At the New York Times, a blog called The New Old Age covers everything about taking care of elderly parents and other loved ones. It’s an excellent resource. The author of the blog, Jane Gross, took care of her own mother when she became too sick to do this herself. Jane has a lot of experience with “the system” – the good and bad. I have a lot of respect for Ms. Gross.
However in her most recent post, she writes about the potential rationing of health care for people who receive federal assistance- based upon the probable “comparative effectiveness research” on medical procedures, pharmaceuticals and devices. What this is about is the Obama administration’s plans to form a board that will decide which procedures will be cost effective…the plan doesn’t come right out and declare that procedures and treatments will be denied payment- but one can assume this will be the case.
Ms. Gross supports the plan and explains why.
We need to remember that a very tiny amount of people are covered by Medicare. Less than 2% of our elderly population receive federal assistance. Even as the baby boomers come to age, these numbers will increase a lot but not enough to make a huge dent, overall, of the elderly population. The fact is, most old people will fend for themselves when they get old: Either they are rich, or have prepared and saved enough money, or their families will provide care.
Ms. Gross:
The goal of comparative effectiveness research isn’t to kill people who otherwise have good and long lives ahead of them. The goal is to make rational decisions about what works and what doesn’t, what makes sense and what doesn’t, in a universe of limited resources — and to stop indulging the fantasy that it is possible, or even desirable, to live forever if we just take one more pill or have one more surgical procedure.
I have a question. Senator Kennedy has brain cancer, tumors and he’s ailing. He is not considered to THAT old- in terms of the discussion Ms. Gross takes on in her post. Kennedy’s cancer is terminal. It is going to kill him. Because of his personal wealth and endless resources, he has been able to get every treatment, every new and untested medication, for his condition. Some of the drugs are only known to extend life by a few weeks if not a month. It’s all very expensive care. He’s rich and can afford it.
What about the lady I once took care of at the local nursing home? She was 75; had mid-stage Alzheimer’s Disease. She relied upon Medicare to pay for her nursing home care. She was able to do her own care still, and recognized her children; she could still manage her ADL’s and she was expected to live another three to five yrs. One day we found a lump on her breast. They sent her out for testing and sure enough, it was cancerous. It was large- but still contained within a sack. It had not metastasized. Her family, her daughter to be exact, declined any treatment, knowing that it would not increase her Mother’s longevity. She figured the “dementia” will kill her Mom before the cancer did her in.
The lady experienced horrendous pain and disfigurement over the next TWO years. That lump grew, it came out of her breast, it weeped blood, pus and other nasty stuff. It smelled terrible. It caused the woman so much pain she would pass out. She never screamed- she would just curl up in a ball and cry softly for hours on end. This is with morphine for pain control. Nothing we did comforted her. The woman lived for two years with this horrible cancer, spreading throughout her frail body- into her liver, then her lungs, her brain, her spine. She lost her sight. She ended up on O2 most the time; she died of breast cancer. Not her dementia.
How do we protect people like this woman, in an age where we are willing to discuss rationing health care for old people? Did this woman deserve to die, in such a horrible manner, simply because her daughter didn’t think her quality of life would suffer? In terms of government funding, would it be acceptable to deny care, based upon some research recommendations?
Ms. Gross points out that many old people (women) are “subjected” to needless tests such as pap smears and annual mammograms…in all my years of experience at nursing homes, never once did I see old ladies being sent out for these tests. I did see families insisting upon exrays when a fall occurred; I did see hip surgeries performed. I’ve seen dental work being performed as well.
K Tree, CNA has noted a few times at her blog, how a DNR order seems to mean- DO NOT TREAT...which is totally wrong. When an old person, confined to a nursing facility, shows symptoms of a UTI or bronchitis or strep throat, I believe they MUST be treated. DNR orders don’t tell us to DENY TREATMENT of these things.
I fear that the world Ms. Gross would like to live in will deny this, and much more. I get a sense of strong resentment from Ms. Gross, towards old people…the sense that somehow these people are a drain on resources and therefore not worthy of receiving a newly defined set of rules for what is adequate and appropriate. We have to be careful when we go down this road. It is, a very slippery slope.
