All right, now I know that this is going to touch on a few peoples "sensitive areas" but I wondered what other nurses thought. It seems to me that only in America is it considered a failure when you die--sometimes death is treated as an insult rather than the natural function it is. I have read that more money is spent on healthcare during pts. last 30 days of life than during their entire lifespan. Too many times patients that we know are going to die end up costing the health care systems ever increasing amounts of money in an attempt to save them from dying.
So is it time to change the public's perception of death and encourage palliative care and hospice more? Does the USA need to adopt guidelines as to what care should be provided for certain medical conditions? And that patients, ones that we all know will be DC'd to a nursing home or to a private residence to eventually die but are kept alive with vents, should be treated with hospice instead of medical care? I heard on the news last month that there are 10,000 people that are home ventilator dependent patients here in the USA.
What brought this up was a case...the pt. is 102 years old, has dementia, and fell, sustaining a compound fracture to an extremity. After surgery, a revision to the surgery, then pneumonia, many days in the hospital, an infection of the external fixation site, more pneumonia, several more days in the hospital, now in a nursing home for IV antibiotics...and she is still a full code per family's wishes. When is enough, enough?
A lot of these pts. end being paid for by tax dollars. Is it time to ration healthcare as a way to control costs and help make healthcare affordable/accessable to everyone?
I don't want the government or my insurance company deciding when I'm ready to die.
Or the limits of your and your family's financial assets? Bone marrow transplant for your child? Can you afford it?
It's such a balancing act! At some point, it does have to rest on the individual's ability and willingness to pay for additional treatments and care... but at what point? Last chance, experimental, expensive cancer treatments for a 90 year old with multiple comorbidities? Most of us would agree that we wouldn't want our insurance premiums or our taxes going to cover such kinds of treatments... but what about the on-going costs of dialysis? What about experimental expensive cancer treatment for an otherwise healthy child? Sigh!!! No easy answers!!!
Specializes in Gerontological, cardiac, med-surg, peds.
Back to the original question - yes, rationing on some level is only a matter of time. We have a demographic shift of enormous proportions upon us - the aging Boomers (82 million strong), plus not enough young working people or resources to take care of them. Medicare is due to become insolvent (aka "broke") in the year 2019 (only 10 years away!).
Is this because, as one man said "They can go to the emergency room" ?
This is the 21st century, healthcare version of "let them eat cake!", don't you think?
Aside from poor reimbursement rates, and people expecting that they and their loved ones will/should live forever,
we also have people with and without insurance misusing our emergency services..No you don't need to come in to the ER for the back pain you've been having for 6 mos..I'm fairly certain that doesn't qualify as an emergency. :icon_roll I think eventually some form of rationing is going to be necessary, and we need a huge amount of public education on appropriate use of medical resources...Frankly I can't imagine how it will be done, the thought alone is mind-boggling...
jjjoy, LPN
2,801 Posts
Or the limits of your and your family's financial assets? Bone marrow transplant for your child? Can you afford it?
It's such a balancing act! At some point, it does have to rest on the individual's ability and willingness to pay for additional treatments and care... but at what point? Last chance, experimental, expensive cancer treatments for a 90 year old with multiple comorbidities? Most of us would agree that we wouldn't want our insurance premiums or our taxes going to cover such kinds of treatments... but what about the on-going costs of dialysis? What about experimental expensive cancer treatment for an otherwise healthy child? Sigh!!! No easy answers!!!