Health Archives - Page 11 of 11 - Fran Moreland Johns

This week’s earlier post about the multiplicity of housing choices for the post-Boomers (and often Boomers ready to downsize or make other shifts) touched on just a few of the possibilities out there. The staying put option is one that many, including my friend Berta whose current consideration of home changes was cited, would choose. The question is addressed at some good length in today’s New York Times:

Stay put or sell?

That’s the question many older people ponder as they move into their 70s and beyond.

Most older people settle on staying put, according to a recent survey by the Home Safety Council, a nonprofit organization dedicated to preventing home-related injuries. (From the source of the survey, you can see where this column is heading, right?)

Staying put makes economic sense. It is not only more comfortable to live out your life in your own home, it’s much more affordable.

Those posh retirement condos and assisted-living facilities might seem easy-living and attractive, but crunching their numbers can take the shine off their attraction fast.

The average annual fee at an assisted-living facility — a place where older people live independently but also receive a host of services like medication monitoring and meals — is $34,000. And in the nation’s most expensive metropolitan areas, including New York, the costs may be closer to $70,000.

The Times article goes on to cite the case of octogenarian Catherine Fisher, who chose to adapt her New Jersey home to her own needs rather than take those needs elsewhere. Sooner or later, countless Americans will face similar choices. Guidelines to what is becoming “an entire service industry… taking shape around the goal of letting people age in place” are worth a quick study now, for whenever “later” comes.

via Patient Money – Cost-Effective Ways to Make Homes Safer for Older People – NYTimes.com.

Not long ago I attended an event at San Francisco’s Commonwealth Club, featuring a speech by the President’s Council of Economic Advisors Chair Christina Romer. Dr. Romer’s talk, “The Great Credit Freeze and the U.S. Economy,” was all about improving healthcare while slowing down the growth of its cost. We know we can’t reduce costs, she said; what we hope to do is reduce the rate of increase. And one way to contain healthcare costs might be to find out what the patient wants. Imagine.

This observation was not in direct response to a question, but could well have been. Dr. Romer was asked, by more than one audience member, about how to address excessive expenditures at the beginning and end of life. A grossly disproportionate share of costs, she conceded, “are spent on the last six months of life. And one thing we’re not doing enough of is letting patients express what they want.”

If the issue were not so grim and sorrowful it would call for a “Well, duh.”

It would be hard to find many people saying they’d like their last few days on this planet to be spent semi-conscious or in pain and distress, hooked up to a tangle of wires and tubes in a blue-lit hospital room (see Scott Bowen’s post 7/14.) But this is in fact the system we have created: we focus on prolongation of life without regard to quality, we aid and abet doctors who equate death with failure, we never talk about our own mortality as if in silence we can become immortal. Most of us would choose to die at home , properly medicated for pain and surrounded by our loved ones; most of us will die in an institution

Audience members had a wide assortment of questions, and Dr. Romer had plenty more to say. But finding out what the patient wants, and acting accordingly, is surely one excellent path towards better care – and even contained cost growth — and everyone in America could begin that process today.

It is an easy solution, even if only a small, partial solution, to this piece of the muddled medi-puzzle of our healthcare system: talk. Tell your doctors, caregivers, loved ones what you do or don’t want. Write it down. Use the forms universally available (Advance Directives, POLST, others.) You might even wind up with what you actually want in your final days. Christina Romer is on your side.

Tag: Health

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