HEALTH CARE: Can Mom Live Forever?
by Tom aka Rusty Rustbelt
HEALTH CARE: Can Mom Live Forever?
Many of us have had the experience of losing a parent. It is a life passage that is impossible to completely prepare for.
Problem is, mom is not going to live forever, and at some point aggressive care makes no sense – except to some of the children.
This puts the hospital, nursing home, doctors and nurses in tough predicaments. And it puts Medicare in a position to finance the care.
Physicians often take the path of least resistance – do what the family wants. Too often the patient is ping-ponged between the hospital and nursing home. Medicare may eventually slow down the revolving transfers by cutting payments, which leaves the doctors and nurses to face the family.
Withholding care can result in unnecessary suffering. Providing too much care may result in unnecessary suffering.
Talk to your parents if they are older. Try to get some agreement among siblings about possible scenarios. Face reality yourself if you are older. Consider a living will.
And even then you cannot anticipate the exact course of anyone’s life.
Tom aka Rusty Rustbelt
bull
While not for everyone & under no circumstances to be imposed arbitraily, hospice is a valid alternative to heroic end of life treatments. My wife works in hospice and when I hear her stories of some of her patients coping with dementia & worse, I hope personally to choose hospice for myself before dementia or alzheimer’s sets in meaning then someone else has to decide for me.
Listen to Tom aka Rusty Rustbelt, talk to your parents & aged relatives, make sure they know what hospice is and what their alternatives are while they can still understand the conversation and make their wishes known. In many cases hospice is the only humane alternative, unless you consider diapers, shower chairs & psychotropic meds to be humane which I do not, life for me requires a certain “quality of life” and a degree of dignity as well. But that’s only my personal opinion, your opinion is your own.
(Except in Texas where Rick Perry signed the “Futile Care Act” meaning if you’re terminal and on Medicaid you get ten days before they pull your plug regardless of mental status. We’re a ‘right to life’ state after all) – oops, accidental rant…
Amen to the note. And also think about yourself. In addition to parents you should let adult children know your wishes and consider a medical power of atttorney and a directive to physicians. In particular if you name one child as having the medical power of attorney, then there is someone to make a decision. Of course Sarah Palin regards this as a death panel. If you don’t want to discuss it with a physician a clergyman might well do. But do consider this for yourself as well as your parents. Recall that if Terry Schaivo had had such a document the whole issue would have been avoided. If her wishes were clear and she had clearly defined her husband as having the power of attorney, likley her parents would not have gotten very far in court.
Amen Rusty. To most of you I am already considered elderly, but I still have a living mother residing in a nursing home. All the details have been worked out.
The last time she was seriously ill, it appeared that whe was no longer willing to live. We had a family conference and decided to conform with her own wishes. So it fell upon yours truly to confront her about her own wishes. She is still with us, and except for the aging process is leading as full a life as possible.
ff, you are naive. Life, for most of us, is a series of difficult decisions, and apparently you have not had to confront any in this category yet.
I have been closo observer to hopsice palliative care.
For the past 13 months I have observed close and personal “aggressive prolongation of life”, with prolonged ventillation.
I vote for the hospice solution. Far more humane.
For me, I prefer the Native American plains tribes’ answer………………..
I have been close observer to hopsice palliative care.
For the past 13 months I have observed close and personal “aggressive prolongation of life”, with prolonged ventillation.
I vote for the hospice solution. Far more humane.
For me, I prefer the Native American plains tribes’ answer………………..
CoRev
agree with you about ff.
ilsm
i don’t know what the Indians’ answer was.
That was helpful (?).
I think he is referring to leaving the elders behind when the tribe moved camps, when the time was near for death.
Have do we balance individual rights with the need to use public resources wisely?
I don’t know about the American Plains Indians specifically. But, the Caribbean Indians who lived on Hispaniola, Cuba, and Puerto Rico withdrew from reality, sat down, refused food and water, and died after a few days. The incidence of such deaths was so prevalent in the early years of the Conquista that few people of indigenous descent remain in the Caribbean. There are a few in Dominica and I think some people of indigenous/European/African ancestry still remain in Cuba and Puerto Rico.
