The Cold Hard Facts?

sasparilla · Dec 7, 2006

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.

Hellllllo Nurse, BSN, RN · Dec 7, 2006

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...

I have had the exact same thoughts.

Jo Dirt · Dec 7, 2006

I agree with Disney, at what point do we stop providing care when the person is obviously not going to get any better? Though its not just there where we spend massive resources.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.

Yes, it is. People have been so far removed from death they think life is worth holding onto at any cost. And you go to any nursing home and look at the miserable, contractured, incontinent, bedridden people, on tube feedings, staring at the wall, some who don't even know they are in the world, and they are kept hanging on for years and years for the sake of being alive.

This is why I hope I never have to work in a nursing home again.

wefdm21 · Dec 7, 2006

THis is exactly why I believe in sitting down and planning this all out on paper. We all know that were going to die. We need to get over this "let's not think about that" mentality. I know that I don't want to be lying in some cold room all tubed up where a machine is practically doing everything for me.

Simplepleasures · Dec 7, 2006

Yes, it is. People have been so far removed from death they think life is worth holding onto at any cost. And you go to any nursing home and look at the miserable, contractured, incontinent, bedridden people, on tube feedings, staring at the wall, some who don't even know they are in the world, and they are kept hanging on for years and years for the sake of being alive.
This is why I hope I never have to work in a nursing home again.

Yes it truly does change a person who works in LTC for any length of time.

It is an insult to the sanctity of life to allow this end of life suffering to go on for so long. Families just dont seem to realize that their loved ones are not happy, why else are most LTC patients on anti depressents? Unrealistic expectations of recovery, selfish desire to keep someone alive, etc. Not even speaking of the overworked staff in LTC,who probably would be able to give so much more of themselves if they had the time.

We had a family that were in court sueing each other because one group were keeping loved one alive, despite the LIVING WILL! It destroyed this family.While a person still has all their faculties, it is IMPERATIVE to tell your loved ones what you want at the end of your life, whether it comes sooner OR later.

I know that I have been forever changed by being wittness to so much suffering over the years.To add insult to injury LTC continues to get away with providing our elderly with what they once dreaded when they were young. WE all will be of the age someday, when we will be in the claws of the LTC corporate beast.:chair:

Maybe we will be very lucky OR maybe the LTC faclities will become extinct,maybe there will be a huge trend away from instutionalizing our elderly and allowing all the Medicaid funds that went to the LTCs to be used for home care.( With nursing help) . This is actually beginning!! It is known as Family Care by Medicaid. I hope and pray to see the phylosophy of wharehousing or elderly become a dirty little secret from the "bad old days" hidden away in some dusty old nursing book.

snowfreeze, BSN, RN · Dec 7, 2006

My mother died of cancer at 41, she had breast cancer at 34. It was treated and she was in "remission" for a while but " It came back". She told me that if I found a major health issue in my life I should just live life onward and not address it. Seems she thought that life dealing with the original issue was less painful than what came after the medical healing.

Columnist · Dec 8, 2006

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.

CapeCodMermaid, RN · Dec 8, 2006

I fully agree that the days of taking care of our elderly in their own homes is probably long past. I also fully understand that it's not fair to them that they lose any and all of the precious things they worked their whole lives for to recieve proper care from the gov't. I've lived thru this first hand, and am in fact still paying off my mother's bills over a year after her death. What was Mom able to leave me from a lifetime of work? Not much, besides alot of good memories.
You all have heard my story already of how I had to take responsibility for my Mom's care, how she had Vulvar ca, was misdiagnosed, and told surgery was successful when it really wasn't. I went to nursing school, held down a job, and ran my own home while visiting Mom every day at the nursing home I had to place her in.
The reason I had to place her? I have three male dogs, Mom had a huge bleeding tumor in a delicate region, do the math. Also, the dressing changes, meds, and helping her in and out of the bathroom, and just the ADL's would have caused me to have to stay home full time, which was not feasible. Also, I'm male, so there was that issue, for her and my comfort. Mom hated the nursing facility, she was only 57, and everyone was much older, but it needed to be done. My younger sister chose to not take responsibility, and stay in another state working at an internship, because she couldn't handle it, so it was me or nothing for poor Mom.
We need to come up with something to help these poor elderly people. Healthcare should be a right in a country as great as ours, not a privelege of the upper classes. For God's sake, these people made our country what it is today, and they have to choose between filling a script or eating for the month. Let's get our priorities straight here, and protect these people, give them the care they need, and let them have something to pass on to their kids!

