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COMMENTARYElder Care: Can We Make it Better?By Brenda Brown-Grooms As Baby Boomers age into Medicare, ours is becoming a society of elders. Research suggests that we are not prepared to take care of either the number of elders or their health-care issues.On a recent PBS broadcast of "Frontline," experts claimed that, although there are about 10,000 to 12,000 geriatricians in the U.S., there is a need for 35,000 to 40,000 today and more in the future. According to Dr. Jeffrey Faber, a geriatrician at Mount Sinai Hospital in New York, those 65 and older will number 70 million, or roughly 20% of the country's population by 2030. Our health-care system, Faber said, is designed neither to address multiple-system shutdowns most commonly seen in older people nor the issue of who will pay for such care. What happens, he said, is that no one is paying for the comprehensive health care of older adults so, after spend-downs, Medicare does, by default. A major question facing a society unprepared to take care of its aging population is this, "What do seniors fear most - being a burden on their children or living out their days in a nursing home?" My mother has a morbid fear of nursing homes. As she has aged, she has decided to be brave and tell her six children on as many occasions as she can muster that she does not want to be a burden on any of us and would prefer to go to a nursing home rather than let that happen. Even as she says the words, I can see just behind eyes that sparkle when she laughs that she is thinking, "Out of five girls and one boy, surely someone will care enough for me to keep me out of an accursed nursing home." We are hoping the same thing. But, in fact, it is going to take a lot more than hope. Experts agree that it is going to take money, planning and advocacy to bring about a paradigm shift that results in a system that doesn't first impoverish seniors before they are eligible for basic health care. It is going to take far more medical students specializing in geriatrics than we currently have. It is going to take a society that has learned to value all its members and doesn't leave out the aging. It is going to take parents and children thinking and planning together. In the meantime, what can my mother, your father, our parents, expect? According to Dr. Audrey Chun, director of the Mt. Sinai Coffey Geriatric Practice, elders can expect to face a system that was not designed to treat chronic diseases that require maintenance (such as high blood pressure and diabetes), but acute diseases with procedures (such as heart attacks and strokes). In my mother's case, she has had to search for a doctor with whom she feels comfortable and who has the time to both listen to her concerns and treat her symptoms, despite the fact that he cannot cure her diabetes or high blood pressure. They have developed a relationship, something that is supposed to happen in a community. Your father can expect that his doctor will not have enough time to sit down with him to determine his medical concerns. The average patient visit is 10 to 15 minutes. In addition, his doctor will not be adequately compensated to behave in such a way with his patients. Your father will need a relationship with his doctor, who may be unable to enter into one with him. Given this fact, it may be a matter of financial survival to limit the number of patients on Medicare. Our parents can expect to lose all their assets if they need to enter a nursing or assisted-living facility. The cost of such care is prohibitively high for anyone who is not wealthy. Everyone else must qualify for Medicare in order to be able to afford medical care. But the Medicare system is overburdened. It is functioning in ways that it was never designed to. It is broken, and, as yet, has not been fixed. What is the alternative? We have yet to imagine or propose it. In the meantime, Baby Boomers are inexorably headed toward retirement and old age, with its chronic diseases that require maintenance and not enough geriatricians to treat them, even though they may live far longer than any previous generation. What is to be done? I believe that basic health care should be a right and should be designed to take care of patients comprehensively. But grass-roots support is needed to make that happen. For most of us, living longer will mean having more than one chronic illness at a time as we become increasingly frail and face dementia. Most Baby Boomer parents, who today are able to care for themselves, do not want to burden their children with their care as they become chronically ill, cannot be cured, cannot remember who and where they are, and can no longer care for themselves. Neither they nor we have imagined what it would be like or how to cope with such a situation. As we all age, however, we must imagine and plan for the possibilities. Nursing homes are full of those who did not. Our parents' fear that they will be a burden on us is slowly being replaced by the fear that they will live longer and longer with less and less quality of life, whether at home or in a nursing facility. In the meantime, my mother, my siblings and I are talking about what to do and how to do it when my mother can no longer care for herself. I am imagining the situation for her and for myself as well. I do this now because I have to look into my mother's eyes. ********* Brenda Brown-Grooms is an independent living coordinator with the Blue Ridge Independent Living Center in Roanoke, Va. PLEASE NOTE: PORTIONS OF THIS WEB SITE ARE UNDER CONSTRUCTION! |
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