The Caribes or indigenes, as the Spanish called them, made poor slaves. Their diminished population and inability to adapt to slavery led the Spanish to import African people as slaves. The extermination of the Caribbean Indians was a scandal in Spain subsequently recorded in a book, La Leyenda Negra by Bernardo de Las Casas is still regarded as the definitive account of that portion of the Spanish Colonial period. Nancy Ortiz
Rusty–Your recent posts on health care have been very insightful and, I think, necessary information for everyone. To think as some do that every trip to the hospital results in a full recovery for the patient and relief for hr/his family is foolish. Younger people are no more prepared to consider the merits of extended periods on a respirator than older ones. And, as you point out, nursing home confinement is difficult even to observe, let alone endure. Anyone who can should prepare. Easier said than done for many people, but the results of not doing so can be needlessly painful. Nancy Ortiz
Nancy, it has been my observation that the very ill and/or old have: “refused food and water, and died after a few days.”, and it is quite common. It was the stage my Mom was approaching. She had C-dif a nasty intestinal infection, and refusing food was natural. But, when she started to refuse the only antibiotic that works against it, we became concerned. She thereafter took her medicine.
The remainder of the story is a saga of the ineptitude that can happen at hospitals and poor (rationing) of medicare, but the real hero in this is her nursing home. They took her back, even while she was still recovering, and nursed her back to health. I’m sure Rusty knows the meaning of that.
BTW, for those out there who do not yet know it, you can have hospice care, even though the patient may not be near death.
CoRev–It’s good when hospitalized people have some ability to understand and react appropriately to the information their families and treating physician. It’s perfectly awful when they can’t. The change can come quite suddenly and is the reason for talking these matters over in advance. If I had it to do over again, I would have sought admission to a hospice for my husband instead of hospitalizing him. But, you don’t have a lot of time to understand the person’s prognosis and sometimes not even a clear diagnosis to work with. So, such posts as Rusty’s are very helpful. I don’t know how often people experience the excellent care your mother found in her convalescent hospital. But, I suspect very few people are so fortunate. Thanks for your remarks on this important topic. Nancy Ortiz
Nancy
thanks for yours.
my uncle did something like you say the indians did. i doubt he was near death, but he had been unable to care for himself for a long time, and one day he seems to have said “enough.” of course we don’t know what he really said, because he could no longer talk. i knew the man, and i think this was his last gift to his family.
Just a minor remark: the real title of the book Nancy Ortiz is referring to is Brevísima relación de la destrucción de las Indias [A most concise account of the destruction of the Indies], and the name of its author is Bartolomé de las Casas. This is the link to an on-line edition, hosted in the most extense virtual library of the whole hispanic world (Biblioteca Virtual Miguel de Cervantes):
http://www.cervantesvirtual.com/servlet/SirveObras/12817291026719384321435/index.htm
Greetings from Spain!
When the elderly could not keep up with the moving clan, they walked off onto the prairie and met the Great Spirit.
It was not so much the tribe left them behind.
Unfortunately I have been confronting it for the last 20 years. Still unlike the spoiled brats in the U.S. who can’t be bothered because of their busy lifestyles I don’t choose the selfish easy way out.. IF you write an article like this you better well be much more detailed in your definitions or you will get many responses like mine. I have a huge issue with Americans who choose to take the easy way out and just try to hide their relatives in nursing homes as opposed to appreciating the last few good years. Again.. unless you provide more details on EXACTLY when YOU think it is time to pull the plug I will fight you with every penny I have. It is not UP to YOU when to decide for me who has been responsible for 24 hour care for a relative for the last 20 years when and if she gets to live another day. BULL CRAP
They walked off into the prairie and met a band of wolves who proceeded to eat them.
Excellent recycling of the old and useless. The wolves droppings fertilized the grass, which was eaten by the Bison, and then the Bison was eaten by the tribe. Circle of life kind of thing. Short, brutish, and hard. Just like mother nature intended it to be before civilization came about…
Or they could get lucky and died of exposure, or starved, or died of thirst….but it was good for the tribe!
