Elder Care; a global issue of finances vs. quality vs. avilable resources vs.........

Discussion in 'Politics, Religion, Social Issues' started by NickZac, Dec 28, 2010.

  1. NickZac macrumors 68000

    NickZac

    Joined:
    Dec 11, 2010
    #1
    So what do you all think needs to change in terms of elder care? Furthermore, how can we provide better care, contain costs, and plan for the future? Almost all industrialized countries are in hot debate.


    Background Info:

    100 years ago (in 1910), the average US lifespan sat at around 50 years. Less than 12% of the population (which was about 91 million in 1910) were older than 64 years. Families were huge, a lot of people died (especially at and around birth), and few people lived to a ripe old age. Also, family demographics were different as more people lived together. The top causes of death were almost all infectious disease; it may be hard to believe but diarrhea was a major cause of death in the early 1900s!!

    Today (from 2007 data), the average US lifespan is about 78 years. Most Western European nations have a slightly higher average lifespan. Almost all major causes of death are chronic diseases. About 15% of the population (which is about 310 million) live past the age of 64 (In Japan, around 22% are 65+!!!). Also, the birth rate has dramatically slowed and so there are fewer children and fewer persons ages 18-64 (which are the prime work years).

    All in all, the ratio of workers to dependents has changed significantly; there are many more dependents, fewer workers, and, a massive cohort (the Baby Boomers @ about 75 million individuals) are about to retire. All of those factors complicate the financial aspect and physical delivery aspect to providing adequate services in elder care. The lifespan is expected to increase, and the birth rate decrease. Fewer people are having to pay for more beneficiaries while the cost of living and the cost of medical care has increased. Private elder care is far too expensive for most people and sooner or later, older persons living in industrialized nations will have at least some aging-based services provided to them from the government. The bottom line is that there are fewer available resources to care for older persons and they will continue to decrease. All industrialized countries are facing current and/or future issues in elder care.

    How should we deal with this? Obviously, we need a system that is financially stable, but that system needs to also ensure a certain standard of quality care. I skipped a lot too so forgive me if I missed anything. Hopefully the Europeans will be able to explain their country's style of elder care in more detail.
     
  2. Ugg macrumors 68000

    Ugg

    Joined:
    Apr 7, 2003
    Location:
    Penryn
    #2
    This is a question that has fascinated me for the last decade or so.


    NIH

    The major issue for me is why we continue to offer and pay for, heroic medical measures in the last year of life.

    My story and it's been told here before is this. My maternal grandmother died in 2004 at the age of 86. Her husband had died 11 years earlier and she was his sole caretaker for the last two years of his life. It took a great deal out of her and while she was not an outspoken woman in general, when it came to EOL issues, she was a tiger.

    She got a Do Not Resuscitate bracelet, she filled out a living will, she took each of her 8 kids aside and told them she would come back to haunt them if they didn't respect her wishes. She also told each of us grandkids. She told her doctor and pretty much every one she could.

    She had been in reasonably good health, she didn't need any parts replaced and took a few meds but nothing burdensome. She collapsed at a friend's funeral, an ambulance was called and she was taken to the local hospital.

    If her wishes had been honored, that's where her life would have ended. She had a faulty ventricular valve and there was no hope for her long term survival. The hospital took it upon themselves to airlift her to a larger regional hospital because the small hospital didn't have the facilities. She lived three more days in an ICU room.

    I have no idea what the bill was for all that, but my guess is that it was way more than what her health care costs had been for the last 20 years.



    We have a system that is ill set up to respect people's final wishes. Maybe computerization can change that. But, we need to have a discussion about what we as a society are willing to pay for. Any discussion that ignores the enormous sums of money that are spent on wasteful tests, procedures and interventions will not get us anywhere.

    We're drowning in debt and
    In other words, over $100 billion is being spent on one year of Americans' life. When do we approach this subject sensibly?
     
  3. leekohler macrumors G5

    leekohler

    Joined:
    Dec 22, 2004
    Location:
    Chicago, Illinois
    #3
    The obvious solution to conservatives and people like fivepoint would be to just let them die. I mean really, they didn't plan well enough to live as long as they have and ran out of money. Why should we worry about them? :rolleyes:

    We should have voluntary death centers for these people. Those who simply realize they have nothing left to contribute and are nothing more than a burden on society should come to this place. They can be killed for a very low rate and disposed of accordingly (cremation encouraged). We appreciate them getting out of the way of the young who want their jobs. Life goes on, right?
     
  4. Ugg macrumors 68000

    Ugg

    Joined:
    Apr 7, 2003
    Location:
    Penryn
    #4
    What's your solution Lee?
     
