spend their last days receiving hospice care, in accordance with their wishes. Hospice care is focused on treating pain and making the patient as comfortable as possible while the terminal condition runs its natural course.

Hospital care is aimed at prolonging life, often using what the study termed "aggressive" procedures, even though the illness is terminal. Medicare pays for both hospital care and end-of-life hospice care.

Before you conjure up visions of "death squads," understand that the study found that those with and without living wills received similar lifesaving treatments at the start of major health events.

"It appears there's a more rapid recognition that when these treatments aren't working any longer, it's those with advance directives who get hospice care," says Lauren Hersch Nicholas, a University of Michigan health economist and lead author of the study. She said that patients in high-spending regions such as Long Island were the least likely to have treatment-limiting advance directives.

There are benefits to survivors of a loved one with an advance directive. "Family members have a somewhat easier decision-making process because they have greater guidance," Hersch Nicholas says. She says that because they don't have to see their loved one endure painful and often futile hospital procedures, surviving spouses typically have lower rates of depression and mortality in the year after their husband or wife dies.

Click here to see a template of a living will, go to bit.ly/nysba-livingwill.