Allow Natural Death

Archive for July, 2011

Going away for awhile

I am going away from my writing as the Grateful Apologist for awhile, but I will leave you with this post from February…one of my all time favorites:

Love and Memory

For those of us who have experienced the death of a loved one, it is nearly impossible to forget the circumstances of their passing. For sudden and unexpected deaths, this is particularly true. Those are memories that can double as nightmares for most of us, and for those who have been there, it is hard to believe that we have lived to love another day. By taking the time to plan for our own good death, we have an opportunity to create a memory that will allow our passing to be one of peace, comfort and dignity. But it is not just our passing that will be a part of  the memories that we will leave behind…it is also the conversations we have with others about it.

Imagine sitting down with an elder loved one who tells you that they need your help. Many of us are already saying yes even if we are not saying it out loud, but then your loved says, “You know I am getting older and I won’t live forever. I want you to help me to be sure I die naturally and not hooked up to machines forever.”  What would you say? Would you tell your loved one that they are just being silly…they are fine and there is no need to worry about such things? Or might you say something like, “Tell me more about what is on your mind.” If you give some thought to how best to show your love, what do you think is the answer that your loved one most wants and needs to hear?

I am not sure if there is a subject that is more intimate than one in which we share our thoughts about our own death or that of a loved one. As we anticipate the sadness of loss or the fear of the unknown that death represents, it draws on our very core of humanness. We may have religious beliefs that inform our thinking on these topics. Or we may not. But it is certain that listening to an elder person who seeks conversation about what for them is a certainty growing ever closer, is perhaps one of the hardest things we will ever do. More so, when we love that person deeply and their conversation reminds us of  the fact that they will not always be here for us. It is possible that some of us will say no to the request – it is too hard to talk about such things – it is far too painful. But if you are one who has the courage to have these kinds of conversation, you will be helping to ease the burden of an elderly person who is aware that achieving our own definition of the good death requires the help of others. It is a time when the simple act of listening can bring peace of mind to your loved one. ..and perhaps a  beautiful memory to you.

But talking about death is scary. Gratefully there are resources to make this easier. Your local hospice should be able to advise readings or persons in your community who are experts in helping us plan the ways we would like to spend the last days, weeks, and months of our lives. Clergy persons are good to speak with as well. Keep asking until you find the assistance you need.

Be assured that the sharing that takes place with a loved one when the certainty of death is acknowledged, can be almost sacred. Exquisite listening is a way to give of yourself. Try. Have love and courage.

Sorry about that cash cow thing….

In my last post I made the comment that Medicare recipients were viewed as cash cows by hospitals that stood to gain the most financial reward from their care; that the fee for service model of health care business made them a bountiful source of revenue. My Domestic Advisor didn’t care much for my choice of words and I was almost ready to soften my language when this morning’s news report brought me a bit of validation. Turns out that in a breakdown of Medicare spending – in all regions of the country – parts of New York State are at the top of the spending list. Those areas also charge the most for an overnight stay in a hospital bed. They are also showing higher than normal numbers of nights spent in hospital.

I admit that my choice of words like “cash cow”, was perhaps overstating my point, and I do apologize if it offended, but it makes me mad to see the data supporting my contention that a Medicare recipient is a source of health care revenue for those organizations, facilities, and companies providing products and services for them. There is a LOT of that data too. See some of it here.

To my way of thinking, the fee for service model has broken the bank (or it will very soon), but what is FAR worse is the needless suffering perpetrated on frail elders at the end of life. Far worse.

The fee-for-service model can’t help frail elders

If you are a frail elder who has chosen to allow natural death rather than receiving multiple interventions, the fee for service model can’t help you to achieve a peaceful and dignified death…it just wouldn’t pay. If that sounds like an overly simplified statement then consider this: A community recognizes the difficulties facing frail elders at the end of their lives and decides that they will try to address the gaps where those elders have been falling through. The local hospice organization has agreed to make a nurse available 24/7 to explore options and admit elders to hospice services when it is appropriate. This hospice referral nurse, by admitting elders to hospice and returning them to their homes has avoided an admission to the hospital and all the attendant costs of testing, surgeries, treatments and all the many interventions to prolong life while sacrificing the quality of the end of that elders last days or weeks. For elders and their loved ones this is a bittersweet outcome, but one that will be supported by hospice staff…and all of it will be paid for by Medicare. Do I need to say that the hospice benefit is FAR less than the cost of prolonging life. I have oversimplified the changes that the current systems of care would need to make in order to deliver the manner of passing that most elders say that they want. And there are more than a few reasons why this plan could fail given the prevailing culture that is at work in most hospitals …data always makes clear that the preference of care providers (doctors and health care facilities) is to treat treat treat all ailments for all people all the time. But one fact more than any other would doom such a plan’s success and that is the financial repercussions on area facilities that have beds to fill – hospitals, nursing homes.

If a frail elder is admitted to hospice and returned to their home to die a peaceful death, much revenue will be missed by the hospitals where they would have previously been receiving tests, treatments, and Intensive Care stays. The fee for service model of care allows unlimited spending for Medicare patients and most of that spending occurs during the last two years of life. So really, it is just not feasible for a hospital to pass up such an opportunity to generate all those fees from all those services that can be brought to bear on an aged and failing body of a frail elder. Indeed, they could be seen as a wonderful cash cow….and for those who are so indelicate as to admit this …they are.

So when legislation is enacted that seeks to limit Medicare spending, there is an unstated hope that a frail elder who hasn’t long to live, will bear less resemblance to a cash cow for the hospital that will generate much needed revenue.  And until the fee for service model is changed…the cash cow will not be allowed a dignified passing….the hospital can’t afford it.

It’s all right here….

The New York Times is again saying it all so much better than I could – citing various folks’ opinions on changes to Medicare’s future.  All my favorite changes and challenges to the way we do health care business are covered here; Current Medicare recipients need to consider also the needs of younger generations as benefits are cut, Fee-for-service must END, More palliation and less intervention at the end of life….read it all right here.

Clearly, I am not the only person who is thinking that the way I am treated at the end of my life is an issue of sustainability.

The Grateful Apologist: Half way through

In my postings as the Grateful Apologist, I have reached the halfway point in my year of writing about the concepts of allowing natural death – advanced aging, frailty and death. I have considerable work to do if this work is going to reach the folks who may benefit from this other way of experiencing “old”.  “Courage my love” is my own mantra as I push forward with this work that still will not let me go.

There is no denying the spiritual nature of contemplating the end of life. And so I am including today a quote that sums up what I have found to be true. And thanks to my friend Grainne, here it is;

“Everything is a choice between fear and love, we may as well choose love because death is coming.”                                                                                                                                                                                -Simon Amstell