Tag Archives: End-of-life care

Expectations and Reality: A Review of Long-Term Care

Tendercare Nursing Home. Photo by Jeffrey Smith.
Photo Credit: Jeffrey Smith.

Unfortunately, it is impossible to create a standardized time frame regarding end-of-life or long-term care since it varies case by case. While there are signs and symptoms that allow people to predict the direction that someone’s health is going, many individuals begin long term care after a sudden life change that leaves them unable to care for themselves at home. One day, they could be healthy and the next, there could be a stroke or fall. In the best-case scenario for a situation like a stroke or fall, patients return home after successful rehabilitation, but more often than not, patients are unable to fully recover. When this happens, depending upon the severity of the person’s impairment, they are either taken care of by family members or moved into an institutional setting.

About 80 percent of seniors receiving long-term care remain within a private home (either their own or a family member’s), and the remaining 20% are moved into facilities. Each situation has pros and cons and what is best for one individual may not be the right choice for another. Those who remain within their homes are often eligible for home-health services to aid family members in their responsibilities. According to the AARP Public Policy Institute, the elderly population in nursing homes has declined over the past ten years with more people receiving care at home, living in assisted living, or being taken care of in group homes. Nursing homes are generally preferred if a person needs 24-hour supervision.

Long-term care, a general term, refers to the type of assistance provided for people with cognitive or physical limitations. Caregivers provide patients with the care needed to complete daily activities. If patients are unable to remain at home, facilities continue rehabilitation to try and strengthen patients and improve their quality of life. Not only does a more functional patient ease the burden of the caregiver, but the more a resident can do by him or herself (eating, using the bathroom, bathing, and changing), the happier they generally are. As age and illness advance, it is important to not have unrealistic expectations since people start to naturally decline.

Typically, long term care is not paid for by insurance companies so cost is definitely a factor when deciding what is best for your loved one. Even with 80 percent of elders receiving care through informal caretakers such as family members, there is still monetary value attributed to this “donated” care. The time spent caring for a loved one could be spent employed elsewhere with wages. There are also transportation costs to think about since an informal caregiver performs duties otherwise performed by paid healthcare aides. It is therefore important to reach out to a social worker as there are benefits that caregivers may not be aware of in their home state. Some states provide a stipend to informal caregivers while other states grant special benefits. Planning ahead and purchasing long-term care insurance can be a good option for many families. Even without this type of insurance, many facilities, especially hospices, charge on a sliding scale. In some states, there is no fee at all beyond Medicaid coverage. See here for eligibility guidelines and a list of Medicaid rules in your home state.

From long-term care, people unavoidably move toward end-of-life or palliative care, and when a loved one makes the transition, it is not about giving up or hastening death. Rather, it is about making death as comfortable and painless as possible. Many people mistakenly believe that admission to a hospice facility is determined by a life expectancy of six months or less, but this is false. Palliative services exist to relieve emotional or physical pain and to manage symptoms.

Before getting to this stage in life, it is crucial to have a written and notarized document, declaring how your loved one would like the end of their life managed in case they become unable to make decisions for themselves. Without preference information available in one’s medical records, it becomes harder on families in a time when things are already hard enough. Thankfully, people live in a time when long-term care and end-of-life care have made one’s later years more comfortable.

Max Gottlieb is the content editor for the Arizona Long Term Care System (ALTCS) and Senior Planning in Phoenix, Arizona, USA. Senior planning is a free service that has helped many Arizona seniors and their families navigate the process of long term care planning. ALTCS and Senior Planning find and arrange care services as well as help people apply for state and federal benefits.

 

 

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How Robot Technology is Caring for the Elderly

Communication
Japan faces a rapidly aging population. As more and more of the population greys, fewer and fewer young people are available to care for the elderly. There is a particular shortage of health care workers who work with the elderly therefore the demand for elderly health care is not being met. Among health care workers, there is a high turnover rate which was close to 17% in 2013. Japan’s answer to this shortage is research in robot technology to assist in elderly health care.

A prototype robot, Robear, has been developed. Designed by Riken, a Japanese research institute, this robot is a polar bear cub look-alike that aids health care workers. The Robear is the successor of two previous heavier robots, RIBA and RIBA-II. Robear helps in lifting patients from beds and supporting them in walking. Apart from research in the robot’s abilities, research into understanding the needs of the elderly has also been done, especially in the appearance of the robot. Researcher Mukai says, “The polar cub-like look is aimed at radiating an atmosphere of strength, geniality and cleanliness at the same time.”

