Welcome to A Better Ending LLC
A Better Ending LLC offers professional consultations to help individuals make informed end-of-life care decisions. A 2-hour consultation is designed to provide comprehensive education on end-of-life options. I am a critical care physician and nephrologist with over 20 years of expertise and experience taking care of patients and their families. Click below to learn more about my consultation packages.
Meet Our Founder
Dr. Jeff Komisarof, MD
Dr. Jeff Komisarof is the founder of A Better Ending LLC and is dedicated to empowering individuals to understand and make informed decisions about their end-of-life care. Over 20 years practicing in intensive care units, Dr. Komisarof has seen how lack of planning and communication with their loved ones can result in people receiving aggressive medical care that they may not want at the end of life. Too often, this care only serves to prolong pain and suffering. My consultation will enable you to spell out your wishes, values, and priorities at the end of life in a way that your family can honor. This is a great gift to both you and your loved ones.
Click below to learn more about Dr. Komisarof.
Consultation Services
Deciding on medical treatment as one nears the end of life is a challenging task. It is a matter that requires careful thought so that we receive the treatment we desire and avoid unnecessary procedures that could prolong suffering. Creating an advanced directive with the help of an attorney typically involves specifying the type of care you wish to receive or avoid should you be in a vegetative state with no hope of getting better. In real life, however, it is very rare to be in a vegetative state, and the chances of recovery with a good quality of life may be similarly low. More often, end of life situations can be intricate and nuanced.
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I am an ICU and kidney doctor, and after 20 years working in intensive care units, I have a wealth of experience taking care of people who are critically ill and at the end of life. When people get this sick, they are often unable to make their own treatment decisions, and these choices are left in the hands of family, who are in an impossibly difficult position of wanting to follow their loved one's wishes, but also not wanting to let go. I have found that unless somebody has made their wishes very clear, families often have difficulty not "doing everything", because they feel they would be letting their loved one down by not fighting until the end. In these cases, doctors are asked to provide life-extending care that often leads to an undesired result, prolonging life WITHOUT quality of life.
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I offer a detailed and thorough consultation that will explore medical scenarios you may experience at the end of life, examine your goals for care at the end of your life including what is an acceptable quality of life, and come up with a detailed plan that your family can follow if they find themselves having to make medical decisions for you. Having your preferences spelled out is a great gift to your family, so they can make decisions that honor your wishes and values without guilt.
Consultation Packages
Basic Consultation
The basic consultation includes a comprehensive assessment of your medical history, as your current state of health has important implications for the decisions you make for your end-of-life care. I then discuss potential end-of-life scenarios, educating you on the reality of being critically ill, and what that entails regarding prognosis of recovery and likely quality of life in the event of survival. After talking about your wishes, values, and priorities as you get older, and what you envision as a "good death", you will make decisions about what types of medical care you do and do not want at the end of life.
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This consultation will ideally include your spouse, children, other family, or friends that will be making medical decisions for you in the event that you are not able to.
I will write up a summary of your decisions after the consultation, which will be a guide to your medical decision makers in the future.
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The consultation will last approximately 2 hours.
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The cost is $1000 for a 2 hour consultation. Additional hours will be prorated at $500 per hour. I am willing to work on a sliding scale to accommodate any economic constraints.
Comprehensive Consultation
The comprehensive consultation starts with the basic consultation on end-of-life decision making. It also includes a more comprehensive assessment of your medical history. At the end of this consultation, in addition to the written summary of your end-of-life care preferences, you will also receive a written summary of recommendations to maximize your health, lifespan, and quality of life. These will include lifestyle recommendations, and may also include medical recommendations that you can then discuss with your primary care physician and medical specialists who know you well.
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This consultation will last approximately 3 hours.
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The cost is $1500 for a 3 hour consultation. Additional hours will be prorated at $500 per hour. I am happy to work on a sliding scale to accommodate any economic constraints.
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Concierge Medical Service
I offer a concierge medical service to selected people who live in close proximity to where I live. This service is intended for people who are medically vulnerable, for whom it is difficult to leave the home for medical evaluation. I provide prompt house calls and easy access by text or phone for medical evaluation and questions as they arise. I will facilitate communication between your primary care provider and medical specialists, helping to explain the importance of your medical treatments and medical information such as labs and imaging studies.
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The cost is $5000 per year. This includes the basic consultation as part of the concierge services. This also includes an unlimited number of house calls, and unlimited contact by text or phone.
Testimonials
End of life decision making for my mother has been emotionally challenging. I wanted to make these decisions for my mother ensuring the least painful and the most dignified outcome. Fortunately, we found Dr. Komisarof. Dr. Komisarof, with his extensive knowledge, expertise and genuine sensitivity has given me and my family peace of mind. I highly recommend his services.
Tara N.
Dr. Jeff has been involved with my wife's medical care for the last few months. He initially worked up a Medical Directive with our family and then did a complete medical exam reviewing her past medical history. It gives us all a sense of relief to know she is getting the best medical attention that is available.
Edward B.