My grandmother died at home, just as she wanted. It cost $145,000
wbur.org
wbur.org
From what I can gather, the $145K cost was the cost of medical care over the months (years? the article never says) at the end of the grandmother's life -- not the cost of "dying at home".
The bulk of the cost seems to come from:
> the total monthly cost was $16,200: $13,000 a month for the 24-hour care, plus $3,200 to rent the apartment
It seems silly to include rent, and then of course round-the-clock private care is going to be $$$.
As far as I can tell, the grandmother needed hospital-level care, but the family didn't want to keep her in a hospital. It's not surprising that hospital-level care at home costs a small fortune.
If the deceased person owed the medical bills - well guess what? she is dead and won't have to pay them unless the creditors go after her estate - if the family's complaint that now their inheritance is going to be less than they thought - too bad.
"I saved my whole life, and wanted to make sure I could give a little back to my loving family, but instead the healthcare industry soaked it all up during my final months."
In civilized countries, somebody else would pay for it. Not through magical fairies, but through taxpayer-funded public healthcare. Instead, in the USA, we're Rugged Individuals™ so we prefer to have a gigantic profitable End Of Life Industry precisely designed to sponge up whatever remains of an elderly person's savings. If you have $500K in assets left, your end of life care will cost $500K. If you have $100K left, your care will cost $100K. If you have $10K left, it will cost $10K.
The solution, in our flawed system, is to do smart estate planning so you die with zero assets. I don't need my parents' money when they go, and I've already told them if they want to help out my sibling or give it to charity, either do it before they die or get it in a structure that can't be confiscated by death profiteers. Either way, have $0 to your name when you finally pass away. Don't give these vultures another gold-lined toilet for their executive suite.
Somebody else paying doesn't make the cost go away. Would it be better to make their children or grandchildren pay?
Would they be better off if they payed 150k in taxes and had no inheritance because of that?
"I saved my whole life, and wanted to make sure I could give a little back to my loving family, but instead the healthcare industry soaked it all up during my final months."
An awful lot of people in this country will never get an inheritance; why is it fair to ask them to pay higher taxes so that the most privileged people can leave bigger inheritances to their kids?
I have no problem with people leaving money to their kids - after they pay their own bills. Don't ask me to pay them so your kids can get a bigger windfall.
Why is this civilized?
In fact it even motivates me to start planning out costs with them.
Sometimes the point of articles can simply be to relate one’s own experience to other people.
In the UK when my mother got told she was terminal and had a couple of months left, she chose to spend them at home. In the end she left hospital in mid-December and died the following May. 5 months at home in a specialist bed, provided by the hospital, all of the equipment required to keep a dying person comfortable again provided by the hospital. Nurses and doctors there every day.
Because of her illness, the government paid her rent, it paid my father a carers allowance, so he was able take time off work.
Total cost: £0.
5 months of excellent at home care for £0.
You shouldn't be dismissing the article as clickbait, it shouldn't cost $145k to die, there shouldn't need to be a discussion here.
You should be so very angry that a country that takes in $3tn a year in federal taxes won't support a working healthcare system
a lifetime of having way more than HALF your income stolen from you..... 0? okay..
seems to me that "some of us" will be perfectly happy buying the services, and some other of us will be perfectly happy NOT buying the services
and where would I go? it seems that universally around the world there are a large amount of people that feel that they are entitled to rob their fellow citizens, at ultimately what is gunpoint threat of being put in jail.
if I just go mind my own business, and conduct business with other likeminded people, and the regime finds out, they will send their brownshirts with guns to drag me away, simply for refusing to give them half
Somalia seems to be the only actually tax-free country. I think border control is lax enough that you can "safely" go live there if you wish.
Not the same thing.
I don’t understand your logic. You claim that the “services” offered to you by your government are worth the taxes you pay. But you don’t want them to be opt-in. Aren’t you tipping your hand a bit? Seems like you might not be so confident that the services are worth it, and that a ton of people wouldn’t opt out.
