Why do spend so much on high-tech health care, so little on comfort for elderly?
Danny’s death this autumn wasn’t nearly as bad as the weeks before it. My husband’s eldest brother died in November at age 71, just two months after entering a nursing home in apparent good health.
Healthy physically, that is. Daniel Meyers had begun the slide into dementia by his early 60s. It wasn’t Alzheimer’s; his family suspects the decades he spent as a commercial deep-sea diver before his last, devastating case of the bends — brought up too fast in a diving bell — ended his career.
In truth, it was a little hard to tell where “Danny being Danny” left off and the dementia began. He was goodhearted and eager to help anyone with anything (whether they wanted help or not, as one funeral joke put it), a magnet for women and a gifted but quirky handyman who had trouble committing to both relationships and construction jobs. He left behind a string of broken hearts and half-tiled bathrooms. Invoicing was an occasional thing, and when his abilities to carry out even simple tasks failed him in later years, he moved from his apartment to a garage and to living in his van, until his family placed him in assisted living and, finally, in the nursing home.
That last move was tough to pull off. He had Medi-Cal, which covers skilled nursing for the poor, but when nursing homes found out he was on the state program, they said they were full up, a common problem. He had to be transferred to a hospital so that a social worker could find him a bed in a San Jose nursing home.
When he arrived, he did it walking and still able to talk. But occasionally, if a staff member moved a hand in front of him, he would grab their wrist in the iron grip that came from a lifetime of physical labor. That led to chemical restraint — drugs that knocked him out so hard that he slept all day in a hunched knot. He was pulled to a sitting position for his meals, but ate little before falling asleep again. In no time, his lean, muscled frame grew gaunt.
His deteriorating condition was obvious when my husband and I arrived for a lunch visit with a chocolate milkshake. Danny ate with maddening, drugged slowness. He would lose interest in his food until my husband gently guided his attention back to his tray. While we’d been told he had no appetite, he polished off his lunch and the milkshake — but it took 45 minutes.
During that time, the aide who normally helped him eat came in three times to see if she could clear his tray, surprised that he was still eating. She was friendly and competent, and I could imagine her doing her best to provide good care. But she didn’t have 45 minutes to feed one man his lunch.
Another brother who visited would make Danny rise from his bed and walk around a while. But family members couldn’t be there three times a day, so he spent most of his time sleeping. He couldn’t even take part in that other depressingly familiar scene in the memory wards of nursing homes — residents lined up in wheelchairs by the nurse’s station, chattering aimlessly or just sitting, slumped and wordless, for hours.
Within two months, Danny had a serious bedsore, and the doctor noticed he had trouble breathing as well. At the hospital, he was diagnosed with congestive heart failure. Given his wretched state and hopeless future, the family decided against treatment. He died two days later, a fate that seemed kinder than a return to nursing care.
It’s not that the facility was substandard or caused his death. Rather, society’s lack of attention to the needs of the infirm elderly means that our collective standard for their quality of life is too low. There’s nothing high-tech about interacting with a mentally faded man, or sitting with him until he finishes a meal. But staffing is expensive, and we’ve been spending our health care dollars on high-tech intervention more than on providing comfort in old age.
Think it can’t happen to you? According to the legal site Nolo.com, Medi-Cal pays for the care of 65 percent of Californians in nursing homes. If we want things to be different for our aging generations, we can’t afford to turn a blind eye to where we might end up some day.