  5. leekohler macrumors G5

    leekohler

    Joined:
    Dec 22, 2004
    Location:
    Chicago, Illinois
    #5
    Umm...gee- coming up with a way to support people if they've come upon hard times. Europe seems to be able to do it. Oh, sorry- forgot that they are evil communists. :rolleyes:
     
  6. NickZac thread starter macrumors 68000

    NickZac

    Joined:
    Dec 11, 2010
    #6
    Heroic medicine is indeed a major issue. Our medical system seems to do everything in its power and capacity to extend life physically. Even living wills, advanced directives, and DNRs often do not have the end result of having the patient says how they die. Western doctors as a whole seems to be scared of death and view the death of a patient as a failure.

    Obviously, in countries with universal health care, actual health resources are rationed due to only so many resources being available. It will be interesting to see how this evolves for the end of care resources allotted.
     
  7. Apple OC macrumors 68040

    Apple OC

    Joined:
    Oct 14, 2010
    Location:
    Hogtown
    #7
    There are just as many stories of people who have had positive results with heroic medical care. The answer is not to pull the plug on older people because they have reached an age where society believes that only the strong should survive. I do believe assisted suicide should be available to those who choose to go that route.

    If you reduced the heroic medicine ... you are leaning towards a trend of ... how low do you go? and who is worth saving? Just because one person's elders want to die early because they want to save the health care system money ... many more would choose to live to the very last breath.

    The countries with UHC all pay for it the same way ... the money is deducted from the people who work. ... Taxes.

    Countries that have this system will never start killing people off early to save health care costs, when they can always get the needed funds through higher taxes.
     
  8. Ugg macrumors 68000

    Ugg

    Joined:
    Apr 7, 2003
    Location:
    Penryn
    #8
     
  9. Apple OC macrumors 68040

    Apple OC

    Joined:
    Oct 14, 2010
    Location:
    Hogtown
    #9
    what happens first is they increase waiting times for medical care, they cut corners on certain procedures and they also raise Taxes ... Governments will always have the ability to take whatever Taxes are needed to cover UHC. Killing people early is just not part of UHC and most likely never will be.
     
  10. Ugg macrumors 68000

    Ugg

    Joined:
    Apr 7, 2003
    Location:
    Penryn
    #10
    Calling it "killing people" tends to squash any chance of discussion, doesn't it?

    You're putting all the focus on the government and while certainly they could do more, I think we as a nation need to have a discussion about end of life issues. How much are WE willing to pay for that last year of life? Is it worth a quarter of all Medicare Expenditures? Currently $100 billion a year.

    One thing I've always believed is that medical science has advanced so quickly, that medical ethics can't keep up.

    There are lots of nursing homes out there with Alzheimers patients and others whose minds have left them. One idea I've had is why keep pumping them full of medications for other long term illnesses? Wouldn't it be more humane to let that person go naturally instead of having their life prolonged by heroic medicine? Sure, it's a small step but keeping someone virtually tied to a bed with tubes running out of them doesn't seem all that humane to me and isn't that what medicine should be about?
     
  11. mcrain macrumors 68000

    mcrain

    Joined:
    Feb 8, 2002
    Location:
    Illinois
    #11
    I say draft every doctor, nurse and medical specialist into the military. Organize the provision of medical services so that doctors/nurses actually work reasonable hours and patients can get help in a reasonable amount of time. Eliminate the buracracy. No more unnecessary paperwork or stupid tests trying to CYA from potential lawsuits because there wouldn't be anymore.

    Pay the doctors fairly and pay the nurses great wages. Encourage people to go into the field similarly to the way the GI bill encourages people to enlist. Give them lifetime benefits and federal retirement. They should also open new government run, free medical and nursing schools.

    In addition, eliminate the profit-hogs of the industry. Private hospitals and most non-profit hospitals make money hand over fist. Physician owned labs where doctors send their patients have been created to maximize their reimbursement rates. Health care should be about health care, not shareholders or million dollar houses.

    Yes, I know THAT would be a government takeover of healthcare, but can anyone explain how doing that would reduce the amount of healthcare available? The only downside would be that there were more patients and a potential short term shortage of physicians to treat them.
     
  12. Eraserhead macrumors G4

    Eraserhead

    Joined:
    Nov 3, 2005
    Location:
    UK
    #12
    This means last year of life healthcare costs each American $25k over a lifetime. I don't know if that really seems worth it to me.
     
  13. rdowns macrumors Penryn

    rdowns

    Joined:
    Jul 11, 2003
    #13
    Just to clarify, there are 75 million baby boomers. Not all are about to retire. The last of the baby boomers are 48 years old. The oldest baby boomers will turn 65 in 2011.
     
  14. CorvusCamenarum macrumors 65816

    CorvusCamenarum

    Joined:
    Dec 16, 2004
    Location:
    Birmingham, AL
    #14
    Many Americans don't have $25k. Come to think of it, there are a lot of Americans that aren't worth $25k (net worth, that is).
     
  15. iJohnHenry macrumors P6

    iJohnHenry

    Joined:
    Mar 22, 2008
    Location:
    On tenterhooks
    #15
    The way that the Arctic ice cap is breaking up, there will be enough ice burgs floating about, to toss old farts like me aboard.

