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Old 04-17-2016, 07:40 AM
 
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But back to the problem of the Silver Tsunami and the ballooning costs of medical care at the later stages of life.

https://med.stanford.edu/news/all-ne...emselves-.html

Fascinating that most physicians would not chose the aggressive medical treatments for themselves that they do for their patients.

We're not talking assisted suicide here, although that is certainly one of the issues, but whether to forgo chemo, radiation, surgery, etc. to prolong the struggle.

A friend's father decided not to pursue treatment for prostrate cancer. He was not interested in the side effects and said he was ready to go when the Lord called him.

His children were so upset. Even went to court to get him declared incompetent to make that decision. Judge agreed with the father that he had the right to make that choice.

Thanks to Medicare and supplemental insurance, those over 65 can obtain just about any medical treatment they can find a physician to agree to. The conversation would likely be vastly different if the cost was coming out of people's inheritance.

Last edited by GotHereQuickAsICould; 04-17-2016 at 08:53 AM..
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Old 04-17-2016, 08:00 AM
 
Location: New York Area
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Quote:
Originally Posted by GotHereQuickAsICould View Post
But back to the problem of the Silver Tsunami and the ballooning costs of medical care at the later stages of life.

https://med.stanford.edu/news/all-ne...emselves-.html

Fascinating that most physicians would not chose the aggressive medical treatments for themselves that they do for their patients
I repped this post. One of the best posts I have read on the subject!

The doctors know all too well that the end of life treatments accomplish little or nothing.

Quote:
Originally Posted by GotHereQuickAsICould View Post
We're not talking assisted suicide here, although that is certainly one of the issues, but whether to forgo chemo, radiation, surgery, etc. to prolong the struggle.

A friend's father decided not to pursue treatment for prostrate cancer. He was not interested in the side effects and said he was ready to go when the Lord called him.

His children were so upset. Even went to court to get him declared incompetent to make that decision. Judge agreed with the father that he had the right to make that choice.
People who implicitly favor heroic measures turn the discussion to the straw man of assisted suicide. While I don't have statistics I believe it is quite rare that an active, assisted suicide is wanted or needed. Usually withholding treatment does the trick. In the case I referenced above for "JA" for example she has received aggressive antibiotic treatments, and an amputation, for infections that under normal conditions would have felled her about three years ago. My mother, RB, had a digestive track blockage, a metastatic tumor removed that would have ended her life rapidly.

Quote:
Originally Posted by GotHereQuickAsICould View Post
Thanks to Medicare and supplemental insurance, those over 65 can obtain just about any medical treatment they can find a physician to agree to. The conversation would likely be vastly different if the cost was coming out of people's inheritance.
Back in the day families would have hard conversations about whether to allocate the usually small family fortunes towards college educations for the younger generations or towards Sisyphean and hopeless struggles to return an elder to a 22 year old condition. Usually the choice was clear.
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Old 04-17-2016, 09:03 AM
 
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My mother and I had a long conversation with her physician about her Advance Health Care Directive (AHCD).

It wasn't just did she want them to jump start her heart if needed, but whether she wanted long-term antibiotics, artificial nutrition or hydration...
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Old 04-17-2016, 09:10 AM
 
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Originally Posted by jbgusa View Post
I repped this post. One of the best posts I have read on the subject!

The doctors know all too well that the end of life treatments accomplish little or nothing.
Thank you. I've given it a lot of thought the last few years.

Read once about a longitudinal study of dialysis treatment. Those in early stages of renal failure usually stated they did not want dialysis. They did not want the side effects, the diminished quality of life, etc.

Except, when it got to the actual time, nearly all chose dialysis.

However, near end of life, many said they regretted that decision, mostly for what it put the people they loved through.

It may be that when we make end of life decisions early on, we make them with our own desires in mind. Towards the end, we may be taking into account the effects on those we love.

Just a thought. Not sure it is valid.
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Old 04-17-2016, 11:36 AM
 
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At my dad's end, and he was 95 and so ready to check out. All paper work in order, no life saving means etc....and yet when he was in hospital for a few days with an issue, 3 different cardio MD's came to my sister and I to give him a pacemaker...3 different MD's...we kept saying NO. Think about it folks, how much money they would make on those pacemakers. My dad died before he got to the hospice bed in his apt.
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Old 04-17-2016, 12:34 PM
 
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http://www.nytimes.com/2010/06/20/ma...er-t.html?_r=0

The Problem of Prolonging Life - The Atlantic

Pacemakers can be a poor idea for some.
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Old 04-17-2016, 03:23 PM
 
Location: Wisconsin
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Originally Posted by jbgusa View Post
That, and more importantly the failure of doctors to honestly present treatment options and likely outcomes. When my mother was choosing whether or not to have chemotherapy it was not explained to her the impact of her deepening dementia. Perhaps the doctor was in a hurry. Perhaps my mother should have been given more than 60 seconds to decide something so profound.

How could your mother of possibly only been given 60 seconds to decide on chemotherapy. After my husband's surgery to remove cancer he had three weeks to decide yes or no or what type of chemotherapy (BTW, this was years before he became disabled). While that may have been unusual, how in the world could a doctor force a patient to make an immediate decision?

Quote:
Originally Posted by charlygal View Post
Perhaps your mother and you could have done your own research. You could have forgone treatment and opted for hospice and palliative care.
Quote:
Originally Posted by jbgusa View Post
What's your suggestion? How do you forgo hospice and/or palliative care and not get reported to Adult Protective Services? I did lots of research.

