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How Will We Live at the End of our Lives?
By Howard Fensterman, Newsday.Com
July 24, 2009
Lost in the fierce debate over what our national health landscape will look like under the Obama administration is the overarching question of where we will spend the last years of our lives.
As an ever larger segment of the population lives longer and massive numbers of the Baby Boom generation make their way toward specialized care, the answer will distort and then dominate the broader debate over America's health care - regardless of where the president wishes to take it.
The nation's nursing home industry currently provides on-site, 24/7 medical care, supervised staff, registered nurses, physicians and a quality of life that has ensured that today's 1.35 million elderly Americans live in dignity. It has also become one of the most highly regulated, supervised and analyzed components of our nation's health care universe.
It is not without controversy. Over the past several years, large corporations have been purchasing nursing homes, changing their business models and inviting criticism over staffing. In addition, periodically, unscrupulous nursing home operators are uncovered stealing services or dollars. Their downfalls become a flash point in society's love-hate relationship with nursing homes and our unease in seeing our own mortality reflected inside their doors.
The new debate is over a profound change in how we care for the elderly, part of the top-down review of America's health care alternatives. Rather than have round-the-clock care in a centralized facility staffed by accredited professionals, some are proposing sending those patients home, accompanied by entry-level health care aides.
The chance of potential mistreatment at home of our elderly is a very real threat under this alternative. Either the federal government replicates the safeguards and bureaucracy now in place for centralized nursing home supervision, or it will be isolating the elderly within an unregulated environment, subject to the whim of their assigned caregiver.
The tracking of medical care and documentation of medications will become suspect under the government's current scenario, as tens of thousands of patients are scattered to individual homes. Gone, too, would be 24/7 emergency bedside assistance. Also at risk would be the socialization crucial to keeping aging minds engaged. We would, in effect, be warehousing our elderly inside their own homes.
President Barack Obama suggests one alternative is to place nursing home patients into community group homes dubbed "independent living centers." The administration has also directed HUD to provide additional Section 8 housing vouchers to help them find affordable housing.
aThese politically expedient alternative care concepts depend on our collective antipathy toward nursing homes in general and the underlying fear of where and how we will spend the last years of our life. Interestingly, only one in five nursing home residents responding to a survey by the Centers for Medicare and Medicaid Services indicated they would actually prefer to live in their home communities.
The fact that this issue has become part of the grand debate on how to reinvent our nation's health care is a reflection of how the nursing home industry has failed to project its innovations, caring, professionalism and compassion.
Before hundreds of millions of dollars in new health care expenses are placed on top of a teetering national economy to create so-called home care, there needs to be a thoughtful review of what nursing homes have achieved by providing effective elder care to a large and now significantly growing portion of our population - and what it will mean to knock it down for the purpose of rebuilding it.
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