So much spent on high-tech health care, so lit­tle on com­fort for el­derly

Honolulu Star-Advertiser - - VIEWS & VOICES - By Karin Klein Karin Klein is a free­lance journalist in Or­ange County, Calif., who has cov­ered ed­u­ca­tion, sci­ence and food pol­icy.

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 high­tech in­ter­ven­tion more than on pro­vid­ing com­fort in old age.

Think it can’t hap­pen to you? Ac­cord­ing to the le­gal site, 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.

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