The Cold Hard Facts?

[Jo Dirt]

I've been involved in nursing (in some form or fashion) for 11 yrs.. Recently, we took in my elderly father-in-law.

I believe I have "been around" when it comes to geriatrics and LTC. The more I look around at what is going on with this the more depressed and hopeless I feel. Time after time, you see these little old people lose everything they have to go in the nursing home, and their dignity and dreams of leaving anything to their children slip right down the drain. One old lady told me, if she knew she was going to wind up in "this" kind of shape she would have offed herself before it got to the point it was (she owned a big farm that neither of her children would be inheriting, and she was really too high acuity to be at home) I could have said, Oh now, Ms. Brown, you don't mean that, you shouldn't say such thing! but I couldn't bring myself to be that hypocritical. It's got me to thinking about when I get old, if I live that long.

Why should healthcare be to the point where the middle class must accept being reduced to paupers to receive any benefit from it? Are there really so many old and infirm people using the recources and putting a strain on the government that it drives up the cost of everything to the point only the extremely wealthy can afford it?

What's the point? Work and slave your whole life so the little bit of property/savings you were able to accumulate can be used to keep you hanging onto life a little while longer in a nursing home? Do you think those people worked and saved because they intended for their money to go to "the company"?

You see all kinds in the nursing home, the virtuous and the trash of society, and in the end no one of them are any better off than the other.

The nursing home equalizes everyone (before their time to be equalized comes).

It also got me to wondering about the real purpose for giving Dr. Kevorkian all the attention he got in the news. It's unknown to some people, but the government really does plan ahead. As cold and heartless as it sounds now, with more and more old and infirm being kept alive longer now, maybe all this technology has backfired on the government and perhaps this was to get society acclimated to the idea of human euthanasia? Of course, they had to bring about the idea in a more subtle way (Dr. Kevorkian) but you know they couldn't just push a law in our faces saying The nursing homes are full and you can't afford the services on your own, but now you can take Grandma down to the clinic and we can make this easier for everyone.

I honestly believe that is where this is heading, though.

Gives me a lot of hope for what the future holds for me...

[JohnBearPA]

I'm sorry for your loss,but surely you don't think the government should pay for people who can pay for themselves just so they 'have something to pass on to their kids'. We waste billions of dollars every year keeping people alive who have no quality of life. We throw medicine away instead of recycling it. My healthcare proxy is hanging on my fridge door and my HCP knows exactly what my wishes are. I'm not sure being home is always the best option. Do I want to burden my family with my care? No...I'd rather be in a home with caring staff where my family can visit as long as they want when they want. I think there would be less resentment because they weren't providing the care. I love my kids and they're great but they are NOT equipped to take care of a sick old person.

Soylent Green....yummy!

I'd rather see some of my tax dollars going towards healthcare for an elderly person who owns their own home, and has worked hard their whole lives than see it go and support these young mothers that have kids just to get more money from welfare. I've seen elderly people living in their own homes have to sell off great-grandma's silver candlesticks to pay for a prescription, sell their homes, cars, any other possessions that might be worth a few bucks before any gov't help came to them. tell me, SURELY you don't believe that fair?

I agree that people that can self-pay should do so, but where exactly do we draw the line? A prized family possession is surely worth more to the owner than a pawn shop will give them for it so they can get their coumadin. I had to sell Mom's car, most of her jewelry, and a few prized pieces of furniture handed down from her mother and grandmother just to pay MD and hosp bills. Gov't help wasn't available when she needed it, and I'm STILL paying bills over a year after her death. Before you ask, no, I didn't try to keep her alive, give her false hopes, or beg the MD's to do all they could. We realized it was hopeless and did Hospice, giving her a death with some dignity intact. What I was saying is that some help should have been an option for her, because if she knew she couldn't pass those things down to my sister and me, as meager as they were, it would have broken her heart.

I stand firm that the gov't needs to take some money away from meaningless research into the sex-lives of pygmy mice and put it into caring for the people that made this country what it is today, it's elderly and infirm population!

[TrudyRN]

Back in the day the community cared for the elderly in their homes, and most people died with dignity in their own beds.

I have been Frederick Douglass' book about his life as a slave in the pre-Civil War days. One story he relates is how an old slave who was no longer able to work was treated. Her owners built her a private hut and then put her in it. Period. No children or grandchildren around, no one to help her get food or brush for the fire she had to build to keep herself warm. No one to keep her company or share her last days and weeks. Just put the old woman out to fend for herself in her crippled old age. Despite the presumably good intentions of her owners, who didn't want her to have to work any more, she was left to suffer and die all alone, with absolutely no one to know whether she even woke up each morning. :angryfire

I agree. Just living just to say we reached a certain age is no gift if one does not have good health, companionship, and decent circumstances. We really need to devise a better way. To the OP - I agree with your take on the government's plans for us masses.

[gitterbug]

I have seen this problem from both sides of the coin. Families who want every thing done for the loved one when all hope of a decent quality of life is gone. Families who do nothing and allow the infirmed, aged family member to die without heroic measures. By herioc measures I do mean fluids, baths, skin care, and as pain free as possible. In the end, I think this issue needs to be addressed more honestly within the family unit. We need to be clear about what we can live with when our loved ones are dying. We need to ask our loved ones while they are able to formulate a plan, what they really want and allow them the dignity to have their wishes. Caregivers come in all types. When I was caring for several of my family members(M,MIL,B,S) I attempted to bid by their wishes. It is not the money we spend or don't spend in the end. It is if our mind is at rest with our actions when the loved one finally passes over. I loved them all, but in the end they each wanted to die with dignity, at home, as pain free as possible, and surrounded with family. I attempted to fullfill those wishes. I have no regrets. I know I will be in their company again.

