This class has been enlightening and has inspired me to think of health care, doctors, hospitals and our systems in the United States in new ways. One interesting thing I want to share relates to the topic of discussing end of life care with family members. My mom is an elderly care lawyer so she is around people in this type of situation every day at work. I haven’t ever really talked to her about end of life care before.
Over this thanksgiving break my grandparents and my stepfather’s parents both were visiting and staying in our house. One morning, I walked into the kitchen to get breakfast and I overheard my mom talking to my step dad telling him that he needed to have this conversation with his parents while they were visiting. She had printed out forms that my step dad and his parents needed to sign, which would give him authority over making decisions about their care, if and when the time came. I stopped what I was doing to listen and watch. My step dad seemed anxious and acted as if he was trying to avoid the conversation. However, my mom eventually convinced him that it was the necessary thing to do.
Later that day I talked to my mom about what she did that morning and I told her how we had just talked about that material in this class. She told me that it was part of her every day duties to inform people about end of life care decisions and she always encourages people to have these discussions with their families, especially on holidays such as Thanksgiving! I thought it was interesting how timing worked out and I wanted to share this story. To rap up my final post I would like to say thank you for a great class, I’ve learned a lot and would recommend this class to any premedical student.
After reading “Fighting to Honor a Father’s Last Wish: To Die at Home,” I have to wonder what could possibly be done to change our current system of elder care and end-of-life care. If the system continues to be largely run for profit, then we are never going to get to a point where we stop spending so much money on unwanted medical care and start investing more in social services. My questions revolve around that idea. What can be done to incentivize home health care and social services? For those who are truly too sick to be cared for at home, what can be done to improve treatment in nursing homes and hospitals? If these institutions are turning such a profit, why is there such a staffing shortage? Surely, they can afford to hire more staff, which is frequently stated to be a way to improve conditions in these settings. Hopefully, changes can be made soon, so that less people have to endure what Joseph Andrey did in his last months of life and more elderly people can die at home, if they so wish.
After reading about the extreme mistreatment Mr. Andrey endured, it seems that he would have been better off anywhere but a nursing home. Were his healthcare providers seriously concerned with his health or were they more concerned with the money his stay in these facilities would bring?
How can healthcare providers force the elderly to remain in their treatment facilities against their will? The treatment Mr. Andrey endured was inhumane. Why isn’t the government stricter with laws that prevent experiences like this from happening?
Would forcing people to make decisions regarding their long term care improve the quality of care in the long run? Or reduce it?
In the long run, is it more expensive to die in a nursing home facility or at home? What is one sacrificing by choosing one or the other? Does being a country that steers away from having conversations of death affect the state of elderly care? If so, in what ways?
The article “Fighting to Honor a Father’s Last Wish: To Die at Home” by Nina Bernstein clearly highlights the shortcomings in institutionalized and home-care forms for the majority of individuals within the United States of America. Collectively as a society, there exists no proper or cost-effective solution for healthy, nurturing, burden-less elder-care. These failures in care are likely speeding up the decline of individuals in the face of the discrepancies. Such raises a huge, frightening, and charged question: is committing an elder to an institution akin to committing them to an earlier death?
Continue reading “Lack of Welfare in Elder Care”
In class we have been talking about long term care of the elderly and we have discussed a few different examples. There is a common thread that links solutions such as personal care, nursing homes, or home health aids, or ‘village’ communities and it is that these options are all expensive. The task of reforming the care of the elderly is a daunting task to say the least but a solution that we have not discussed comes from the field of public health. If in the future public health and healthcare measures improve the quality of life for the elderly enough, then it is feasible to see a world where the amount of care needed for these people drastically decreases. The average stay of someone in a nursing home right now is about 2 years, but if most people in the population were able to take care of themselves with minimal help until say 6 months to the end of their life then expenses would drop drastically. Im proposing that once primary care measures and public health measures in this country improve the issue of elderly care will begin to solve itself. Could these complications one day be seen as outdated problems?
Americans over age 65 are projected to increase from 13 percent in 2010 to more than 20 percent in 2050. Americans over age 85 will increase from 1.8 percent in 2010 to 4.3 percent in 2050, and these are the Americans that are most likely to need long-term care. With the cost of long-term medical care at the end of life averaging at about $78,000 a year, how can Americans revise our system to better suite the aging population of America?
Galston’s article talks about multiple solutions to this aging problem. He defines the German solution to their aging population. Germany instituted a mandatory long-term care system in 1995. This system creates a tax that is equally split between workers and employers which funds a mandatory care system. Germans are required to either participate in this federal elderly care or opt out and pay for private care. This type of system is similar to universal healthcare but applies directly to the elderly. Since we are facing an aging population, would implicating a similar system to the German system be beneficial to our country? Would it be possible to establish a federal health care system to provide across the board care to the elderly population even though we already have medicare?
In the study “Does Investor Ownership of Nursing Homes Compromise the Quality of Care,” Dr. Harrington et al. concluded that investor owned nursing homes have larger deficiencies in patient care. They found several reasons that point to this, including the fact that for-profit homes have lower nurse staffing ratios, and that most investor-owned facilities were part of a chain. They also suggested that the large size of the facilities lead to lower quality of care, but public nursing homes had larger facilities yet maintained a better quality of care. They though the most palpable explanation for the reduced quality of care is the cost-driven mindset of for-profit facilities: overall, investor owned health maintenance organizations have lower quality of care, and spend less money and emphasis on clinical care and divert their focus to administration and profit. Continue reading “Does Investor Ownership of Nursing Homes Compromise the Quality of Care?”
In the textbook, it states that “historically, nursing homes residents overwhelmingly were white” and that the “usage of nursing homes by African Americans and Hispanics increased significantly from 2000 to 2007.” This got me thinking about about the Asian population and I was wondering why aren’t there more Asians in nursing homes? I think the reason for this is because of the mindset that most Asians have. In Asian culture, family is very important, especially when it comes to elders. It is expected that children are suppose to take care of their parents themselves and not leave them in a stranger’s care.
Continue reading “Asians in Nursing Homes”
In “Does Investor Ownership of Nursing Homes Compromise the Quality of Care?” study authors investigated the effects of for-profit nursing home systems on quality of care, and concluded that, compared to other systems, a variety of deficiencies plaque the investor-owned systems. This thus raises the question, how can we develop cost-effective and care-effective solutions to the deficient investor owned homes? One potential option that seems to embody both qualities is the Green House Project.
Continue reading “Elder Care Disparities and Rarities”