I pay for water, and then i pay 150% taxes on the water because reasons.. I would just hire someone to drill a well for me on market terms, but the regime made it illegal
edit: actually its about 300% taxes on the water
It's positively utopian! Meanwhile, in the hellscape:
> On average in the U.S., the length of time between a call for help and the arrival of emergency medical services is about eight minutes.
[0] https://www.reuters.com/article/us-health-emergency-response...
and what does it matter to you if I can opt out of paying? one less person to serve? great? everyone is happy.
either way, that is not the case for the majority of my income. and dont get me started on when I go to purchase gasoline here in europe, not only am i first hit with 50% income tax, then a cool >20% sales tax, and then the outrageous taxes on the gasoline itself and the related industries. so I buy €100 worth of product, and more than 95 of them go to the government. Thanks! you sure did 95% of the work for me there (not)
https://listentotaxman.com/?year=2022&taxregion=uk&age=0&tim...
I would argue taxation is only theft if the money is spend on extremely bad, costly and possibly corrupt policy decisions like US wars in Vietnam, Iraq, Afghanistan or even the war on drugs. Probably a lot of these policy decisions are influenced by lobbying from various industries and special interest groups. Follow the money.
And somebody has to pay the medical support staff.
The sense that "this is necessary so it should be free" is not unique to the parent comment, but it is incorrect.
These taxes are harvested from capitalist economic activity.
Consider the “out” for the US debt ceiling being bandied about is minting a trillion dollar coin.
Regardless, setting up a mini hospital in someone’s home is just dumb. There is no reason for such a high level of service. You want to die at home? Sure. I’m down for MAID at home.
You want a suite of private doctors and equipment at home? Pay for it. If you want public service you should go to public service facilities.
I just had an elderly family member that would have died if not for the hospital saving their life but they can't stop complaining about the $4k they have to pay.
One would have to be painfully ignorant of basic economics to not see that setting up a mini hospital in a person's home is not going to be cheap. It is practically like complaining about the cost of taking a private vs commercial jet.
"In December, as many as 500 patients per week were dying in Britain because of E.R. waits, according to the Royal College of Emergency Medicine, a figure rivaling (and perhaps surpassing) the death toll from Covid-19. On average, English ambulances were taking an hour and a half to respond to stroke and heart-attack calls, compared with a target time of 18 minutes; nationwide, 10 times as many patients spent more than four hours waiting in emergency rooms as did in 2011. The waiting list for scheduled treatments recently passed seven million — more than 10 percent of the country — prompting nurses to strike. The National Health Service has been in crisis for years, but over the holidays, as wait times spiked, the crisis moved to the very center of a narrative of national decline."
https://www.nytimes.com/2023/01/25/opinion/uk-economic-decli...
No. Often repeated, never true. The NHS has had at or above inflation budget increases every year of Tory government[1]
https://ichef.bbci.co.uk/news/976/cpsprodpb/166A5/production...
Look! Real terms money on the Y-axis, it only goes up!
"Squeezing in terms of funding", "Try and privatise it" are common myths repeated by the Labour party to get elected, and NHS bosses to increase the pie even further.
(2) The government is destroying it in other ways, such as not having a proper recruitment pipeline, outsourcing the lucrative parts to the private sector, and failing to pay staff adequately (literally - nurses going to food banks).
Yes, there has been mismanagement with the recruitment pipeline, because every government prefers to pillage poorer nations for their healthcare staff since it's quicker than training them.
But remember, that's not the original claim is it - I didn't say the Conservatives are doing a perfect (or even good) job, I said they're not "squeezing it dry of funding" and not "trying to privatise it", which are both, still, false.
Also "outsourcing the lucrative parts" - give source for your claim please. They do cross subsidize, allowing private patients to pay for treatment in NHS hospitals, but that's not the same thing.
