Hey everyone, just one last quick question regarding some interesting news I heard about this week about ObamaCare. It seems that ObamaCare enrollees will be paying even higher premiums next year, even though the number of applicants has skyrocketed this year. Does anyone have any insight as to why these premiums are rising? I read that the Cadillac Tax is getting cut, which is meant to expand healthcare to those who cannot afford care, so with that tax getting cut and rise of premiums, where is that extra money going?
In discussion yesterday, death brokering came up as a topic. I looked further into it and looked at the idea that death is cultural, but how does brokering pay into it? How do we use death culture to our advantage? Feedback/comments would be very appreciated!
Usually, end of life care can take up the last few years of a person’s life depending on the type of illness they have. In Chapter 10 of Weitz, he tells us that Medicare only pays for 6 months of end of life care in hospices. This forces the hospices to choose patients that would fit within that 6 month time span, so that they don’t need to pay out of pocket for those patients. Becoming federally funded rather than non-profit and for care caused hospices to have to adjust to these rules. Is it fair for those who do not fit in this 6 month time span to just be sent away from hospices, just because the federal government won’t pay for them? It seems like this is very similar to the time before Obamacare when insurance companies would turn down people due to pre-existing conditions that they didn’t want to, in the long run, end up funding.
I personally have had a family member pass of Leukemia in a hospice like setting, The Abraham House. Even with the entire family in agreement, it was still difficult to see my relative there and accept that there were no available treatment options left at his stage. He was in the home for three to four months, during which time he developed strong relationships with the daily staff. This nonprofit hospice model proved to be one of the best experiences with the healthcare system that he ever had, and truly brought him comfort during his last few months. The home was modeled after a real home, with a real kitchen, living room, and patient rooms. Caregivers cooked home-esque meals, and offered to eat with patients if possible. My uncle’s health actually briefly improved once he was transferred into the home from highly medicalized hospital settings. If anything, the Abraham House is the gold standard of pallative care.
Last year I did my WR 150 paper on physician-assisted suicide in the U.S., and I learned a lot about what made the public so afraid of legalizing it. Most of those who were against it stated that, while they believed in supporting their loved ones’ final wishes and their right to comfortable deaths, their hesitation was rooted in both the newness of the idea, and in the lack of preparation and regulation that the laws would require. However, the article “Tip-Toeing Toward Conversations About Death”, by Martha Bebinger, recognizes the recent advances in end of life care. With physicians now being required to discuss the options available to their patients, and families being encouraged to discuss loved ones’ wishes in advance, will the public see progress being made, and perhaps support physician-assisted suicide for willing patients with terminal illnesses?
“Tip-Toeing Toward Conversations About Death”by Bebinger provides a comprehensive look into the issue of health proxies and healthcare decision responsibility. Most interestingly, the article mentions that increased awareness surrounding the issue may be a significant advance in patient-centered care, a topic discussed prior in our class.
While reading the New York Times article, Fighting to Honor a Father’s Last Wish: To Die at Home, it seemed like this situation where people are put in homes against their wishes and just to the satisfaction of the nursing homes is a widespread problem. What I thought was interesting was that the percent of people dying at home had actually increased from 2000 to 2009. Unfortunately they did not include more recent data, but why would this happen? It is clear this is what patients have been asking for, for many years through living wills and conversations with families but is that why this changed? Are families starting to have that conversation earlier or is it the physicians that are taking charge and bringing everyone together to make a decision? Also does this mean that we are starting to solve this problem of going against peoples wishes? There still is a huge gap from the 35% that die at home to the ~60% that wish to die at home, but it is interesting to see some progress.
In the article, “Tip-Toeing Toward Conversations About Death”, by Martha Bebinger, the evolvement of health care in regards to death is discussed. Bebinger stated that a new law in Massachusetts was passed, “urges more of us to make preparations for these wrenching experiences by requiring that doctors offer information on end-of-life care to “appropriate” patients.” This is a huge step for health care. Most of the time doctors only focused on saving patients lives, not making them comfortable for their death.
This huge step in health care is really important because families and patients should be able to live the last days of their lives in a way that makes them the most comfortable. I fully support this new law. However, it brings about a few questions. With this new evolvement in health care will assisted suicide soon be legalized in Massachusetts and other states?
Last week during discussion section as we debated the use of “granny cams” in nursing homes someone brought up the fact that these “granny cams” should not be used because of the fact that cameras aren’t allowed in any other type of medical room setting. This reasoning makes sense however, it relies on families playing a large role in protecting the patient. How can nursing homes alleviate families from this major responsibility without infringing on patient privacy?
Through the last view lectures, we learned many aspects of end of life care, such as being in the intensive care unit, in nursing homes, and in hospice care. The main overall view we can get from these aspects is we need to change our view of death, and make sure the patient gets what they want or deserve. Maybe they would not prefer treatment and rather die in the hands of their loved ones or near them, therefore sending them not to ICUs but rather to hospice facilities or just the comfort of home. Maybe the old would rather be living their own lives, like those in the neighborhood for the elderly, instead of being monitored for their own health. This would lead us to believe that we need a change in how we view death and aging.
Whereas death may be viewed as a terrible thing and prevented, we should treat is as an inevitable situation and have the patient be the one in control when it is their own death. Death should not be a taboo subject, but again it should be embraced when the time has come. In this state, the most optimal thing to do would be allowing the patient the most comfort they can afford. Aging should be viewed in a similar fashion. People who are aging should not be viewed as feeble or fragile and have to be looked for (unless they have to due to a condition such as Alzheimer’s) but rather looked as capable individuals who have their own wants or needs. Rather then confine them because they are close to death, allow them to do whatever they want because they almost have no more life to live. There is a shift toward this view, but a lot more thought would be needed to fully push the view toward the main picture and have it embraced by everyone. At this point, will we be able to actually conquer death: when we accept it and gain a sense of comfort from it.