Most families with loved ones in nursing homes know that our current healthcare system is inadequate for people nearing the end of life. Our nursing homes are understaffed and underfunded, we continue to pour money into treating illnesses instead of patients, and the population as a whole are living longer and longer. Elder law attorneys at Pintas & Mullins offer a glimpse into this complex problem, and what prompted a national committee to call for a large-scale overhaul.
In the mid-1800s, life expectancy ranged around 45 years; today, the life expectancy is around 80 years. The factors driving this are multi-faceted and not exclusive only to rich or developed nations - every nation's citizens are enjoying longer lifespans. Although there are obvious, unprecedented benefits to this, there is also considerable worry regarding our nation's healthcare.
The Institute of Medicine recently appointed 21 nonpartisan officials to a committee to discuss, research, and attempt to fix how we handle end-of-life care in the United States. The committee released a report on Wednesday, including recommendations to change current Medicare and Medicaid policies. The simple truth is that, if nothing is done, our healthcare costs will balloon out of control, leaving no resources leftover for other social issues.
Many changes will take congressional action to accomplish, such as providing better long-term coverage for elderly Medicaid patients. Other ideas would take a science and research overhaul, to emphasize living healthily into old age instead of just tacking on a few more years in the nursing home. In other words, instead of treating ailments after they happen, we must focus on prevention.
Many elderly people, particularly those in nursing homes, live out their last years in progressive disability and illness. If elderly patients received the care they personally desired, would they not be happier and, in turn, healthier? Instead of trying to treat elderly patients retroactively, officials are trying to urge Medicare and other insurers to have conversations with patients on advance care planning, well before that time comes.
The panel was made up of experts from all fields, including lawyers, doctors and nurses, insurers, aging experts, and even religious leaders. In their report, titled "Dying in America," they ask for a major restructuring of our health care delivery programs, along with elimination of the current incentive programs that encourage expensive tests and treatments with no real value.
Our current insurance system reimburses doctors for performing procedures or implanting medical devices, regardless of whether it is the right or wanted choice for that patient. This type of fee-for-service medicine is the center from which the change must come. Panel members were adamant on this point - saying that if the current law does now allow this to change, then the law itself must change.
Instead of extensive, complex surgeries, elderly patients far and wide prefer low-tech services focused on home-based care and pain management. In this vein, medical groups need to greatly increase training for palliative care and establish guidelines for patients who wish to avoid extensive procedures but still wish to be treated compassionately. Not only would this make heath care more satisfying for those patients, but it would lower the overall burden on the system in terms of dollars.
Ezekiel Emanuel recently wrote an article in The Atlantic stating, very bluntly, that he hopes to die at age 75. He discusses the type and amount of health care he would consent to after 75, and he is adamant that stretching out old age is not the life he wants. He cites statistics from various studies showing, among other things, that half of American women aged 80 and older had a functional limitation.