7 Things You MUST Know About Death in the USA (Adult Read)
Potentially $100k+ worth of advice and pointers no one tells you regarding death options and avoiding insane bills. Based on true stories. In memory of my father.
This sounds awfully morbid, and it is, but it’s important.
Background
My father passed away last month. It triggered a variety of emotions / thoughts, including:
Anger (at how slow it is to get drugs / medical help)
Sadness
Questioning my own beliefs for a short period of time
Rethinking everything I thought I knew about “dying in peace” and “End of Life options” (aka assisted suicide)1
Rethinking what it really means to “enjoy every day of life / health while you can.”
Adding fuel to the flames of the anger / sadness above were some lessons that NO ONE told me until I / my family asked. Here are some things to know about dying and sickness that I learned through the process that could help you as well.
🗒 NOTE: I am not a licensed medical practitioner, CPA, attorney, or insurance agent. This is not legal, not medical, and not financial advice. It is informational only, based on one account, in one particular state, with specific conditions / medical coverage. Please consult your doctor, lawyer, medical provider, insurance, and licensed professional for your own situation.
The 7 things no tells you about death
1) At the end of life you essentially have 2 options: Fight or Call it
We’re REALLY good at keeping people in existence. Not so good at keeping people going and in an amazing state (as of writing this). Depending on the situation, your (or your loved one’s) medical provider may offer a slew of options or, in my dad’s case 2. I’m going to use my father here as an example rather than stating generalizations.
Medical intervention - In my father’s case, we tried multiple drugs and options… The final one was surgery, which, for his condition would have likely ended in death due to infection, or, worse for a once active guy like him, unable to walk for 6 months and increasingly worse life.. Never having the same quality of life again, which, in his current state was already not great due to Parkinsons and diabetes.
Go home and live out the last days - In which case there are options within this…
Therapy sessions - In my father’s case, this ended up proving pointless. Now, for any normal person without a bunch of diseases, this would have been great but when you’re fighting on all fronts, this may not be the answer for all.
Hospice - If you’re in pain
“Poison pill” - What my dad called it.
No intervention - We had been doing something as a family working with these illnesses for years and that wasn’t working. Pills, all of it.
Here is a photo of a pill crusher - So you can put pills in ice cream/food:
2)Hospice at home does NOT entail many nurses
Unless you have a great program, if you’re going to do hospice at home2 , it’s most likely that hospice will only send nurses to check up on you (or your loved one) a few times a week, perhaps every day, but only if you (or they) are near the final days. (As of writing this in a mid-size city, due to staffing shortages and current hospice trends.)
Hospice does not send nurses often they can send drugs. And, if you or your loved one is going down the hospice route.
If you or your loved one wants to go the hospice at home route and you’re the one ill / need a lot of help, ensure that your loved one (or you, if you’re the one taking care of them) can manage / have help available depending on how much care is needed.
3)Order ALL medical supplies/rentals via your Doctor BEFORE going back home
As of writing this, we are slowly exiting the pandemic. Medical supplies are in short supply. Hospital beds are in high demand. My dad didn’t have a hospital bed when he returned home for 7 days.
This meant we had to manually lift him for food, drink, and other activities.
By being ordered by your doctor, it may also be easier to make the insurance claim. If you need medical equipment or are anticipating needing it, ask your doctor for how to best approach it for insurance purposes.
Below is a machine that deserves the Nobel Prize — The electric hospital bed
(I checked but do not think it has received the prize— YET)
At first we had my father in the master bedroom in a normal bed as we waited for the delivery. After 5 days, he said “Put me downstairs near the TV when it arrives”.
The living room was his favorite part of the house. And, we’re glad we did as it was easier to watch him, eat, and share some final TV shows together.
4)Call 911 and get taken in the ambulance if you have an emergency (and have medical insurance that will cover it)
Yes, the ambulance can cost out of pocket $$$ (insurance should cover 911 ambulance emergencies so ensure that the doctor declares it’s an emergency and don’t let the ambulance company take you for a ride bill-wise, ensure once insurance pays, they stop spamming you).
Why get in the expensive ambulance? You skip the ER line or are more likly to be helped sooner.
