The Hospital Is No Place for the Elderly

[xchrom]

http://www.theatlantic.com/magazine/archive/2013/12/the-home-remedy-for-old-age/354680/

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It is 1976. Brad Stuart is in his third year of medical school at Stanford, doing his first clinical rotation. He is told to look at an elderly man with advanced lymphoma. The patient is feeble and near death, his bone marrow eviscerated by cancer. The supervising oncologist has ordered a course of chemotherapy using a very toxic investigational drug. Stuart knows enough to feel certain that the treatment will kill the patient, and he does not believe the patient understands this. Like a buck private challenging a colonel, he appeals the decision, but a panel of doctors declines to intervene. Well, Stuart thinks, if it must be done, I will do it myself. He mixes the drug and administers it. The patient says, “That hurts!” A few days later, the man’s bed is empty. What happened? He bled into his brain and died last night. Stuart leaves the room with his fists clenched.

To this day, he believes he killed the patient. “I walked out of that room and said, ‘There has got to be a better way than this,’ ” he told me recently. “I was appalled by how we care for—or, more accurately, fail to care about—people who are near the end of life. We literally treat them to death.”

Here is a puzzling fact: From 1970 until 2009, spending on health care in this country rose by more than 9 percent annually, creating fiscal havoc. But in 2009, 2010, and 2011, health-care spending increased by less than 4 percent a year. What explains the change? The recession surely had something to do with it. But several recent studies have found that the recession is not the whole story. One such study, by the Harvard University economists David Cutler and Nikhil Sahni, estimates that “structural changes” in our health-care system account for more than half of the slowdown.

In a sense, Brad Stuart is one of those changes. He is a leader in a growing movement advocating home-based primary care, which represents a fundamental change in the way we care for people who are chronically very ill. The idea is simple: rather than wait until people get sick and need hospitalization, you build a multidisciplinary team that visits them at home, coordinates health-related services, and tries to nip problems in the bud. For the past 15 years, at Sutter Health, a giant network of hospitals and doctors in Northern California, Stuart has devoted himself to developing home-based care for frail, elderly patients.

[pipoman]

1. As the "baby boomers" age

creative solutions to the foreseen higher demand on increasingly unaffordable health care is being sought. I work in senior health care and 2 weeks ago the non-profit I work for was awarded our state's only "PACE" program expansion. Prior to that I had not heard of PACE...

The Program of All-Inclusive Care for the Elderly (PACE) provides comprehensive long term services and supports to Medicaid and Medicare enrollees. An interdisciplinary team of health professionals provides individuals with coordinated care. For most participants, the comprehensive service package enables them to receive care at home rather than receive care in a nursing home.

Financing for the program is capped, which allows providers to deliver all services participants need rather than limit them to those reimbursable under Medicare and Medicaid fee-for-service plans. The PACE model of care is established as a provider in the Medicare program and as enables states to provide PACE services to Medicaid beneficiaries as state option.

http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Long-Term-Services-and-Support/Integrating-Care/Program-of-All-Inclusive-Care-for-the-Elderly-PACE/Program-of-All-Inclusive-Care-for-the-Elderly-PACE.html

Very revolutionary and progressive approach to senior healthcare..I am excited to be involved in the planning and establishment of our first PACE center over next year..

[LiberalEsto]

2. My father-in-law was almost "treated to death" in a hospital earlier this year

Even though we were told by his doctor that there was no hope of recovery, he was in a bed that jiggled him constantly to prevent bedsores. He was constantly being woken up for breathing therapy, injections, tests and every other darned thing. You could see that he was miserable. They wouldn't give him enough morphine to ease the agony of his surgical wounds, for fear of causing addiction!

Moreover, the hospital would only allow two people in the room at a time, even though almost all of his 8 sons and daughters,their spouses and older children were there. They kept sending up security guards to order people out of the room.

Finally it dawned on us to see if he would do better in a hospice. He did have advance directives, fortunately. There was a hospice on another floor in the same hospital, and what a difference it made. He was given enough pain medication to ease his suffering, and something to help him relax. He was able to do his dying at his own pace over three days, have a priest come to administer last rites, and be surrounded by loving family members as he gently slipped away. The hospice did everything they could to prepare family members for the process of his dying. I am so thankful he was able to die in peace instead of being jiggled and poked to death while moaning in extreme pain.

[xchrom]

3. i relate in a number of ways to your story -- and 1 of the worst

is getting enough pain medication for seriously ill people.

i think our society morals get very confused here.

[Uben]

4. No chemo for me.....

...if I have a terminal cancer. I've seen too much of it. How many doctors do you know who underwent chemo with a terminal disease? They just don't do it because they know. Hospice is the way to go. I don't wanna spend my final days in a hospital being poked and experimented on. I wanna die at home, in my bed, with my family there. Sure, chemo may keep you alive a bit longer, but at what cost?

Personally, I believe there should be a legal drug that one could opt to take that would let you go peacefully in your sleep. I've accepted my mortality and know when my turn is up, it's over. Death is the easy part, it's this damned living that's so hard. I know a lot will disagree, but this is my choice, and I want to go on my terms, not someone else's.

[pipoman]

6. I agree with everything except

after watching my sister and my mother die of cancer I really wouldn't want my loved ones to have to think of my final days and ultimate death every time they enter that room...it isn't pretty. I would rather they remember me using that room when I was at least animated. Both died in a county "Hospice House" and I can't tell you what a great thing they are. In the hospital everyone there is trying to save someone's life or praying and hopeful for recovery, at Hospice House everyone is there because they are participating in a loved one's death process, or caring for the patients in an effort to allow them peace and dignity in death. I would choose that over dying in my own home.

Oh, and my dad died of a heart attack while making coffee...no notice. He dropped on the kitchen floor. I have never been able to get that out of my mind, even though my mother and step father remodeled the kitchen years later..

[Historic NY]

5. Doctors coming to home seriously how crass.......

who would have thought homes set up so the sick could stay home. My what are we regressing too...

[CFLDem]

7. The most depressing part of my last trip to ER

were the seemingly discarded elderly throughout the hospital wing. Moaning and wailing, and otherwise painfully despondent in their last hours.

Ugh no thanks.