[gitterbug]

P.S. I would rather see my tax dollars spent on legal citizens of this country for care, food, medicine, and shelter, just to name a few things, than sent to Iraq, Iran, and a few other countries I can name.

[Jo Dirt]

I'm sorry for your loss,but surely you don't think the government should pay for people who can pay for themselves just so they 'have something to pass on to their kids'. We waste billions of dollars every year keeping people alive who have no quality of life. We throw medicine away instead of recycling it. My healthcare proxy is hanging on my fridge door and my HCP knows exactly what my wishes are. I'm not sure being home is always the best option. Do I want to burden my family with my care? No...I'd rather be in a home with caring staff where my family can visit as long as they want when they want. I think there would be less resentment because they weren't providing the care. I love my kids and they're great but they are NOT equipped to take care of a sick old person.

Soylent Green....yummy!

Why should and does the government pay for about 80% of the crap they pay for and to support people (illegals, foreign countries) and causes that are the true waste of tax dollars.

Didn't these old people who were once working members of society help fund the government (who shouldn't be expected to take care of them now that they can't contribute tax dollars like they once did?)

Why should the working class of society not be able to comfortably afford medical care without taking a vow of poverty? Why are the deadbeats of society who never worked or paid taxes "entitled" to the same "quality" of care the working class - who not only paid their dues in taxes but now must have what they worked their whole lives for, sucked away?

Yes, people who can afford it should pay, but why can't the middle class afford it without being takent to the cleaners?

I also believe nursing homes have gone beyond serving their purpose. I also wholeheartedly agree that family should not be burdened with taking care of old people. I'll take a gift certificate to Dr. Kevorkian's clinic over the option of going to a nursing home anyday.

[CapeCodMermaid, RN]

You won't get an arguement from me about the waste in government...and you're right...why should WE pay for illegals when we can't take care of those CITIZENS who have contributed their whole lives. I don't like waste of any kind. I also don't like it when people know how to use the system...I worked at a SNF where the owner's mother was a resident...HE had more money than God....SHE was there on Medicaid!

[DoubleblessedRN, ADN, RN, EMT-B, EMT-P]

What really angers and saddens me are the elderly in LTC who have a legal guardian through on of those guardianship services. I don't work in LTC, (I'm not a nurse yet, but I'm a paramedic) and I've picked up many, many pts from LTC. I have seen so many people with those who are 85+ and a FULL code who are just hospitalized for infection after infection after infection. Isn't it funny how they are not removed from life support (after virtually all possibilities are exhausted) until after the first of the month?

[TrudyRN]

This has been a very interesting thread to read. I've agreed with so many of the sentiments, while others have bid me pause and forced me to examine my own values.

One thing I believe contributes to the "life at all cost" ideal is the fact that so many people choose to live in denial. It's not that they "can't" face facts; it's that they "won't." Some people believe honesty is vulgar or rude. Other people believe they shouldn't have to be subjected (or their loved one shouldn't be subjected) to the emotional pain and upset that often accompany facing the facts. I know this because I live with an entire family of such people.

Although my MIL and FIL talked openly about end-of-life issues and had living wills, when the end finally was coming for my MIL and she was suffering from ovarian cancer (at age 86), my FIL insisted neither the doctors nor the family TELL my MIL she was dying. He said he did this in order to "protect" her. In reality, it did not protect her. The first few weeks after her diagnosis of terminal cancer, she spent most of the time upset and confused because she couldn't understand why she had to go to a nursing home instead of going home. As the weeks wore on, we kept imploring my FIL to come to terms with the fact she was terminal and to let us move her to hospice, but he was adamant this not happen. He kept saying, "She has to fight!" Talk about denial.

She was finally moved to hospice after she had lost consciousness, two days before she died. Rather than "protect" her feelings, my FIL's utter denial of the situation forced her to endure unimaginable confusion and bewilderment about what she was going through. Obviously, when she continued losing weight and feeling unwell in the nursing home, she figured out she was dying. But the matter was never talked about openly.

Think about it: she could have made the most of her final few months, surrounded by loved ones, and died with dignity, but instead her last days slipped away in pain and confusion about what was happening to her. I think that's really frightful.

Anyway, my point is that I believe this sort of denial is exactly why so many families seem to believe in the "life at all cost" philosophy. They are in total denial about the reality that death is part of life. I think this rationale also explains why so many people abandon their family members in nursing homes. If they never visit, they can live in comfortable denial about what their parents' (or grandparents or whomever) life is like -- and the picture in their mind's-eye is always rosy.

This is one of the reasons I'm very interested in going into geriatric nursing. I want to be in a position to provide comfort and dignity to those elders whose families can't or won't come to grips with end-of-life realities.

She might have known more than you think, semisweet. Also, her husband probably just could not stop being her protector or face the fact that he was losing his lifemate. It is very, very hard.

[TrudyRN]

I agree with Disney, at what point do we stop providing care when the person is obviously not going to get any better? I'm only a nursing student right now, but I see thousands upon thousands of dollars spent on people who are at the end of their lives and I can't help but think that some of that money might be better spent on insuring the uninsured, on preventative medicine, on healthcare for children. It seems we can't let the elderly die with any dignity.

Though its not just there where we spend massive resources. I was in NICU the other day and saw several very preterm infants who will not have any quality of life at all (if they even make it out of there) but who will consume (and are currently consuming) so many healthcare dollars over the course of their sad, difficult lives. I know this may sound heartless to some but hard choices aren't being made and a lot of it I think is doctors and institutions just covering their butts.

Can't blame them for covering their butts. Being sued is a nightmare. I agree that we need, as a nation, to start doing health care right. Health care should not be a privilege. Everyone, including illegals, should be able to get health care. How much of it - aye, there's the rub, Matey.