"Once someone has a medical crisis, we don't have time to have these discussions," said Bud Hammes, director of medical humanities at Gundersen Lutheran hospital. "This is really meant to help patients and their families to receive the right amount of care at the right time so that we neither over treat or under treat any patients"
The discussions are also saving people money, according to Hammes. In La Crosse, the average expenditure on health care in the final year of a person's life is about $18,000, compared to the national average of $25,000. Chronically ill Medicare patients spend on average $46,000 in just the last six months of life.
Years ago La Crosse resident Ann Kottnour, 53, spoke to her mother Margaret Peterson, 89, about what she wanted the end of her life to be. Together they wrote a medical directive outlining Peterson's specific requests.
"By the time we completed it her health had started to fail," said Kottnour.
Peterson has Parkinson's disease and dementia and when she ended up in a nursing home following a medical emergency in January, Kottnour brought her home, knowing her mother did not want to die there.
"We have a tendency to always want to make it better, and to treat anything and everything that we know how to treat. And there are times when people just want to be done," said Kottnour, a nurse. "As we all age I think we should have the choice if we think it's our time to let go."
When Joe and Janice Hauser moved to La Crosse at age 70, every physician told them to speak to a counselor and begin creating a medical directive.
"I think it's important to all have down on paper, so your physician knows and your family knows what you want," Janice Hauser said.
These conversations have resulted in more than 85 percent of La Crosse residents having a medical directive in an electronic file by the time they die.
While some ask for aggressive life-saving measures, most patients ask for limitations on their care in the final months of life.
"When you really help inform patients, really help them make these decisions, involve their families so it's really a shared decision and everyone's on the same page, people don't want to die hooked up to machines," Hammes said.
Kottnour said she just wants her mother to die with dignity.
"Our mother has given to us all of our lives and has been there for us and so I feel that it's our turn to give some back and be able to follow through with her wishes," Kottnour said.