It’s Time to Act Courageously
A summary of: Byock, I. (2010). “It is Time for our Generation to Act Courageously.” ADEC Forum: The quarterly publication of the Association for Death Education and Counseling, 36(2), 1-5.
Nowadays, people are living much longer with chronic, serious illnesses and the aging population is growing drastically. This lends itself to the growing number of elders who need comprehensive care through the end of life.
Dr. Byock, Director of Palliative Medicine at Dartmouth-Hitchcock Medical Center, described a typical patient he encountered in his work. “Dennis”, an 83 year old man who was hospitalized three times in three months, the first for chest pain, another for fever and confusion, and the third for a fall caused by low blood pressure, was challenged by a steady physical decline and increasing level of difficulty in being able to care for himself. He discovered that finding basic assistance such as someone to come to his home to check his blood pressure and help him manage his medications, help him dress, bathe and prepare meals was very difficult to come by. Dennis did not qualify for hospice under Medicare guidelines, unless he chose to give up dialysis, thus, embrace his dying. Dr. Byock explained that the team had to send Dennis home from the hospital with inadequate support.
Though the number of people dealing with situations like Dennis’s is growing, services that specialize in the comfort and well-being of patients (and their families) through the end of life such as palliative care programs and hospice, are often sparsely available or underutilized. Hospital-based palliative care programs, like the one Dr. Byock is part of, exist only in a third of American hospitals and many are minimally staffed. The majority of people that will receive hospice care will begin receiving care long after they have become eligible for the service. Further, the nation’s long term care facilities are understaffed and direct care workers are treated as entry-level employees.
Cultural avoidance of death and dying, the fact that other pressing issues such as natural disasters and the economic crisis are calling our attention, and the stigma associated with palliative care and hospice are some barriers to needed change in the arena of illness and end of life care. Our society is in great need of breaking down these barriers in order to provide care to people throughout life and illness, across the spectrum of home, assisted living, skilled nursing, and acute care settings.
One suggestion is to connect the dots between social services, health care, and basic civic services. For instance, in small communities, there could be roles for police, firemen, mail carriers and delivery service personnel, as resources to monitor and help the elderly. One example of this is having someone from Meals on Wheels check in on a client when they come to deliver a meal.
The article displays a list of examples of potential policy objectives that would instill positive change on the front of end-of-life care. Some of these include:
- Connecting standards for safe minimum staffing in nursing homes and assisted living facilities to licensure and reimbursement.
- Expanding education in pain management, care planning, communications, geriatrics, hospice and palliative care of all medical and nursing students tied to accreditation and funding.
- Eliminating the arbitrary distinction between “curative” and palliative care under Medicare, Medicaid, and private insurance.
We are at a point where a strong and significant social and political action is required in order for our society to be able to provide good care to the growing number of elderly people with chronic illnesses who are facing the end of life. This article provides an illustration of this growing need and provides examples of tangible ways to create change.
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