As I age there is one thing I am very sure and emphatic about. When the time comes I want to die with dignity at home. We are reading and hearing about many seniors who have lived their lives with dignity being treated in a non-caring, hostile and even abusive manner as death approaches. They are not dying with the dignity they are entitled to. They are not given the opportunity to pass away in the comfort of their own home, surrounded by their worldly possessions, their books, their music, the food they enjoy, pictures showing their lives and most importantly privacy. Many are forced to be sentenced to uncaring nursing facilities, impersonal hospice care or to hospitals which are way too eager to discharge them not to home but to a facility which has as its main goal to make money such as a nursing home or a hospice.
Nursing homes can cost five to ten times what it costs for home health care. Way too often home care agencies refuse to take on new patients or drop patients because they claim that they are unable to make the profit they want under the NYS Medicaid Laws. Medicare does not help. For a person to receive home care under Medicare a doctor has to state that the person has only six months to live. Home care under Medicare is only for a few days per week not the daily care needed. If a patient accepted the home care under Medicare which pays more than Medicaid the daily visits provided through Medicaid would end. This is a Catch 22. A recently released report “Dying in America” issued by the federally funded Institute of Medicine has called for a total overhaul of our nations end-of life care. Medicare has to emphasize home care and not hospital/hospice care for those near the end of their lives. It called for “major reorientation and restructuring of Medicare, Medicaid and other health care delivery programs” and the elimination of “perverse financial incentives” One committee member stated, “If you meet their needs, treat their pain, treat their depression, get them some help in the house, your costs plummet,” It is interesting to note that this bipartisan panel was funded in the amount of $1.2M by an anonymous donor who gave no input as to its members or how the study was conducted.
As our longevity increases and people reach their 80s, 90s and older the need for a coordinated system to allow end-of-life care to be in the way the patient and not the system or the provider wants. Personally I would favor assisted suicide at a point and with proper counseling. I feel that one option is to be able to designate a friend or relative to be with the person during the end-of-life stage to provide home care functions, reading of vital signs and other non-medical needs. They should be paid at a rate commensurate with what they are doing. This would cost much less than hospital or hospice care. In no way am I saying that all hospitals and hospices are bad and only interested in financial gain. Calvary is one with the most humane treatment at the end-of-life.
I strongly urge that our elected officials, Federal, State and City come up with a coordinated plan for end-of-life procedures favoring the right to die at home. As always I elicit comments and suggestions.
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