National shortage of home-care workers threatening the option of aging at home (drug, raising)
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The problem is that "big government" creates problems as well as solves them. For example, as you discussed, Medicare and Social Security makes possible a decent life well into old age. But it also creates a lot more people in old age.
Back in 1937, when Social Security was inaugurated, 65 was the retirement age. Though SS had some Ponzi Scheme attributes it really wasn't bad. Medicare, when established in 1965, presented a way for people to get health coverage after their years of employment, and was frankly, in some respects, needed once health care priced itself out of the ability of most to pay privately. This did two things: 1) created a spiral that drove medical prices up faster than inflation; and 2) extended people's lives, destroying any rational actuarial assumptions. We now have many living into their 90's. Many of those would not be alive if, say, people had to choose between their grandchildren's education and an expensive medical procedure that would be expected to have little or no benefit.
Saving up for maybe five years of retirement was probably a lot easier than saving up for thirty years of retirement.
It’s not having more insurance that extended peoples lives, it was advances in medicine. They didn’t have cholesterol lowering drugs and drugs to lower blood pressure. They didn’t do angioplasties or have tests to detect cancer or clogged arteries. They couldn’t save babies born 4 months premature, etc etc.
I agree about insurance driving price increases though. But it’s all health insurance.
But also back then a doctor could charge $5.00 because he didn’t have $600,000 in student loans and to pay back nor need $2000 a month for malpractice insurance. So it’s multi-faceted with insurance only partly to blame.
And now that it’s mostly corporate the profit factor and needing next quarters numbers to be higher than last is yet another even bigger driver of rising costs.
It’s not having more insurance that extended peoples lives, it was advances in medicine. They didn’t have cholesterol lowering drugs and drugs to lower blood pressure. They didn’t do angioplasties or have tests to detect cancer or clogged arteries. They couldn’t save babies born 4 months premature, etc etc.
Back in the day, though, even if treatments were available hard decisions about how to pay for them were needed. Now finances are no longer an issue for any given procedure. Thus an 85 year old, say, had to make a decision about an angioplasty, whether the procedure was worth draining a grandchild's potential educational nest-egg. While it was a cruel decision, the current third-party pay system inevitably results in waste.
Back in the day, though, even if treatments were available hard decisions about how to pay for them were needed. Now finances are no longer an issue for any given procedure. Thus an 85 year old, say, had to make a decision about an angioplasty, whether the procedure was worth draining a grandchild's potential educational nest-egg. While it was a cruel decision, the current third-party pay system inevitably results in waste.
I can see the hankering for the past. You have made your point that grandma should be leaving her savings for the grandchild’s nest-egg rather than waste it on getting medical attention and living longer. And, yes - third-party pay (not just in retirement) reduce disincentive for controlling the usage of healthcare. That’s one point of view. On the other hand, we have a massively overpriced healthcare system where the grandma would have to make such a choice, should she be paying out of pocket as you might prefer.
I can see the logic - were the old folks just died quicker and stopped taking their time about it (and left their assets as nest egg for the grand-child), the shortage of home-care workers would become a glut. Maybe that’s the answer but I’d think not.
There are fewer younger people due to demographic shifts of aging population globally (not affected by the specifics of the US situation), low unemployment, higher wages and shortage of workers. So, the simplest answer is that the hard-work and low pay combined with the broader context is what’s responsible.
I can see the hankering for the past. You have made your point that grandma should be leaving her savings for the grandchild’s nest-egg rather than waste it on getting medical attention and living longer. And, yes - third-party pay (not just in retirement) reduce disincentive for controlling the usage of healthcare. That’s one point of view. On the other hand, we have a massively overpriced healthcare system where the grandma would have to make such a choice, should she be paying out of pocket as you might prefer.
I can see the logic - were the old folks just died quicker and stopped taking their time about it (and left their assets as nest egg for the grand-child), the shortage of home-care workers would become a glut. Maybe that’s the answer but I’d think not.
I see this post as a naked appeal to emotion. What if, as is likely, the treatments grandma gets succeed in a minuscule lengthening of life, for, say, $80,000? What if the quality of life is absent? I just fund out an uncle who wsa the family's brain trust is, at age, 93, acutely demented. I last spoke to him in March and he sounded like he was slipping but not gone. My friend's mother, at 98, is mentally sharp but it is difficult to get her out of her fetid second-floor apartment, in a walkup, safely. Why, oh why, are we prolonging those "lives"?
