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"Hoping to Die at Home"
Old 09-29-2014, 05:50 AM   #1
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"Hoping to Die at Home"

Very sobering article to factor into future plans. The medical establishment seems to be focused on leveraging the infirm to extract payment:

http://www.nytimes.com/2014/09/26/ny...mid=tw-nytimes
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Old 09-29-2014, 06:54 AM   #2
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This is a good (but depressing) piece that uses some typical end of life tragedies to demonstrate how the financial decks are stacked against sensible end of life care. Medicaid, in particular, is structured to push people into rehab centers and nursing homes which end up exacerbating the old folks' problems while extending their final days. The article cites a NYT article about a National Academy of Science funded funded report on recommended changes to end of life care. The report itself is behind a pay wall. Absent legislation (good luck with the polarized Hill) the problems will just get worse as us boomers plug up the system. This is why I opted for LTC policies for DW and myself.
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Old 09-29-2014, 07:23 AM   #3
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Talk about dying at home........ last week there was a woman in the town next to us who passed at age 93 in the same room that she was born in on the family farm.

For those who think that she may have been a farm recluse, nothing could be further from the truth.... she was a fixture in the community and served in the state legislature. And her 9 children and 4 step-children are carrying on the torch.
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Old 09-29-2014, 08:06 AM   #4
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The article was nothing but depressing. Just can't think of anything else to add.
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Old 09-29-2014, 08:20 AM   #5
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Wonder what hiring one's own, personal, in-home care would cost (instead of depending on spotty, mediocre help paid for by insurance)? Maybe that is what we should be continuing to LBOM in retirement for!

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Old 09-29-2014, 09:28 AM   #6
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I've known 3 folks that chose to die at home. One was a prominent DR. could have gone anywhere. Hospice came in for palative care. IIRC, all 3 had family to care for them, aided by the proper help. In these cases death was quick(few weeks to 2 months).

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Old 09-29-2014, 11:23 AM   #7
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Very sad, sad commentary on how pathetically inadequate the "system" (and most of society") has become about dealing with end-of-life care, and death in general. In my experience, very few have the perspective, devotion, and energy that this woman had in her heart to fight for her father's dying wish.
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Old 09-29-2014, 11:27 AM   #8
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Every elderly person and patients with a life threatening condition should be aware of National POLST

I too would like to die at home but only if my caretakers have adequate assistance.
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Old 09-29-2014, 12:37 PM   #9
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In the past few years a number of home-care companies have opened up in our town. I think they are partly doing so to provide care now, paid directly by the patient, but also partly positioning themselves for future changes in how Medicaid subsidizes home care vs more expensive nursing home care.

The care provided in the NYT story is such a mess in many ways. Sad.
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Old 09-29-2014, 01:04 PM   #10
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Originally Posted by Amethyst View Post
Wonder what hiring one's own, personal, in-home care would cost (instead of depending on spotty, mediocre help paid for by insurance)? Maybe that is what we should be continuing to LBOM in retirement for!

Amethyst
The 93 year old lady living next door to me is getting just that and according to her son, its about $20/hour. She is getting 24 hour care daily as we see the different cars/aids change shifts in the late afternoon. Very expensive.
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Old 09-29-2014, 01:19 PM   #11
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Humm, that is about half what my LTC pays. If they are paying the caregivers directly add Social Security and Medicare taxes to that $20.
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Old 09-29-2014, 01:19 PM   #12
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........snip.....

The care provided in the NYT story is such a mess in many ways. Sad.
I couldn't agree more, just plain not right. I guess if I look at my DM's passing she was first sent to a nursing home in FL. They probably would not have allowed her to leave, as she couldn't do 2 ELFs. Luckily, I guess, she passed 6 months later. The 3 people I knew that choose home care, the social workers never got involved with until hospice was involved. In their cases each had aggressive cancer so it was quick.