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!

subee, MSN, CRNA · Dec 8, 2006

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!

And where is this nursing home with a "caring staff where my family can visit as long as they want when they want." I have seen a hospice that I would die in but I have never seen a nursing home that would fill the bill. I don't want anyone taking care of me unless I'm going to get better. When I get too frail to care for myself I plan to take a month's supply of Ambien - period.

For all the patients I've lifted, I want to give that money to family and charities, not a nursing home. People have to accept that a healthy life is just dying more slowly and take care of busines - not leave it to your family to do. Just gather my cats, get under a warm blanket with a cup of tea and a good book and just take a long nap.

CapeCodMermaid, RN · Dec 8, 2006

I'm sure my post would get knocked off here if I gave the name of the nursing home, but the one I work at now and the one I worked at before this one had plenty of caring people...99% of the staff were caring...AND, we let families and friends visit ANY time they want. They can get there at 8am and stay till 11pm if that's what they want.If the plane lands at midnight and they get to the facility at 2am we let them in. I've had CNAs come in on their days off to sit with people who had no family so they wouldn't be alone when they die. I sit with people all the time so they won't die alone. Not all homes are horrible places.

ebony2 · Dec 8, 2006

Look at what we are dealing with here. growing numbers of seniors, closing of nursing home beds(at least in New England where I am from). Major issues with no long term solutions. The cost of providing care continues to escalate out of hand. People so removed from the actual problems trying to devise action plans to solve the problems.

DO ANY OF THESE IDEAS SEEM PLAUSIBLE....

Taking care of people in needing their own homes instead of an facility.

Having families involved in this process to the extent they can. Implemantation of regional casemanagers to triage services needed by elders and having a larger staffing pool through combining home-care LTC and rehabilitation services. Something along these lines would have to be more cost effective.

As far as who dies and when. Who better to make that decision than thos who are facing that situation. I all my years of practice I have only met one patient who wanted life under any circumstances. Most other s know exactly when their quality of life would no longer be acceptable to them. By expanding advanced directives options could be included for just these types of sitiation. Fear of making the wrong situation and guilt could be virtually eliminated. Tightening of eligibility for nursing home placement to those cases requiring skilled short term care or chronic care needing behavioral management(uncontrolled). Would this b easy to accomplish, no change ever is. We all have ideas on the subject. No one to take them seriously.

Altra, BSN, RN · Dec 8, 2006

And where is this nursing home with a "caring staff where my family can visit as long as they want when they want." I have seen a hospice that I would die in but I have never seen a nursing home that would fill the bill.

Two of my grandparents have been in 3 different facilities ... all 3 allowed unlimited family visitation and encouraged family participation to whatever extent possible.

Medical treatment has advanced by light years in the last 50 years. We now routinely treat, for example, the HTN & CAD at age 50 that would otherwise have likely produced a non-recoverable stroke or MI at age 60. To not do so is unthinkable. Yes, this contributes to a population of frail 80- & 90-year olds ... but does this justify turning back the clock? The elderly of today are the first generation in history to have the luxury to contemplate the concept of quality of life.

I know first-hand the burndens of caring for elderly family members, as do many here.

Motorcycle Mama, I agree w/TraumaRUS ... I hope you're getting appropriate care from your health care providers and I encourage you to seek additional assistance from family/friends. Best wishes to you.