That seems… incredibly low for a licensed profession
The people in the NHS that I talk to say it's running on goodwill and sticking plasters right now.
This one indicates "unfunded mandates" - a trick the GOP in the US has done for decades (notably so-called Medicare Advantage which created a crisis that didn't exist): https://www.theguardian.com/commentisfree/2022/apr/05/tories...
Another specific tactic is privatizing things that didn't need privatization (or the result is less efficient than what existed before, but it happened to make some corporations and ministers/secretaries a lot of money) - see "failed efficiency savings and privatization" here:
https://www.opendemocracy.net/en/nhs-crisis-rishi-sunak-cons...
Of course, Brexit (another Tory gift to their owners) really messed up things for NHS and caused a number of challenges (see above).
The bulk of the budget should go to front line workers not administrators.
We know perfectly well that we pay for it through taxes.
The only issue with public healthcare is the government corruption that tries to kill or diminish public healthcare, but it's still a hell of a lot better for society than private.
Correct, but the US has the rather odd status of spending even more per capita in public funds towards healthcare before they even get to the privately funded portion. The NHS has a lot of problems, but at least it's not (outside of dentistry) making us pay both ways at once.
But that also makes it easier to understand the need to get rid of them and have the government fund healthcare.
My mom passed away recently (Monday) and it would have been impossible for her (because it was impossible for me) to try and navigate insurance claims (and subsequent denials lol), hospital billing, Medicaid, Medicare, Ohio Medicaid, and other programs. It's just level after level of waste and all of this could be combined into just one god damn program that does the same work and we would save money. But jobs. Oh and also let's not forget the now 3-6 spam calls I get daily from official sounding scam artists who try to "help" with your medical problems (steal money) in your darkest hours and most vulnerable. Does nobody seriously care? Why does the United States of America allow its citizens to be robbed?
When we were clearing out her things we probably had an entire trash bag worth of prescription medication.- Waste Maybe you should be required to return the empty? All those pills had to be safely disposed of.
Equipment - thankfully we could donate this to a local charity but many hospitals and healthcare facilities won't accept things like wound bandages even if they are brand new and sealed in a box.
Transportation - It's unreliable. Companies like Caresource contract with the government to provide rides to get patients to appointments, but they then further subcontract these rides to the most obviously shitty companies imaginable and then those companies contract the rides out to random people who will go pick people up for money. It works sometimes, but ultimately things happen. We had multiple no-call, no-shows and my mom who needed lifesaving cancer treatment had a hard time getting to scheduled appointments. More waste.
I could go on and on.
The thing that pisses me off the most is that we're explicitly opting in to spend more money. It's just a tax that goes to the health insurance industry instead of the government. Health insurance companies are just parasitic entities and do not innovate or provide market efficiencies - they just work to find how they can deny claims and try to "innovate" on billing complication. Unlike pharmaceutical companies and healthcare equipment companies. There are still efficiencies to be had there with licensing, drug patents, trials, etc. but health insurance is a complete scam. If we just did single-payer then we could see some actual innovating on the insurance side from whatever business was remaining that the "wealthy" could afford - which I'm fine with.
I do dislike the usage of "free" to describe the NHS or any government run healthcare program since it's inaccurate (nothing is free) but as another user pointed out the US system is like double cost because you pay taxes, you don't get any of the benefit, and then you have to pay too. Philosophically I prefer people to say "hey we should fund this" versus "I need my free thing from the government" because the former is indicative of a society coming together to support itself and the other is indicative of social collapse. People don't call Social Security free very often, but instead support it because "I paid for it".
The main thing is knowing that if you need any procedures, services, an ambulance, critical or emergency care, etc, you'll not be asked up front to pay for it, you'll just be treated. Seeing that principle erode over time is heartbreaking and terrifying.
