Cost Effectiveness Vs The Elderly
Posted by Heather on February 23rd, 2009 / 
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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.
February 24th, 2009 at 11:56 am
She comes across as a vindictive bitter b-tch. I’m sorry for the harshness. But she has problems.
I got the impression she resents old people, who in her opinion don’t **want** health care because people like her tell them not to be a burden.
I have never seen residents get all these tests either. The only time they do is when family insists- which BYW it is family who demand all the treatments and surgeries. I have also witnessed firsthand, nurses who deny care based upon a DNR. One man I worked with had a UTI and the nurse refused to give him his antibiotics. She was of course fired- but her attitude wasn’t lone.
When we start to respect old people some of this will change. Until then, they are at the mercy of our ever-growing society of selfish, ME PEOPLE. it saddens me.
February 24th, 2009 at 11:59 am
I also want to add that I took heart in some of the comments left at this article. While most agreed with the need for cost comparisons, many also stated the issues should not be decided upon by any government. I agree that this is where it’s headed: Government control over care options. We might need to go this route though cause everything’s so expensive…so lone as life isn’t denied to people.
February 26th, 2009 at 9:07 am
I’ve beem reading TNOA for a couple months now and it’s very biased against old people in general. Which makes no sense. But for me I see bias in almost every posting. It’s almost as though the author wishes old people would just go away, stop infringing into their adult children’s lives- they’re such an inconvience, and so on.
The world is full of too many selfish Baby Boomer generation people. It’s not all about them and aging parents who need help, are bringing this home. The selfish forget how much sacrifice their parents made on behalf of them when they were babies and little kids. The circle of life should not be broken, but people like Jane Gross break it all the time and it angers me to no end.
February 26th, 2009 at 9:04 pm
I havennot noticed bias in every article at that site but it is there now and again. More like resentment to old people. Since their old and no longer capable of being productive members of society- taxpaying- let’s just limit their choices in life or death. Disgusting. I don’t think she really means to be this way,but she does come off that way at times.
February 26th, 2009 at 10:37 pm
I’ve only seen slight hints of her thoughts about old people. A while back she posted an article written by some doctor who advocates rationing of health care services to older people- blatant, right up front kind of guy he was…and is. She didn’t endorse his stance directly, but the fact she allowed him to post his extreme views tells me a lot. The post mentioned here appears to me to be one of those rants we think about alot, write out and HIT SEND before thinking….I got the feeling she was more angry at Rush Limbaugh than she is at old people- angry at him for daring to mention the things she doesn’t agree with.
It’s sad when we allow politics to enter the discussion- it really ruins the debate. I honestly believe this is a moot issue: Human life is valuable and doctors and their patients should have the final say on what treatments, drugs, surgeries and what not are viable. Each human being is different and so is their health care. Everyone needs to remember this. IF we go down the road of endorsing ANY form of rationing, who will check us when we decide handicapped kids or brain injured adults or people with too many freckles….you get my point. It does need to be said: The Health Care Board Obama is talking about was used before in history. The Nazi’s first used it back in the mid 1930′s to determine who would receive what forms of services…and it led to concentration camps and the Holocaust. We cannot forget history.