5 Things Singaporeans Don’t Know About End-of-Life Planning

Unexpected costs can make palliative care for a loved one dauntingly expensive. Take note of these 5 points to avoid getting caught in a financial bind.

No matter how long medical science extends our life, we all have to face the reaper. In the final years and months, as our loved ones await the inevitable, the last thing we want is more stress for money reasons.

Hence, it’s important to prepare financially for the twilight years of our dependents and family. Here are  five key things to note.

Insurance May Not Cover Palliative Care Equipment

Palliative care is, contrary to popular belief, not “care for those who are definitely going to die”. Palliative care can, and often is, coupled with medical treatments that continue trying to prompt recovery.

That said, one factor that’s often ignored is the prohibitive cost of palliative care. For example, say the dying person would prefer to be at home (especially if the end could come at any time). This may require the rental of medical equipment, such as oxygen tanks, dialysis machines, or other devices that would usually only be available in a treatment centre or hospital.

Some insurance policies, however, only cover the cost of treatment when the patient goes to a centre or hospital. The policy may not cover the rental of medical equipment for palliative care, which might mean you have to pay out of pocket.

If you have a loved one who may nearing the end, and they want to spend their final days at home, speak to your financial adviser quickly. If your policy does not cover palliative care at home, you need to know early to plan for the costs.

Hiring a Caregiver May Not be Optional

Many families make the mistake of assuming they can care for the dying. In truth, it’s rarely as straightforward as we imagine.

Certain illnesses may mean the loss of coherency, or the ability to communicate. For example, advanced stages of Alzheimer’s may mean your loved one is unable to recognise you, and may often be angry or agitated. This can be difficult to bear with day-in and day-out, over the course of several years (particularly if a sole family member is placed in charge).

You also have to acknowledge your own physical limitations, if you’re the main caregiver. It’s difficult to be available around the clock; and if you’re elderly yourself, you may endanger your own health by having to lift or carry the patient.

No matter how determined you are to look after the dying by yourself, budget for a caregiver just in case. Seek out agencies that specialise in this, and approach your neighbourhood community services if a private caregiver is beyond your budget (many HDB estates have volunteers from grassroots communities, who can lend a hand).

Medical Costs Most Certainly Will Increase Significantly

Contrary to popular belief, switching to palliative care doesn’t mean medical treatment will be cheaper.

For example, patients who are in intense pain may require more expensive painkillers, and patients with multiple health problems may need a whole regimen of drugs on a daily basis. Even if medical costs do fall, they may not drop as much as you assume.

You must also be prepared for situations where medical costs increase, during the last few years. For instance, a cancer patient may initially pay a lower cost, by choosing not to have chemotherapy. Later on however, they require more frequent ambulance trips, or longer hospital stays in intensive care.

This can be mitigated with the correct whole life insurance policy, or even basic term insurance. Many policies pay out a lump sum for terminal illness, which will more than cover the costs; speak to a financial adviser about complementing MediShield Life with such policies.

Denial Can Break You Financially

This is the greatest hidden danger in end-of-life care. Studies in countries like the United States have shown that, when loved ones come down with incurable conditions or illnesses, denial is the immediate response.

No matter how level-headed you usually are, the reality of such a situation can change you. Most families push for aggressive and expensive intervention, in some cases even falling for scams (e.g. fake “miracle cures” that extort tens of thousands of dollars from them).

This situation is aggravated if the dying person can’t communicate, and hasn’t declared their intent. For example, if your dying parent is on life support and in a coma, should you make the decision to end their life?

Doctors will carry on medical care if the dying person has not signed a Do-Not-Resuscitate (DNR) order, and if the family does not give consent to end treatment. However, every month of medical care could rack up thousands in medical bills, and even insurance benefits will eventually run out.

It’s best to discuss such situations early. Families are more likely to overcome their denial, and take steps to end it if the dying patient makes their wishes known.

Bad Credit Can Seriously Hurt You

You’ll often find yourself confronted by unexpected costs, when caring for the dying.

From emergency room visits, to flying abroad for experimental treatment, the number of unknowns and variables are staggering. Even the old rule of thumb - saving up six months of your expenses - may not suffice. For example, you may be in situations where you not only need to pay for medical treatment, but you also face permanently reduced income (e.g. you need a job that allows you more hours at home, to provide care).

The chances are high that, at some point, you will need a loan from the bank. This is where previously bad behaviour, such as paying your credit cards late, could come back to haunt you.

Banks are not obliged to lend you the full two to four times your monthly income for personal loans - especially if they see that you’ve applied for several large loans quite recently. What will convince them to fork out a big loan is if you’ve proven reliable, over the course of many years.

There’s nothing more painful than being denied credit for a major operation, which could potentially prolong the life of your loved one. Be responsible with credit, to ensure you can get it when it’s most needed.

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