Wednesday, July 11, 2012

The Costs of Care

The price tag for end-of-life care can be overwhelming for most Americans. According to AARP Magazine (June/July 2012), nursing homes, which can provide extensive, skilled medical care, are the most expensive facilities, with average costs of $222.00 per day. That’s a whopping $6,660.00 per month. Next in line are assisted-living facilities, which offer a home-like atmosphere, and cost $3,300.00 per month for a one-bedroom private residence. A third option, home health care, allows elderly patients to stay in their homes while receiving daily care. The national median hourly rate for a non-Medicare certified home care aide is $19.00. Prices vary from state to state on all facilities. For instance, Alaska nursing homes charge a median cost of $783.00 daily, which adds up to an astounding $23,490.00 per month.

Do we dare explore hospital charges? Amanda Bennett, who chronicles her husband's end-of-life drama in The Cost of Hope (Random House, 2012), indicates just how out-of-control our system really is. In the last year of his life, they paid $33,382.00 for one hospital stay; $43,711.00 for the next. And a final $14,022.00 for the last three days of life. Over a seven-year period total, costs for care were an unbelievable $618,616.00.

Is this an inevitable part of the American way of dying?  The word is spreading to patients and their families that these excess expenses are an unfortunate side effect of medical advances and specialization.  Our medical system is a dysfunctional one that feels like a hyped-up conveyor belt passing patients from one professional to another. Critics say that the medical machine keeps on ordering tests and procedures even on dying patients, treating the symptoms, but ignoring the whole person. In short, we have a disease-treatment system rather than a health care system caring for human beings, which does little to extend life, and may make matters worse, especially for patients with dementia.

How can patients and their families fight back against overtreatment and runaway costs that may plunge families into bankruptcy and poverty, not to mention emotional turmoil?  I recommend three approaches. First is careful monitoring of all tests to avoid duplication. A second consideration is to evaluate your insurance company’s payment for specific procedures, which can vary widely. Third is to have that conversation with trusted professionals, your primary physician or hospice worker, about when “enough is enough,” and make an immediate shift into “comfort care.”

Your calm and supportive presence, along with pain management can raise everyone’s spirits, most significantly your dying loved one’s sense of peace.

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