One topic I have found especially interesting this semester is the state of long-term care in America. Last week I explored what another country is doing. For this week, I wanted to see what innovations were happening in America. When it comes to taking care of our elderly population, there have been some recent innovations that represent a move towards patient-centered care. Once people saw the horrors of nursing homes that did not treat their residents like dignified people, they set out to change the status quo. Out of the darkness has come innovations like The Green House Project or the concept of aging in place that are designed to return autonomy and comfort back to our older Americans. Aging in place is defined by the US Centers for Disease Control and Prevention as “the ability to live in one’s own home and community safely, independently, and comfortably, regardless of age, income, or ability level.” An AARP report found that 90 percent of adults over age 65 would prefer to stay in their home. How can we make this possible though when there are safety concerns? Partners for Livable Communities and the National Association of Area Agencies on Aging are at the forefront of working to make Aging in Place a lifestyle for as many people as possible. As technology improves, so does our ability to make this a reality. There are assistive technologies, like home safety and security systems and telemedicine, that can be incorporated to make independent living possible. Policies and laws can be enacted that support working towards this goal. Far down the road, there are entire smart houses that can be made to address many of the common issues elders who live alone face. The concept of Aging in Place is great because there is room to tailor the experience to each individual and their needs.
The Green House Project is on a mission to create meaningful lives. They are a national brand, run on an evidence-based model proven study after study to work. Green House homes are staffed with healthcare teams and made with the help of expert consultants. They are working to transform long-term care with a focus on caring, living and thriving. The concept starts with actually changing the physical environment typical of long-term care. These houses are set up like actual homes. They feature an open kitchen, living room, access to outside and private rooms and bathrooms. There are only 10-12 people per house. The set up fosters building community. These facilities still meet federal and state licensing requirements. Not only is the living environment different, there is also a focus on caring. The Green Houses focus on changing the typical institutional organizational chart and enabling deep relationships between the residents and caregivers. There is a culture of nurturing care and a family experience through common dinners. Family and guests are welcome to visit. The residents are given flexibility in their preferences and personal routines. They are encouraged to pursue what they are passionate about and continue personal growth. With both of these concepts comes the question of how to pay for them. The frustrating thing about these places is they are only available to wealthier individuals. They are rather expensive and only accept a small number of people. I hope that eventually we can reach this style and level of care for all individuals, without money as a barrier.
My father-in-law, a small town general practice physician, would have loved to read about this concept. He passed away in April, and never spent a day in a nursing home. He was adamant about dying in his own bed. He never suffered any dementia and was in full control of his mental faculties up to the end. It's just that his 96 year-old body simply gave out. We were fortunate to have VA-funded home health care for activities of daily living, and he was hospice status the last year. He also faced reality early on and signed papers to be declared Do Not Resuscitate. The family's out of pocket expenses were minimal over the last 24 months.
ReplyDeleteYes, we were fortunate that he had VA benefits as a World War 2 veteran. But the primary thing we had going for him was his knowledge (as a retired physician) that the end was near, and he and the family peacefully accepted this. He wanted absolutely nothing heroic done.
Can his particular situation be extrapolated to the general US elderly population? I don't think so. I don't know the exact percentage, but I would estimate only a small minority of the elderly population has VA benefits. And likewise, few elderly have the benefit of a physician's education. Thus they (and/or the family) insist on doing everything to keep Ma or Pa alive, cost and patient suffering be damned.
I applaud the Green House initiative and thank you for this overview. Something for you to think about: should the federal government mandate everyone carry Long Term Care Insurance (legal concerns aside for purposes of this discussion). My wife and I obtained it in our 50's through my employer, and it costs ~$225/month. I'll be out of pocket $75,000 in premiums before we might (and I emphasize "might") need it. We might never need it. What could you suggest to policymakers if they asked Dr. Bonica's class for input on this issue?
Thank you for sharing your story with me. We had a speaker in class discuss hospice care and I found it an intriguing concept. I recently read Atul Gawande's "Being Mortal" and he talked about how many American's do what you mentioned: pay an extensive amount of money to extend the last few months/years of life. It is an interesting cultural component to our society.
ReplyDeleteThe concept of long term care is great in my opinion. It is awful hearing stories of people who go bankrupt paying for their care. I think long term care should be mandated, but not in its current state. I think that it is frequently far too expensive. A mandate would obviously drive up demand and hopefully thus lower prices. The insurance would help a lot of people later on. At the same time, I can see a lot of people being resistant because no one likes to think of getting older and the problems associated with that. This will be an interesting debate for years to come.