It’s also a lot easier to prove to insurance that a situation is an emergency and should you need caretaking after, you can get the doctor to order it for you and that can be easier to claim with insurance.
5)You are not necessarily on the hook for your deceased loved one’s credit card debts unless you’re a joint account holder.
This is not financial or legal advice but some notes from just recently dealing with this in the family.
Credit card debt is UNSECURED DEBT. What does this mean?
Because I cannot give you legal advice, but can tell you a story (something I learned when I was working on EasyTrust), here is how it played out (a real story)..
Family member 1 had $50,000 in credit card debt.
The debts were spread across multiple cards.
His wife was joint on the account on only 1 credit card.
She was mad for YEARS about this.
Low and behold, she learned, this was actually a BLESSING.
If she was a joint holder on all those cards she would have been responsible.
But she wasn’t! How did she find this out? She connected with a nonprofit that helps individuals consolidate debts.
Before paying ANYTHING of a deceased loved one, contact a neutral third party (an attorney / debt relief nonprofit) who specializes in debt / family estate settlement / property who can help you identify options and next steps.
The credit card companies may attempt to collect on the deceased one’s estate but that depends on the situation, amount of debt, the company’s aggression, and laws where you are living. You also should have an expert on your side to understand your rights and protect yourself from any illegal dealings.
What I’m trying to say here is if your loved one dies (or you), that outstanding credit card debt may not necessarily need to be paid off… They may go after the estate to collect, but unless you’re personally on the account, you aren’t personally responsible for that debt.
6)Drugs are not (necessarily) bad if you’ve lived your good (long) life and are ready
NOTE: This section applies to people who are ailing. They’ve lived a good life (we hope), and they’re ready to move to the next chapter. It is not about abusing drugs, it’s about situations where medical technology has not yet solved their problem, and pain / suffering is the only option. Similar to how one puts their pet down when it has reached its final days rather than letting it suffer. Humans are more valuable than pets3, but that is often considered compassion.4
When my dad was ready to call it quits. EVERY article online was touting how morphine wouldn’t kill, just help with “comfort”.
Then there was all the “Opioids kill!” articles.
And, many of the nurses, some thinking we want him to live LONG in “comfort” would say: “Don’t worry, it doesn’t kill him.”
And I was panicking… That’s what he wanted! How do we get to these disaster outcomes of the news?
To be out of pain and misery was EXACTLY what my dad wanted… He had YEARS of PAIN, YEARS of gradual decreases in quality of life, and increasingly depressing diabetes impacts. And, ALAS, his internal organs were literally unable to perform. It was the end. And, this is a man who was STRONG, independent, never needed help, never complained when he was injured, hiked, build ships, built cabins, and more… He was over this new crumbier life of pain and inability to do basic tasks.
He didn’t want to just sit there like a lump for days… weeks… to come.
And, where he lived, doctors weren’t issuing fast end of life options. Only real option in that direction was hospice…
And, we didn’t want to OD him, we wanted it done as pain-free, 100% legal, and as “peaceful” as possible.
MOST articles online were either:
“Oh morphine doesn’t kill people” or “Opioids are the worst”…
Few really gave details of what I wanted to know, just opinion pieces.
Here was the reality:
Hospice will give morphine, if you want the max dose due to being in major pain, tell them!! Tell them how painful it is and show them the suffering so they know what to give you.
If you’re the one watching after them, you may be shocked.
“Comfort” as coined by caretakers is code for dying and having NO CLUE if the other party is in actual pain or thirsty or whatnot. We have high reason to believe they are out of it, but I have to consult a morphine user to get a good answer here.
Notice I didn’t say “dying silently?” There will / could be coughing, choking sounds, loud breathing, and more… That’s the body dying. It’s pretty messed up when you’re watching it and there’s nothing you can do (or should do if they’re ready to go).
I say “it” as at this point, it is no longer your relative. This is just the final phase and they’re on their way out… It’s beyond sad if it’s a person you care about (or care about but don’t usually articulate that sort of thing verbally).
7)Burials cannot be on your own property in some states. You CAN cremate and throw the ashes on your property.
A photo of my arrival at the largest and oldest cemetery in the area— With wild turkeys.