What are your fantastic ideas?

The previous poster did not forgo hospice she said forgo treatment and put her into hospice.

What does her POA for health care state? If she stated in her POA that no-extra ordinary methods be done to prolong her life why would APS get involved if you are following her wishes?


I'm sorry but maybe I am missing something important or misreading something.
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Old 04-17-2016, 04:58 PM
 
Location: New York Area
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Originally Posted by germaine2626 View Post
How could your mother of possibly only been given 60 seconds to decide on chemotherapy. After my husband's surgery to remove cancer he had three weeks to decide yes or no or what type of chemotherapy (BTW, this was years before he became disabled). While that may have been unusual, how in the world could a doctor force a patient to make an immediate decision?
The scheduling starts almost immediately and the patient feels committed.
Quote:
Originally Posted by germaine2626 View Post
The previous poster did not forgo hospice she said forgo treatment and put her into hospice.

What does her POA for health care state? If she stated in her POA that no-extra ordinary methods be done to prolong her life why would APS get involved if you are following her wishes?
I had both a health care proxy and a POA. The problem is that if you don't do what hospice or the health care providers say they can, and will, report you to Adult Protective Services. Do you want to provide a defense on charges of "elder abuse"?
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Old 04-17-2016, 05:14 PM
 
Location: Wisconsin
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Originally Posted by jbgusa View Post
The scheduling starts almost immediately and the patient feels committed.
I had both a health care proxy and a POA. The problem is that if you don't do what hospice or the health care providers say they can, and will, report you to Adult Protective Services. Do you want to provide a defense on charges of "elder abuse"?

Maybe, my husband's situation was different than most. After he was released from the hospital after his surgery, he had time to visit two different oncologists in their offices, and completely discuss and research various treatment options (heck, I even read medical research on-line about the different options). There was absolutely no pressure to make a rush decision even though it had been a "stage three" cancerous tumor. I believe that he started chemo three weeks later.

Maybe your mother just had a bad doctor or a doctor with a bad bedside manner.

Regarding hospice & elder abuse. Your situation was very, very different than the experiences of my friends whose parents or other relatives went into hospice.

Maybe there was just something unusual about either the hospice providers or your mother's situation.


I'm sorry that happened to you and your family.
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Old 04-17-2016, 07:48 PM
 
Location: Raleigh NC
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Originally Posted by jbgusa View Post
The three relatives in question in question are, and I'll use initials:

RB - My mother;
JA - My mother-in-law;
GB - My stepmother-in-law; and



They are, collectively, the tale of what has gone wrong with modern medicine, and why, no matter what Hillary Clinton, Bernie Sanders, Ted Cruz, John Kasich or Donald Trump say, we're heading into a brick wall. All (with the limited exceptions of EB and SB) are examples of egregious and largely spending on health care. All except JA, who has suffered from multiple sclerosis for about 45 years developed their illnesses after they turned 75. And even JA's most expensive health crises have developed starting just before she turned 75.

RB – Exhibit “A” for my point. Her situation is the biggest illustration of futility. My mother died in 2014 at age 82. She barely knew a sick day in her life until 2007, when she began experiencing vaginal discharges. The cause was not diagnosed until the summer of 2008 when she had a hysterectomy. The doctors knew that there had been some spread so she went through a tough battery of chemo and x-ray treatments. Those weakened her ankle sufficiently that she experienced a severe break, and after surgery for that, a few weeks of rehabilitation.

During late 2011 she experienced a colon blockage. After the proctoscope examination, where the probe could not be completed because of blockage I asked the doctor if the cause could be metastasis from the earlier uterine cancer. Before I finished my sentence he said “no.” She emerged from surgery with dementia, which waned and then waxed again. She also had another round of chemo. She went on 24 hour home care from fall of 2013 until her death in 2014. Her long-term care insurance paid for this.

The toll on me was severe. I wound up losing my job, partially over the distractions involved. And my wife was diverted from helping her own parents, whose condition was worsening. So, about six and a half not very good years, and lots of money down the drain.

JA – My mother-in-law has been fighting MS for about 45 years, give or take. She was ambulatory till about 1995, and then has been wheelchair bound.

The other health problems began with a leg infection a bit more than three years ago, which ended in the amputation of one of her legs. Last fall, she suffered another infection and hospitalization, which caused some serious depression last fall. After a brief recovery, she was back in the hospital in early April, for e-coli and other infections. During this hospitalization she had a kidney stone removed and a urinary stent installed. She’s recovering now but about the only thing that moves are her lips, digestive tract and lungs.


GB – Almost 79 years old. Around the first half of Marh my wife's stepmother had a fall and felt dizzy in her second home, a Florida apartment. My father-in-law and my wife's stepmother normally live in New York City. She has been having bouts of dizziness and seizures in the last three or so years. For rest of story Great Train Escape - Or Getting Relative Out of Crooked Rehab Facility. She also has had other seizures and now recurrent melanoma.

The overall theme of this is lots of medical care, almost no quality of life. There is nothing any politician is going to do, whether with a return to pre-Obamacare conditions or a single-payer system, that will resolve any of this.

Does anyone else see a solution?
I agree, this kind of situation does take a toll on caregivers,and I'm sorry you seem to have more than your share to deal with!

I don't understand what any of your stories have to do with the heath care system itself. People get old and sick. Illness is a challenge to quality of life. What did you want the government or politicians to do for your elders?
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