So when do we get the death panels again? (OK over-the-top cheap shot…)
Islam will change
BTW, reguardless of my note above I actually agree with the sentiments here. (I just have no time for romantisizing the INdians).
I heartily recommend hospice care when the time comes and plan to use it myself to go out in my home surronded by family. Like my father-in-law.
Definitely not going down to the zoo and walking into the lions cage at feeding time to go the traditional Indian way…
Islam will change
wel, ff
sounds like you need a break. i don’t know if anyone here is recommending pulling the plug. me, unless someone can come up with a better argument that you have, would be in favor of a culture in which it was understood that “heroic” measures would not be taken. and that death, while no fun for any of the people involved is not avoidable, and you may do yourself harm running from it.
actually sounds a lot like the american way.
only we leave them in an old folks home where we won’t have to think about them.
expect the government to pay for it.
and then go home and vote to cut our taxes.
oh hell, buff.
them wolves are the representatives of the Great Spirit on earth. it’s the way i would choose to go.
ah buff
faced with a choice between the vultures and the doctors, i’ll take the vultures.
profundador
thank you sincerely. when nancy gets back she will thank you.
The point is to discuss the issues when one is still in possession of ones faculties and document the results. The issue of how much is enough is an issue that is uniquely personal and family oriented. But the fact that the issue should be discussed now, and even for people in their 20s and 30s (because of cases like Terry Shaivo and the possiblity of traumatic brain injury present at any age). Decide for example if you are in a persistent vegatative state do you want pallative care or more? If you decide and document then your wishes will be granted. No one is saying that anyone elses should make the decision but the person who should do it early.
Now if medicaid is paying the issue may be a bit different because then its how do we play god, having aquired god-like powers to extend life. When society as a whole is paying then somehow a law like the cited one in Texas is needed about medical futility.
Nancy, said :’-It’s good when hospitalized people have some ability to understand and react appropriately to the information their families and treating physician. It’s perfectly awful when they can’t. ” agreed. My Mom has made the decisions easy for the rest of us.
FF: No one mentioned ventilator patients or pulling plugs. Wow, you are wound a little too tight.
coberly – I thought my sarcasm was well over the top here….and obvious!!
🙂
buff
i took the sarcasm and ran with it.
Profundador–Thanks for the link. I’ve already bookmarked it. It was a long, long time ago when I read that book; so I appreciate being reminded of the correct title and author’s first name. Come back when you can. Quite a few of the people you see commenting here are regulars. I’d be interested in you insight into the current financial situation in Spain and the rest of Europe. Thanks again. Nancy Ortiz
well there you have it.
I agree with CoRev and we are both wrong.
turns out ff is not naive, but maybe too much the opposite.
rusty
probably bad framing. we don’t balance individual rights with the public’s resources. rights have something to do with being left alone. we might agree to grant each other rights that involve some kind of mutual care, but since this is a “contractual” right and not a “god given right” we get to specify the terms. i think reasonable and decent grownups could arrive at some sort of agreement about how much “care” they will as a group offer each member.
where we get in trouble is the right says we can never do no such thing. and the left imagines “we” can grant unlimited care and the rich have to pay for it.
Thank you so much for your kind words! I must say, however, that I cannot give much insight into Europe’s financial mess, since I am just a philologist. My contact with economics takes place only during leisure time, and it consists mostly in having a look at “slightly left of center” blogs such as Angry Bear (1).
(1) Well, once upon a time I tried to read Friedrich List’s National system of political economy (http://www.archive.org/details/nationalsystemp01colwgoog), but I succeeded only in part.
great article you posted here full of quality contents.
http://www.workoutexercises.org
profundador
i don’t know that any of us have any “insight” even into America’s financial mess. Except the insight that comes from looking at it from the inside. i would have preferred a life in which i did not have to “think” about politics and economics (politics with pretensions), but everywhere i turned around i stepped in it.