    It worked for our Northern ancestors.
     
  16. Ugg macrumors 68000

    Ugg

    Joined:
    Apr 7, 2003
    Location:
    Penryn
    #16
    Most of the boomers retiring now are at the peak of their earning power. It'll be years before their replacements earn the same amount of money which means reduced payments into SS and Medicare.

    It's also notable that today's boomers are less likely to simply fade away. They want all their joints to be as good as new so they can play tennis/golf/cycle, etc up until the very end.

    A growing field of elder care is robotics as well as remote health care. I have an uncle who had a quadruple bypass this summer and had a pacemaker installed. He has a device that plugs into the electrical outlet in their house which collects and transmits information that's fed into it from the pacemaker. With a constant feed, the doctor is able to monitor him constantly and only sees my uncle when his meds or diet need adjusting.

    It's not cheap but then it's also not cheap when people show up at midnight at the emergency room. The technology is promising but so far nobody has turned it into cost savings.
     
  17. NickZac thread starter macrumors 68000

    NickZac

    Joined:
    Dec 11, 2010
    #17
    Correct; but the amount of people who will be retiring starting in 2011 will be disproportionate to the population for the next decade and a half. It is also an immediate problem because many of the jobs that older works are about to leave do not have people from the younger generation willing (or capable) of replacing these jobs. Some are also critical for the functioning of our society.



    You do realize that taxes don't buy everything, right? Countries with universal health care ration care usually based on an age basis. Funding or not, there are limited resources. Many countries with universal health care put 'age caps' for organ transplant recipients (you can't buy stuff like organs, or more doctors or nurses).

    The US uses a financial system in which those who can pay get the services.

    You can't say one is inherently better, as both systems ration care which you seem to see as 'killing people'
     
  18. NickZac thread starter macrumors 68000

    NickZac

    Joined:
    Dec 11, 2010
    #18
    The Organ Donation-Transplant Issue

    Here's another question which is going to bring some discussion...

    There are not enough organs donated to match the number of needed transplants...so:
    1) do you think there should be 'age caps' on specific or all organ transplants? (ex: you are over age 65 and have renal failure, you do not get a kidney)
    2) do you think who gets organs should be prioritized by any one method?
    3) do you think that organs should be bought? (there is a black market for organs actually)
    4) do you think people who are NOT organ donors, themselves, should still be given an organ?
    5) do you think it is okay for elderly persons to sell certain organs (ex kidney) for money?
     
  19. iJohnHenry macrumors P6

    iJohnHenry

    Joined:
    Mar 22, 2008
    Location:
    On tenterhooks
    #19
    Have a nice day. :)
     
  20. Eraserhead macrumors G4

    Eraserhead

    Joined:
    Nov 3, 2005
    Location:
    UK
    #20
    ^^ What about if they have HIV/AIDs? How can they be an organ donor then?


    It wouldn't be fair to ban people from getting blood if they can't donate, as people can not donate for legitimate reasons (e.g. being a man who has sex with other men).
     
  21. Mac'nCheese macrumors 68030

    Mac'nCheese

    Joined:
    Feb 9, 2010
    #21
    I agree 100%. But in this country, the "morality" of people is that any type of decision that ends your life early is suicide and a sin. B.S. if you ask me.

    YES, YES, NO, YES, uh...maybe

    You're right. We shouldn't punish those who we don't allow to donate only those heathly enough to do so but refuse. BUT.... if they have HIV/AIDs, we raise the question of shouldn't the organ go to a healthier person. Kind of like giving a new liver to a guy with a drinking problem. Seems like a waste...
     
  22. Ugg macrumors 68000

    Ugg

    Joined:
    Apr 7, 2003
    Location:
    Penryn
    #22
    Ummm, you do realize that if a 20 year old is infected with HIV, he has a good chance of reaching his 75th birthday. Of course that's based on today's treatments, not what will be available 20 years from now.

    HIV treatment has come a long way in the last decade.
     
  23. Mac'nCheese macrumors 68030

    Mac'nCheese

    Joined:
    Feb 9, 2010
    #23
    That's a very good point.
     
  24. skunk macrumors G4

    skunk

    Joined:
    Jun 29, 2002
    Location:
    Republic of Ukistan
    #24
    I'd say that a reasonable cut-off point for organ transplant would be 80, which is approximately the average life expectancy, at least in our part of the world. Of course this might lead to a sudden rush by 79-year-olds to get themselves re-equipped just in case...
     
  25. iJohnHenry macrumors P6

    iJohnHenry

    Joined:
    Mar 22, 2008
    Location:
    On tenterhooks
    #25
    Sorry, I cannot agree, although 80 is not in play in my point.

    What of Stephen William Hawking, and his continued survival due to extraordinary efforts?

    I agree that a "committee" to decide who lives and who dies is not ideal.

    And although this smacks of survival of the fittest, or genetic selection, but what choice do we have, at the moment??
     

Share This Page