And the massively overpriced health care system is that way for a reason. As Willie Sutton said, "that's where the money is." Maple Avenue and East Post Road in White Plains are literally being reconstructed as glittering additions to White Plains Hospital!
I see this post as a naked appeal to emotion. What if, as is likely, the treatments grandma gets succeed in a minuscule lengthening of life, for, say, $80,000? What if the quality of life is absent? I just fund out an uncle who wsa the family's brain trust is, at age, 93, acutely demented. I last spoke to him in March and he sounded like he was slipping but not gone. My friend's mother, at 98, is mentally sharp but it is difficult to get her out of her fetid second-floor apartment, in a walkup, safely. Why, oh why, are we prolonging those "lives"?
And the massively overpriced health care system is that way for a reason. As Willie Sutton said, "that's where the money is." Maple Avenue and East Post Road in White Plains are literally being reconstructed as glittering additions to White Plains Hospital!
Have you filled out a Health Care Directive and filed it with your state to be sure you don't become one of those old people who are no longer worth caring for? You can state on the form under what conditions you don't want to be saved.
I agree that an old person with advanced dementia should not be given any major surgery or other extensive medical procedures. But in the case of the mentally sharp 98 year old... why hasn't a relative or friend moved her to a more suitable living arrangement? She sounds like one who should be given every chance to keep living.
I see this post as a naked appeal to emotion. What if, as is likely, the treatments grandma gets succeed in a minuscule lengthening of life, for, say, $80,000? What if the quality of life is absent? I just fund out an uncle who wsa the family's brain trust is, at age, 93, acutely demented. I last spoke to him in March and he sounded like he was slipping but not gone. My friend's mother, at 98, is mentally sharp but it is difficult to get her out of her fetid second-floor apartment, in a walkup, safely. Why, oh why, are we prolonging those "lives"?
And the massively overpriced health care system is that way for a reason. As Willie Sutton said, "that's where the money is." Maple Avenue and East Post Road in White Plains are literally being reconstructed as glittering additions to White Plains Hospital!
Well - “we” do not get to decide what treatment grandma gets or does not get. She or her medical representative / directive does. “We” are not prolonging her life - presumably she is. And, last I checked, euthanasia is not legal in the US and most other countries, for very good ethical reasons that seem to elude you. Unfortunately, we do not have even a legal right assisted suicide for the most parts in this country - and limited one in in some parts [something I support and highly].
I, for one, am not interested in unnecessarily prolonging my life but that’s in abstract. How easy is it to make a decision when it is to be made could be different story. And, in most states - there is no “decision” to be made as it is not a legal option available to one. Yes - there are those who would point to a gun or starving oneself as a way out but how can someone with dementia exercise even that option. Or, folks such as myself who do not have or plan to own a gun.
So, even though I am not inclined to unnecessarily prolong my life, I am not comfortable with outsiders pressuring others to let go because these outsiders have decided that the old person’s useful life is over and they are consuming precious resources. And, that’s the judgment you are suggesting. And, your logic would extend to others, for instance, younger handicapped people as well. There are, in fact, many examples of abuses of precisely your logic have happened - Nazi era to begin with but elsewhere it is legal as well.
If, on the other hand, you were arguing for an un-encumbered right to die - I’d very enthusiastically support you.
Back in the day, though, even if treatments were available hard decisions about how to pay for them were needed. Now finances are no longer an issue for any given procedure. Thus an 85 year old, say, had to make a decision about an angioplasty, whether the procedure was worth draining a grandchild's potential educational nest-egg. While it was a cruel decision, the current third-party pay system inevitably results in waste.
Have you filled out a Health Care Directive and filed it with your state to be sure you don't become one of those old people who are no longer worth caring for? You can state on the form under what conditions you don't want to be saved.
I agree that an old person with advanced dementia should not be given any major surgery or other extensive medical procedures. But in the case of the mentally sharp 98 year old... why hasn't a relative or friend moved her to a more suitable living arrangement? She sounds like one who should be given every chance to keep living.
That is making a judgement call, exactly the same as the poster you replied to did as well when they asked "why oh why are we prolonging those 'lives.' " Judgement calls and opinions differ wildly on this type of subject, even among health-care professionals and medical ethicists. And many people's opinions change as they move thru one age-group to another as it is wholly natural to adapt your position to your vested interest, much like politics. Very few people are capable or even desirous of taking a stance that will endanger their own interests for the good of others.
