More senior citizens are dying at home - Miami-Dade - MiamiHerald.com

By John Dorschner

jdorschner@MiamiHerald.com

After years of experts and patients saying people at the end of life might be more comfortable dying at home, a new study says that may finally be happening: fewer seniors in the United States and South Florida are dying in hospitals.

But the same survey finds that in the last months of life for seniors throughout the United States and especially in Miami, the trend is for more of them to see large numbers of specialists and to spend more time in expensive intensive care units.

Those are the results of the latest study from the Dartmouth Atlas, a project of the Dartmouth Medical School. The project for years has been using Medicare data to expose anomalies in healthcare costs and wide geographic disparities in expenses.

“Miami is practically off the charts,” says David Goodman, a Dartmouth researcher who was the lead author of the study. “It really continues to stand out” for having the highest costs and most extensive treatments in the last months of life, even when adjusted for age, ethnicity, race and severity of illness.

via miamiherald.com

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This American Death: The Movie

How has the pursuit of a good or natural death been altered by advances in medical technology which now can almost always extend life, if only for a few minutes, hours or days? Who does not question their Do Not Resuscitate order with death staring them in the face? How can doctors be expected to manage death when they receive so little end-of-life training? And where can a person go to die in peace, if they have no family and do not want to endure hospital procedures?

This American Death explores the complicated world of death and dying in contemporary America, examining the cultural and systemic issues which conspire against Americans experiencing a so-called good death. Despite the consensus that exists among Americans about how they wish to die - surrounded by loved ones, pain free and relatively unaided by technology - why do so many still die in hospitals, in pain, supported by machines? The film looks at why, when a good death is seemingly achievable, few actually experience one?

via thisamericandeath.com

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The care was futile, and the patient's wishes, KevinMD.com

by Jim deMaine, MD

“We have a patient on a ventilator here who is stable enough to transfer to your ICU, if that’s OK with you.”

This call, coming from the transfer coordinator, is emblematic of an insurance generated “medical care” coverage issue. I am salaried under the patient’s insurance carrier so the insurer wants this patient back under its wing as soon as possible.

The community hospital has been keeping Stella Norris (not her real name), an 89 year old woman, as long as possible. She is incapacitated from a massive stroke suffered five years ago. There is a feeding tube inserted through the stomach wall and she has needed total body care. 911 was called when she stopped breathing and she was taken to the closest hospital.

via kevinmd.com

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I'll Never Ration. Not Me. Not I. - NYTimes.com

Opposition to health-care rationing is a little like opposition to growing up. It sounds great. It’s just not very practical.

A society’s resources are always limited. So we have to make choices about what we can afford and what we can’t. Not everyone can afford to own a vacation home — which means vacation homes are rationed. Not everyone can afford to live in towns with excellent public schools — which means that good public education is rationed.

Similarly, we can’t afford to try every feasible medical treatment on every patient. Instead, we make choices. The most obvious form of rationing is the millions of Americans who lack health insurance today. Most of them get less medical care than they need and, in the process, keep down the nation’s total medical bill.

But even those with health insurance experience rationing. How? In many ways.

This country has not spent the money to install computerized medical records, and we suffer more medical errors than many other countries. We underpay primary care doctors, relative to specialists, and we’re left stewing in waiting rooms while our primary-care doctors try to see as many patients as possible. Specialists are usually not paid for time they spend collaborating with doctors in other specialties, and many hard-to-diagnose conditions go untreated. Nurses are usually not paid to counsel people on how to improve their diets or remember to take their pills, and manageable cases of diabetes and heart disease become fatal.

via economix.blogs.nytimes.com

At some point we'll need to accept the fact that we cannot all have every test, every operation, every treatment, every new medicine or see every specialist.

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Death in a hospital is not always comfortable, KevinMD.com

In America, too many people die in the hospital.

I don’t mean that they die due to medical error or incompetence, though that’s always a hot topic of discussion amongst doctors, researchers, administrators, and regulators.

What I mean is that if you ask most people, they say they’d rather die at home, surrounded by their loved ones, drifting off to sleep painlessly after having had last rites administered (feel free to plug in your religious/atheistic ritual of choice here).

Why, then, do so many who want this type of death instead die medically, here in the hospital, undergoing painful treatment and the deprivations and degradations of medical care?

The answer has both simple and complex aspects. But I’ll start by sharing something that most medical professionals believe:

When my time comes, the last place I want to be is in the hospital. Don’t get me wrong–I like GlassHospital–it’s a good place to work, teach, and learn. But when the grim reaper is calling my name, I want to be as far away from here as I can.

No IVs. No needle sticks to test my blood. No waking me up to check vital signs every shift. No hospital food. No fluorescent lights.

No feeding tubes; no bladder catheters (ouch!); for Heaven’s sake, no breathing machines (‘mechanical ventilators’).

via kevinmd.com

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