Yesterday something far too easy for me to imagine happened less then 2 miles from my home:
http://www.mcall.com/news/breaking/mc-allentown-lehigh-valley-hospital-murder-suicide-20130319,0,2694606.story
A couple who had been married for 64 years, husband killed his wife who was being forced out of inpatient hospice after only a week. He then shot himself. She was basically blind, paralyzed and in terrible pain. She was in hospice, but she had temporarily stabilized. Inpatient hospice doesn't like to house patients for more then 10 days. So he was told he had to find someplace else or bring her home. He felt he had no choice but to end everything for both of them.
And here we hit a lot of personal experience. When Dad was first diagnosed with his Brain Cancer, he spent almost a month in ICU, finally received his surgery after we initiated a transfer to a university hospital, and then returned to a nearby rehabilitation hospital. One week later he was home, and 2 weeks after that he was discharged from outpatient physical therapy. He was then able to do chemo and radiation on an outpatient basis from home.
When this tumor recurred last August, we envisioned a similar plan without the long initial stay in the ICU. Unfortunately, Dad wasn't getting better. And even more unfortunately, everyone we met that was involved in "discharge planning" was less then useless. After tracking down a social worker who was probably covering 25-50 patients, you were thrown some brochures, a bunch of forms with tons of detailed financial questions, and oh yeah, medicare says we aren't allowed to make any real recommendations. The bewildered family (if there even is one) is forced to try and wade through the difference between assisted living, transitional living, acute rehabilitation, long term rehabilitation, sub-acute rehabilitation, nursing home care, hospice, home health aide, visiting nursing, private duty nursing etc. All those terms give me a headache now, let alone when you want a safe (and affordable) place for your dad to be, TOMORROW. Me and mom did the hasty tour of a dozen local nursing homes with no notice in two days. I wouldn't make any major decision that quickly, but you want me to send my dad someplace with a 15 minute tour and whatever information I can gather on-line. Oh yeah, and this is with the denial and heartache of someone that is this sick to begin with. Really bad idea.
When we first realized that dad was this sick, and not likely to get better; we brought up the idea of hospice. And I must admit that my family thought of hospice as a place. Someplace that dad could go, that would be similar but not a hospital. Some PLACE where he could get the care he needed to ease his last days. What we discovered was that the place in hospice is almost always the home. And home hospice care is limited in scope to providing a small amount of daily assistance, not the round the clock that a truly helpless person needs. While inpatient hospice certainly exists; it is for an acute transition or respite care (up to 5 days). It isn't a place where someone can ease away their last few months in care and comfort. And while medicare language discusses physical therapy in a hospice context. You are quickly told that this is strictly about safety, how to use a hoyer-lift, pick up falls, etc. and not at all about the comfort or self-care of the sick individual.
And like so much else in healthcare in this country, a dedicated caregiver is assumed. Someone who can step in and provide the round the clock care needed to send someone, that might otherwise be in intensive care, home. Even without life-saving intervention, there is still a great deal of comfort care that goes into daily patient care. And when we were investing nursing homes, we found out that the average patient even at a good home, receives less then 1 hour of attention a day. That's one hour, to feed, dress, bathe, change clothes/bedding/diapers, dispense medications, move/rotate the patient to prevent bedsores, and provide comfort and companionship to a frequently very confused individual. In home hospice, we also get about this hour of day from an aide and/or nurse. And while these have been great, there is still 23 hours where the family is taking care of the patient. Dad doesn't usually wait for a nurse to fill a diaper, throw up, break into a fever, need feeding/water/blankets moved, etc. etc etc. Most of this has fallen to my mother. Who is providing all of this care, while not always sleeping well herself, and DEALING WITH THE FACT THAT HER HUSBAND IS DYING.
I can really sympathize with this husband in ending the pain and suffering for him and his wife. And I really hate a health care system that can leave someone feeling that it's their only option.
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