Another robot being developed in the country is the ChihiraAico, a 32-year-old Japanese woman look-alike that is supposed to ease communication between humans and non-humans. The creators at Toshiba are aiming to use ChihiraAico with patients with dementia to help them connect with counselors and medical staff with ease. On the other side of the Pacific, the USA is developing PARO, a robotic pet. There is evidence to show that pets can effectively combat loneliness among the elderly and PARO currently shows promising results. A pilot test in a home suggested that elderly residents feel calmer and less anxious after interacting with these robotic pets.

Robotic technology in Japan is not limited to health care, and has expanded to a range of end-of-life services. As more and more elderly people take charge of their funerals, Japan’s end-of-life industry has come up with ‘skyscraper graveyards’. Traditionally, the Japanese cremate the dead and store the ashes in the family crypts in cemeteries. Due to the space constraints, ‘skyscraper graveyards’ have become increasingly popular. Relatives are given identity cards and robotic arms assist them in retrieving the urns stored in vaults deep underground.

Using robots for elderly health care has advantages and disadvantages. On the one hand, robots can effectively aid in the under-staffed health care system in Japan by assisting in hospitals and elder care units. It can also be placed in individual homes and provide remote monitoring of the individual. Moreover, it can help combat loneliness. On the other hand, the use of such expensive technology raises questions on the lack of human relationships and its impact on family dynamics.

Is robot technology the future of elderly health care? What is the scope for robots outside of high income countries like Japan and USA? What, if any, impact will the high dependability on robots have on human-to-human interaction? Only time can answer these questions. Japan’s experiments with robots are promising, and if this technology proves to decrease the burden of aging on Japan’s health care, there will only be more demand and a greater space for robotic technology.

Namratha Rao is currently pursuing her MSPH in International Health in Social and Behavioral Interventions at the Johns Hopkins University Bloomberg School of Public Health. 

Promoting Advance Directives, Reducing Medicare Spending

*This article was extracted from a longer, in-depth, paper written during my internship with a policy forum in Washington, D.C. 

More and more people are living to the age of 100. As our longevity increases, it is crucial to have an advance directive to make health care decisions, which may reduce the overall cost of end-of-life care. While Medicare guarantees access to health insurance for individual Americans and lawful residents aged 65 and older, the program faces significant fiscal challenges over the long-term. Advance directives may reduce Medicare spending since older adults can opt out of aggressive medical intervention by dictating their wishes in the event of a life-threatening illness. As Congress continues to debate over the best way to fix Medicare, costs will likely increase if older adults continue to ignore advance directives.

Living Will document with pen, closeupAbout 27.4 percent of Medicare expenses for the elderly are spent in the last year of a person’s life. Advance directives can reduce that percentage because older adults may not prefer lifesaving machines that impact costs. If a person wants to avoid lifesaving machines without having an advance directive, doctors will keep such people alive at the expense of other patients. The latter will be deprived of necessary medical treatment and hospitals may become overcrowded. Also, these machines and other medical resources will contribute to the cost of care because they are expensive and scarce. Unless people write binding living wills, families are reluctant to “pull the plug,” and medical professionals are afraid of being sued if they do. Increasing the use of advance directives is necessary for preventing such problems.

Studies have shown that adults are more likely to complete advance directives that are written in everyday language and less focused on technical treatments. However, many people are currently unaware of advance directives and even fewer complete them. Since advance directives are very lengthy and tedious to complete, most seniors prefer family surrogates. The present state of healthcare systems also compounds the problem. For instance, there are only two states that offer living will “registries.” Residents can file their living will and allow doctors and other healthcare providers to have access to their documents. However, the Washington State living will registry has been closed by the state government because of lack of funds, among other problems.

If insurance pools take into account the costs spent on people that will never get well, premiums for younger and healthy people are going to be very expensive. It is difficult when people are without an advance directive and do not want lifesaving machines. At the same time, if such people wish to have invasive and aggressive medical treatment in poor prognosis states, then health systems should accommodate and respect their wishes.

Advanced directives are not only for the elderly. Our society is getting older, and people have to deal with it. Health professionals need to determine effective ways of promoting advance directives among elderly patients. For example, a study showed that a replicable intervention mainly targeting doctors achieved a moderate increase in advance directives among older ambulatory patients. Future interventions may need to address doctors’ attitudes and comfort discussing these documents since patients cite their physician most often as the one who influenced them most to make a health behavior change. Increasing the use of advance directives among elderly persons is essential since it reduces Medicare spending and the national budget concurrently.

Living wills and health care proxies need restructuring hence these documents have to be well prepared to reduce confusion, jargon, and ambiguity. It is also vital for healthcare institutions to advocate and support the use of advance directives. More states should invest in the living will “registries” and promote advance directives to increase enrollment. If a patient has an advance directive and requests lifesaving machines, families and health professionals should respect their wishes. In the long run, advance directives are necessary because they can reduce the overall cost of end-of-life care for individuals and families.

Sophie Okolo is the Founder of Global Health Aging.