I will give you the example of my own Father, who is a very, very good man in many ways, and is someone I care deeply about. Earlier this year, thru a series of painful events, he was diagnosed with alzheimer's. Thankfully, his cognitive decline is very mild at this stage and he is living, for the most part, contentedly (for now), in an upscale ALF (where I wouldn't mind living myself). But there was a lot of drama getting him there. I will just say it flat out- he was willing to allow his children to somewhat wreck their lives in order to have what he wanted, how he wanted it, and where. He was/is a good Father and he cried, felt sad, but that fact remains in black and white. I have read many stories on the care-giving forum (where I posted when my Father first began experiencing difficulties-- such kind replies!) of how common this type of 'me, not thee' thinking becomes. Aging can be an incredibly sad and resource-consuming process. And yet, yes, I would prefer my Father to live forever, as would he, naturally.
But, if I had to choose between allocating resources so that my Father could live forever and allocating resources to meet the needs of the youngest members of my family? There could be only one choice, as my Father has had a full life of almost 86 years and my youngest nephew is only 13. And keep in mind that I have known and cared about my Father all my life and have only a moderate relationship with this teenage boy... but fair is fair.
And don't think that I exempt myself from wanting to live forever, when the time comes, no matter the cost to society and others. I don't think that I would want to be a burden upon others, but I have seen/heard enough to believe that this is easier to say, than to do...
Last edited by herringbone; 10-08-2022 at 10:25 PM..
That is making a judgement call, exactly the same as the poster you replied to did as well when they asked "why oh why are we prolonging those 'lives.' " Judgement calls and opinions differ wildly on this type of subject, even among health-care professionals and medical ethicists. And many people's opinions change as they move thru one age-group to another as it is wholly natural to adapt your position to your vested interest, much like politics. Very few people are capable or even desirous of taking a stance that will endanger their own interests for the good of others.
I will give you the example of my own Father, who is a very, very good man in many ways, and is someone I care deeply about. Earlier this year, thru a series of painful events, he was diagnosed with alzheimer's. Thankfully, his cognitive decline is very mild at this stage and he is living, for the most part, contentedly (for now), in an upscale ALF (where I wouldn't mind living myself). But there was a lot of drama getting him there. I will just say it flat out- he was willing to allow his children to somewhat wreck their lives in order to have what he wanted, how he wanted it, and where. He was/is a good Father and he cried, felt sad, but that fact remains in black and white. I have read many stories on the care-giving forum (where I posted when my Father first began experiencing difficulties-- such kind replies!) of how common this type of 'me, not thee' thinking becomes. Aging can be an incredibly sad and resource-consuming process. And yet, yes, I would prefer my Father to live forever, as would he, naturally.
But, if I had to choose between allocating resources so that my Father could live forever and allocating resources to meet the needs of the youngest members of my family? There could be only one choice, as my Father has had a full life of almost 86 years and my youngest nephew is only 13. And keep in mind that I have known and cared about my Father all my life and have only a moderate relationship with this teenage boy... but fair is fair.
And don't think that I exempt myself from wanting to live forever, when the time comes, no matter the cost to society and others. I don't think that I would want to be a burden upon others, but I have seen/heard enough to believe that this is easier to say, than to do...
I have gone on the Alzheimer's journey with my father, to the point where his internal organs started shutting down. Yes, that happens when Alzheimer's progresses to the point that it affects the parts of the brain that control the heart, lungs, etc. I told the doctor to just keep him comfortable at that point. No reason to prolong the agony.
And because I have been on that journey, I will say again, an old person with advanced dementia should not be given any major surgery or other extensive medical procedures. They won't know the difference and will only be more confused by going to a hospital and dealing with all the unknowns involved in surgery, recovery and rehab, not to mention being taken to various locations within the hospital. Alzheimer's patients need consistent, boring routines.
Have you filled out a Health Care Directive and filed it with your state to be sure you don't become one of those old people who are no longer worth caring for? You can state on the form under what conditions you don't want to be saved.
I have filled out such a directive. Under current New York law it is effective as to people in a "long-term vegetative state." For someone like my 93 year old uncle he is ambulatory but demented. ALS and MS similarly don't render someone to be vegetative.
Quote:
Originally Posted by ansible90
I agree that an old person with advanced dementia should not be given any major surgery or other extensive medical procedures. But in the case of the mentally sharp 98 year old... why hasn't a relative or friend moved her to a more suitable living arrangement? She sounds like one who should be given every chance to keep living.
My close friend is her son. Basically he says, and knowing his mother I agree, that she would not last long in assisted living.
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