Are Americans Overtreated to Death by the Medical Establishment?

A truly valuable article from the AP today "Americans are treated, and overtreated, to death".  The article stares down a hard question - When do we stop focusing on a cure and start caring about how we die?

The statistics are disturbing:

Americans increasingly are treated to death, spending more time in hospitals in their final days, trying last-ditch treatments that often buy only weeks of time, and racking up bills that have made medical care a leading cause of bankruptcies.

More than 80 percent of people who die in the United States have a long, progressive illness such as cancer, heart failure or Alzheimer's disease.

More than 80 percent of such patients say they want to avoid hospitalization and intensive care when they are dying, according to the Dartmouth Atlas Project, which tracks health care trends.

Yet the numbers show that's not what is happening:

_The average time spent in hospice and palliative care, which stresses comfort and quality of life once an illness is incurable, is falling because people are starting it too late. In 2008, one-third of people who received hospice care had it for a week or less, says the National Hospice and Palliative Care Organization.

_Hospitalizations during the last six months of life are rising: from 1,302 per 1,000 Medicare recipients in 1996 to 1,441 in 2005, Dartmouth reports. Treating chronic illness in the last two years of life gobbles up nearly one-third of all Medicare dollars.

Do we want to tell people they can't be treated for their disease because .... (fill in the reason - money, age, citizenship, whatever?).  I don't think so.  However, what is missing from the discussion about terminal disease is how do you care for it as opposed to how do you cure it, because there may not be a cure.  Death is part of life - harsh and unwanted and soul-destroying as it may be, it is and always will be the end.

The article suggest that an answer to all of these disturbing questions may start in a conversation - a real back and forth dialog with all parties being fully informed - of what it means to battle a disease or care for it.  

So where do you go to have that dialog? In a conversation I had with David J. Shulkin, MD, Chief Operating Officer and President-elect, Morristown Memorial Hospital a few weeks ago he suggest patient message boards.  He believes that patients need to be active participants in their own health care, and part of that is leveraging the experience of other dealing with the disease is addressing the "cure" v. "care" question.  

Image: renjith krishnan / FreeDigitalPhotos.net

Jailed Convicts v. Seniors in Nursing Homes - Who has the better deal?

I already tweeted this great post from South Carolina Nursing Home Blog,  but it has been sticking with me.  All seniors have done is work hard their whole lives, age, and not have planned to need to spend $10,000 a month on the care they need to stay alive - and for that they get institutionalized in a nursing home.  Criminals steal, maim and murder and they get 3 square and rights as inmates that are closely monitored and enforced.  Nothing is so simple just to compare the two situations on their faces, but the question "Do we treat convicts better than our elderly?" deserves consideration.

Food for thought:

Let's put the seniors in jail, and the criminals in a nursing home. This way the seniors would have access to showers, hobbies,and walks, they'd receive unlimited free prescriptions, dental and medical treatment, wheel chairs etc. and they'd receive money instead of paying it out.

They would have constant video monitoring, so they could be helped instantly, if they fell, or needed assistance.

Bedding would be washed twice a week, and all clothing would be ironed and returned to them.

A guard would check on them every 20 minutes, and bring their meals and snacks to their cell. They would have family visits in a suite built for that purpose.
They would have access to a library, weight room, spiritual counselling, pool, and education, simple clothing, shoes, slippers, P. J.'s and legal aid would be free, on request.

Private, secure rooms for all, with an exercise outdoor yard, with gardens.
Each senior could have a P. C., T. V., Radio, and daily phone calls.

There would be a board of directors, to hear complaints, and the guards would have a code of conduct, that would be strictly adhered to.

The "criminals" would get cold food, be left all alone, and unsupervised.
Lights off at 8pm, and showers once a week.

Live in a tiny room, and pay $5000.00 per month and have no hope of ever getting out. Justice for all.