We have 20 acres in a state that doesn’t allow us to bury our dad there. It makes sense I guess, but at the same time… C’mon. (I could see an awkward property disclosure: “My dad is buried here” that could spook potential buyers...)
Chances are, even if you are in a state that allows that, you probably don’t want to place them there. So, what you’ll want to discuss with your loved one, or think to yourself:
Do you care about flexible location, stable location, being one piece, cheap & traditional, cheap & flexible, and/or a plot fit for royalty?
Flexible Location - Cremation - Your family member can scatter you pretty much wherever you’d like. 5
Stable location - Burial - Eg: If you want to be next to your ancestors / in a beloved spot or heck, the idea of setting yours / a loved one’s dead body on fire just isn’t for you (this was me for my entire life until last month).
One piece - Burial - You can go down in a casket. Like in the movies. Traditional and to the ground. If you care, pick a strong one as caskets can break down over time.
Plot of dedicated land - Burial - You can get your eternal resting spot.
Cheap & traditional - Burial in an unkept part of the cemetery ground. Ask for the plots that don’t have upkeep and ask for price difference (I didn’t directly ask this but I did ask the grounds keeper so many questions we arrived at this topic.)
Cheap & flexible - Cremation and placement in cemetery ground or cremation container to go home with your loved ones (you’ll want a long-term solution as I’ve literally heard that remains can end up in closets.)
Plot fit for royalty - If you / your loved one wants the great headstone with the best view, burial is probably the way.
Pro tips: If it snows in the cemetery, select a headstone that is more up-right so you can find it in the winter. If there is a designated ashes thrown spot in the cemetery, consider skipping it, they may through other people’s ashes there, and at that point you may be better off finding a different spot. Cemeteries have headstones that can hold the ashes, so you can still get your dedicated spot at a more affordable price.
Now, I’m speaking a lot about money here because some relatives would turn in their graves / rustle in their boxes if they heard that you were selling their beloved farm to bury them. If you have ample funds / this is important to your loved one, then that is different. I recommend selecting when you are not too emotional.
And, attempt to think practically. As impossible as that may be at a time like this.
Wrapping up
There were many other lessons, but I hope these at least get you thinking that there are options for you / your loved one. They may not be pretty, but perhaps the most important thing you can do if in doubt is - Ask, Ask, and Ask some more. And, when you’re done asking… Call non-stop and kindly ask some more to ensure your loved one gets what they need.
I hope this helps you, or better yet, that you don’t need to use this information and it’s a truly peaceful ending and long wonderful life —
Wishing you and your family great health and happiness!
In dedication to my father, Captain Al, who was a builder, sailor, and for a time, importer of bags made of human hair, woven baskets, custom carvings, other Southeast Asian imports with my mother in SF. He was also a proud Eagle Scout, back when Boy Scouts did crazy things like hike barely charted wilderness alone for days with no parental supervision. He always put the customer and AAA-rating/Good Sam RV rating board first when he was in the hospitality business. And, a great laissez-faire father who always encouraged us to do what we wanted (as long as it wasn’t a bad idea).
Cheers to you Dad. (Photo of my mother, Joy, and dad, Captain Al on the pirate ship he built.)
For example: Why on earth is it so easy to put down a pet in pain out of compassion and so difficult to find an equally fast painless solution to help a person go quickly… (I know some answers but it doesn’t resonate until you’re watching someone in pain who’s over it..)
Not only great to save on funds, but also to give more peace to your loved one - If you can handle having them at home.
May be disputable to some.
I did not realize this and struggled for 7 straight days thinking about ending one’s own life. Being a bit more on the religious side (and living in the atheist belt so I don’t often talk about it) the FINAL message I had was this: “If I am to believe what I believe, and we are already saved, and I’m fussing about a “sin” and Jesus died for us already, then how can I possibly doubt the outcome of where he’ll end up?” And… was this even a “sin”? I grew up Catholic, and there is a lot of content that I still, with all my historical canonical and (Christianity-renounced) non-canonical text reading have yet to figure out when some of these “mortal sins” became sins. Now my dad was a hardened anti-religion person for some time, but I believe he came around to some new conclusions toward the end of life, thanks to my mom.
Technically you need a permit to throw the ashes elsewhere… not sure how this is enforced / caught. I’m sure there are stories.