I really believe how we pass is a family decision not an agency. I live my life pretty much how I choose, I feel it's my right to pass the same way.
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Old 09-29-2014, 02:05 PM   #13
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My mother is 85 years old and has been receiving 24x7 in home care for about 4 years now. It has its own set of problems: for $17.50/hour she receives naive young people, who often have had no experience caring for older people. The firm shows little interest in supervising it's employees and seems to have little interest in understanding Mom's health issues or cares, or of making sure any of us kids who live out of town, have enough information to know she's receiving adequate care. There are more issues but I'll stop for now....

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Old 09-29-2014, 03:02 PM   #14
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My mother is 85 years old and has been receiving 24x7 in home care for about 4 years now. It has its own set of problems: for $17.50/hour she receives naive young people, who often have had no experience caring for older people. The firm shows little interest in supervising it's employees and seems to have little interest in understanding Mom's health issues or cares, or of making sure any of us kids who live out of town, have enough information to know she's receiving adequate care. There are more issues but I'll stop for now....

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I can relate. DF was in assisted living his last year. The day shift workers said he was a joy to be around. My sister visited almost daily, she thought he got good care. We checked he wasn't sundowning.

The night shift was a different story. Their story was he was an abusive, mean person. That didn't fit his first 95 years of life. After his death one of the day shift persons apologized to sister for the actions of the night shift staff. They(night shift) get paid little and care less. It's sad that even with almost daily visits there were still questions of the quality of care.




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Old 09-29-2014, 03:17 PM   #15
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How can a nursing home refuse to discharge a resident?
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Old 09-29-2014, 03:30 PM   #16
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Agree with others .. a sad, sobering read ... but indeed what we have seen in the recent past with DM's passing in 2012.

She declined treatment, opted for home hospice, etc and I was POA (DD passed in 1990 and I am an only child). Ended up costing right about $2100 a week for 24 hour skilled care in home (in shifts 3x8 shifts). $12.50 per hour x 168 hours per week of coverage (24x7) (rural area of Mid-Atlantic state) as DW and I live 2500 miles away. Fortunate that DM had plenty of cash and that we were not planning on or relying on anything from DM financially. Also good that it only went on a few weeks (b/c DM was hurting not because of the $$). The hospice Co/Medicare/Medicaid and her primary doc worked well together -- but I hate to say I think it was the exception rather than the rule.

In hindsight, I will say that allowing her to die at home was very important to her once she had decided she had had enough. And DW and I are proud we could honor her wish in that way and preserve what remained of her dignity to the end. A wake-up call for all of our family, for sure, in tems of how hard it is to actually get that to happen even when the person in question is lucid, clear and firm in her decision-making as well as the costs.
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Old 09-29-2014, 03:38 PM   #17
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How can a nursing home refuse to discharge a resident?
I don't think it's the home, but assigned social workers. I know in DM's case she could change facilities, but home was not an option.

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Old 09-29-2014, 04:36 PM   #18
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Wonder what hiring one's own, personal, in-home care would cost (instead of depending on spotty, mediocre help paid for by insurance)? Maybe that is what we should be continuing to LBOM in retirement for!

Amethyst

It costs my aunt $13 an hour for a home care helper she found on her own to take care of my 86-year old uncle with Alzheimer's and a host of health issues. The wonderful woman is there 5 nights a week from 10pm to 10am. If working through an agency, my aunt was quoted anywhere from $16 to $25 an hour. My aunt also has another helper a few days a week so she can do errands and get out of the house.

They did get a hospital-like bed and one of those chair-gizmos to take him up and down the stairs for free from the VA.
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Old 09-29-2014, 04:54 PM   #19
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The article was nothing but depressing. Just can't think of anything else to add.
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Old 09-29-2014, 06:12 PM   #20
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Wonder what hiring one's own, personal, in-home care would cost (instead of depending on spotty, mediocre help paid for by insurance)? Maybe that is what we should be continuing to LBOM in retirement for!

Amethyst
I looked into this about a year ago. Thru an agency, $300/ day, in metro LA, all costs. The agency would do this with 2 paid 8 hour shifts, and one shift covered by an off duty caregiver sleeping, but also paid to be on call, on site, during the 3rd shift. The normal rate was about $20 hr for part time thru this agency.

If I had any Idea how little time Dad had left , I would have done this. If our souls meet up in an afterlife, I will have to answer for failing to get better care for him
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