Fighting to Honor a Father’s Last Wish: To Die at Home

This extraordinary, long, sad article in the September 26, 2014 NY Times, documents the last couple of years of a 92 year-old man’s life. He served our country in WWII, worked for the U.S. Postal Service and was a law-abiding citizen.  His wish was to die at home and his daughter tried to honor that, but the Medical-Industrial Complex is ill-designed to allow this.  This article is mandatory reading, not just for KOHD, but for any sentient individual concerned with how we die in America.

“Yet the system was never engineered to support families through this, and its financial incentives reward harmful transitions among homes, hospitals and nursing homes.

“We have these frail older people moving about in the medical-industrial complex that we’ve constructed,” Dr. Teno said. “It’s all about profit margins. It’s not about caring for people.”

Many geriatric experts say that if the wasteful medical spending on this stage of life could be redirected, it could pay for all the social supports and services actually needed by today’s fragile elders and their families. Instead, public money has been shuffled in the same system, benefiting health care businesses but not necessarily patients.

“To Dr. Joanne Lynn, a veteran hospice physician consulted for the Institute of Medicine report, the problem goes beyond perverse financial incentives. Most developed countries spend much less on medical care over all than the United States, but nearly twice as much on social supports.

“Why can I get a $100,000 drug but I can’t get supper?” she asked, pointing to the budget sequestration that slashed federal spending on meals for seniors last year.”

“It was the nurses aides who mattered most and earned the least, Ms. Stefanides reflected. The primary care physician whom GuildNet assigned to her father never met him. The nurses who showed up to treat his deep ulcers kept changing. Yet the two aides who split the week as “live-ins” were paid so little by a subcontractor that they had to take second jobs, they told her.”

“The records his daughter obtained showed that in the last year of his life, his care cost at least a million dollars. Was that the best, she wondered, that a million dollars could buy?

Click "Fighting to Honor a Father’s Last Wish: To Die at Home" to access full article.  

See also, IOM article on End of Life issues.