I don’t know where the dividing line is between a large family and a small nation-state, but the vonKaenel extended family has certainly crossed that line. We have the requisite number of old and young people. We have opposing viewpoints from Sarah Palin supporters to occupiers. When you add in the in-laws, we have ethnic and racial diversity, and we include ardent supporters of opposing sports teams. Like other small nation-states, we also have significant health-care concerns.

This year, these health concerns focused on my 84-year-old mother and my two grandnieces. The 5-year-old twins are beautiful, energetic, smart, rambunctious and profoundly deaf. Over the last few years, the twins have received therapy, hearing aids and most recently, implants to help improve their hearing. A major highlight of our holiday gathering was to see how much the twins have improved and adapted to their implants. While they still struggle to hear and speak, there has been a significant improvement in their condition. They now interact and participate in the group and are a joy to be around. But these expensive treatments and procedures may not be possible in the future. My niece, a single parent working at a retail store, cannot afford to pay for them on her own, and the government may not continue to assist them, given proposed budget cuts.

My mother, who has been hospitalized for congestive heart failure and recently suffered several small strokes, is certain that this will be her last Christmas. She also has health-care concerns. She is fearful that her passing will be in pain, or not at home, or that she will lose control. She does not want to be put on a respirator or to endure any extraordinary procedures. Such end-of-life procedures have unfortunately become very common and extremely expensive for many Americans.

In recent studies, individuals who receive end-of-life counseling and are involved in a hospice program have a more satisfactory emotional outcome along with fewer hospital stays, less pain and less expensive procedures. By adopting more humane end-of-life practices, such as hospice care and patient directives, we can make the final transition easier and more spiritually focused, while saving considerable amounts of money. Recent studies have found that a hospice patient can save tens of thousands of dollars, with far better outcomes than the norm.

While our vonKaenel nation-state can never agree on a political candidate, sports team or which of the sisters was most obnoxious in junior high, we certainly can agree on health-care priorities. It is so important to make my mom’s final days pain free and to ensure needed medical assistance for the adorable twins. And if the vonKaenel nation-state can agree on anything, I have hope that the rest of our nation can do the same.