Elderly Face Future of High Health Care Costs,
Needless Pain, Distress in U.S. Without Change
Meeting the challenges of long lives requires
substantial changes, quickly
Nov. 12, 2013 – “The United States needs
arrangements that allow elderly people to live with confidence, comfort,
and meaningfulness at a cost that families can afford and the nation can
sustain. Without significant structural changes in service delivery, an
aging nation faces a future of substantial costs and needless pain and
distress among those who are old,” writes Joanne Lynn, M.D., of the
Center for Elder Care and Advanced Illness, Altarum Institute,
Washington, D.C., in a Viewpoint appearing in the November 13 issue of
JAMA, a theme issue on critical issues in U.S. health care.
Dr. Lynn presented the article at a JAMA
media briefing at the National Press Club in Washington, D.C.
The current “care system” for an elderly person
with self-care disability and numerous diagnoses “provides disjointed
specialty services, ignores the challenges of living with disabilities,
tolerates routine errors in medications and transitions, disdains
individual preferences, and provides little support for paid or
Included: economics of health care; people who
receive care and organizations that provide care; value created in terms
of objective health outcomes and perceptions of quality of care;
potential factors driving change, including consolidation of insurers
and health systems; the patient as consumer - see
U.S. spends 50 percent more of GDP on health
care, yet life expectancy growing slower here than in other countries;
much higher medical costs and worse outcomes; aging population not cause
costs - see video
"This maladapted service delivery system now
generates about half of the person’s lifetime costs for health care
services, yet patients and families are left fearful and disoriented,
with pain, discomfort, and distress," she says.
Dr. Lynn provides specific changes she contends are
critical for improving care for this population, an approach she calls “MediCaring”.
She writes that discussions about living with
frailty now are virtually absent from popular media, political
discussion, and professional education. “To counteract this shortcoming,
reformers will need to generate discussion about the challenges of
aging, disability, and death, along with the continuing opportunities to
live meaningfully and comfortably. Medical professionals, political
leaders, and popular culture must generate vigorous discussion about how
people live well with frailty and how best to die.”
“Each frail elderly person has unique resources,
priorities, fears, medical issues, and aspirations, and each should be
given an opportunity to evaluate his or her potential futures and to
have an individualized plan for services. A multidisciplinary team
should conduct an appropriately comprehensive assessment and work with
the patient and family to generate a care plan that documents the
patient’s goals and the chosen service strategies.”
“The service delivery system should encompass
health care and long-term services and supports as equal partners,” Dr.
Lynn writes. “A balanced system would give integrated multidisciplinary
teams the tools and authority to match services with each frail person’s
priority needs. …
“Today, a physician can order any drug for any
Medicare patient at any cost - but that physician cannot order a
substitute caregiver or adequate housing, except perhaps by arranging
nursing home admission. The mismatch of service availability with the
priorities of frail elderly people engenders high costs as well as
frustration and heightened fear of decline and death for frail elders.”
Dr. Lynn also suggests that “by allowing localities
to take a role in monitoring and managing their arrangements for
supporting frail elders, the services could become more reliable and
appropriate, and most or all of the funding for supplementing social
services for people who cannot afford them could come from sharing in
the savings from better health care.”
“Essential reforms include requiring development
and use of comprehensive care plans; modifying medical care to ensure
continuity, comprehensiveness, honesty about treatment goals, and
comfort; bringing health care and long-term services and supports
together into stable funding and management arrangements; and enabling
some degree of local monitoring and control.
“Meeting the challenges of long lives requires
substantial changes, quickly, in how people in the United States
envision health care, community obligations, and the lives of frail
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