John T said:
"70% of our health care costs are used in the last two years of life, so perhaps that's where we should start looking."
That thought brings to mind one approach to cost reduction that
I'm not sure we have discussed all that much here in forum threads: the substantial changes in our social structure that have occurred over the past century or so, changes which have significantly impacted increases in medical costs.
(Granted this may be getting a little away from the original thread topic, but since it's cost reduction related, and especially in view of John T's above figure of 70 %, maybe I could make a quick comment about
In fact, some of these changes were discussed, as some of you who participate in the forum book club may remember, when we talked about
Atul Gawande's "Being Mortal" a few months ago.
In his book Gawande made the point that even just a few decades ago it was common practice for families, as least in the U.S., to take in elderly relatives to live out their lives within the family structure, at a time when the hospice concept was still in the future (late 1960s at the earliest).
I know this is true because it happened in my family. In 1956, when I was 10 years old, my great-grandmother came to live with my father, mother and me. As a child I was pleased that "great-grandma" was coming to stay with us, but nobody told me at the time that she was really coming to die with us. I guess because of my age no one felt it necessary to inform me that she had been hobbled by a series of heart crises, had been given only a short time to live, and because it was family tradition,
it was now incumbent upon the family, and not the state or some institution, to see to her care in her last days, by taking her in.
She stayed in the guest room, which became her room, and my mother became her caretaker, with very frequent visits by my grandmother ("great-grandma's" daughter).
I still remember after all these years the sad day when I came home from school in the afternoon one spring day to be told by my mom that "great-grandma" had passed on that morning.
It was the end of a cycle that had been going on in my family for generations: the older relatives staying with and living their final days with the younger ones.
Two points. The first is that this form of home care undoubtedly saved a great deal of money, that would have had to be spent, if my great-grandmother had had to go into some kind of institutional final care.
But the second point is: how many modern families are either in a position to perform this kind of home-based caregiving, noble as one would concede that it is, and regardless of possible cost savings, with virtually all of us working now, or living in different parts of the country? It’s simply no longer feasible for many (most?) of us, and Gawande makes this point in his book.
But to a degree I am perhaps the 21st century version of this kind of family-based caregiving. My mother, who turned 97 recently, lives in a senior-oriented condominium about
a 15-minute drive from my house If necessary, I can drive to her quickly, if she has not already needed to push her Life-alert
button. At this point I do most everything for her now (bill-paying, grocery shopping, transportation to appointments, and the like) while a daynurse makes regular visits during the week to take care of her personal needs such as bathing or taking medications. (Mom isn't officially in hospice status, but because of her age-related disabilities, she is very much in a position similar to that of my great-grandmother back in 1956).
Will Mom out of necessity have to move into a nursing home at some point? We don’t know yet, but for now I am, as noted, doing the 21st century version of taking into one's home, so to speak, the elderly relative.
And so far the only cost to Mom is that daynurse. She owns her condo, and so far Medicare and a small pension is taking care of her medical and other, small needs, primarily food and utilities. Contrast that to the cost of living in a retirement community.
Apologies if this has been a bit long, but the point I have tried to make is that if some way could be identified to involve families more in the care of their aging relatives, instead of relying on an institutional, and expensive, approach to achieve this, state or otherwise, perhaps at least some of the costs could be reduced.
Chronic prostatitis (age 60 on)
BPH w/ urinary obstruction, 6/2011
Ongoing high PSA, 7/2011-12/2011
Biopsy, 12/2011: positive 3/12 (90%, 70%, 5%)
Gleason 6(3+3), T1c
No mets, PCa likely still organ contained
IMRT w/ HT (Lupron), 4/2012-6/2012
PSAs (since post-IMRT): 0.1 or lower
Post Edited (81GyGuy) : 11/10/2017 3:13:10 PM (GMT-7)