(rant) Healthcare as an industry doesn't function properly under a capitalist model, which expects that competition and consumer choice will encourage innovation and further competition, leading to a better outcome for the consumer. If you need healthcare, you don't really have a choice in it, or your choices are artificially restricted by circumstance, so you can't benefit from a competitive marketplace. It's a broken system, as far as I am concerned.
I agree with your statement that "Free" is likely short-hand but I personally still don't like it because I prefer to think of items like that less so as entitlements because entitlements are easy to attack and dismantle. On the other hand when someone feels like they paid for something they are more likely to defend it. Social Security in the US is IMO a good example of this.
[1] Price discovery is impossible in a free market where you can't be denied service. Since society is (in my view correctly) not willing to let people die on the street if they can't pay for treatment the health insurance industry can't function except as a parasite with the aim to extract as much as it can and redistribute it to employees and shareholders. I do think healthcare costs would be cheaper under a "pure" free market where we let people die on the streets, though, but again I just don't find that acceptable.
The system works, assuming it's adequately funded, which it hasn't been for a while. Salaries aren't high enough to live on (thanks to the conservative government and creeping privatisation), and then brexit and other immigration policies have caused a shortage of trained professionals and no one willing to fill the vacancies.
There's a whole heap of issues (I've left out quite a few) stacked up against the NHS, and yet it powers on, doing its best.
In the words of Luke Skywalker: Amazing. Everything you said in that sentence is false.
But focusing on the "it's not free" part; perhaps a distinction should be made in terms of "background passive costs paid regularly (e.g. taxes)" vs "additional costs once you're ill".
What is "not" free in the NHS is the first, but the latter is generally free.
This distinction becomes very meaningful when you realise that, in the US, things like the £145k quoted in the article fall in the latter category, while still paying for the former (in terms of regular insurance or whatnot).
This "dishonest" comparison made when the "NHS is not free" argument is thrown to justify why in the US things cost money, is to ignore the fact that you are also paying the background stuff in the US too, even in the absence of illness, but this is rarely counted in these discussions.
I would love it if someone armed with more numbers than I could give a breakdown of what it costs annually a person to passively contribute to the NHS through taxes vs an average US medical insurance scheme (assuming the US does not have other healthcare related taxes which I do not know about).
The U.S. government pays about the same amount per capita (1.2 trillion for ~400 million people or $3000/person) on healthcare as the UK gov. That’s before private insurance costs. Some of this is on things like Medicare, Medicaid, and the VA, which are nationalized health systems for specific portions of the population, but the point still stands that we’re not avoiding taxes going the private route.
This is complete nonsense. The British public knows very well that the HNS is (or was) and should be "free at point of use", and also paid for via tax. The public want it and want it well funded. The current British political establishment does not like this state of things and seeks to privatise it, but due to the popularity of the NHS, cannot just come out and and say it.
"That's the standard technique of privatization: defund, make sure things don't work, people get angry, you hand it over to private capital."
No, the collapse is caused by the government which has been methodically dismantling it for a couple of decades now, replacing it with private health insurance and moving the ownership of NHS trusts and GP offices to private companies.
It’s basically what they chose in this case, Medicare would’ve paid for the hospital and hospice. Even if there was a bill no one is obligated to pay it unless the estate has money for private care. In this case it’s assumed her estate doesn’t have the funds to pay for private care or rent an apartment.
Her case also seems complicated because assisted living and hospice couldn’t tend to her needs but the hospital thought a lesser facility could provide it. Bouncing her back and forth.
The American Healthcare system is insane but at least in this one regard the cost of being an unreasonable egoist is not being paid by the rest of society. Go fucking die in a hospital like everyone else and don't take away limited resources from people that might actually get better. Or if you do, at least pay the bill yourself.
State paid nursing home fees are like $150k/yr last time I checked, most of that going to administration. It's certainly not going to the nursing assistants that they don't hire who aren't checking on you. Plus the portable mobile equipment (xray etc) that someone drives over and wheels in to perform perfunctory diagnostics, plus the ambulance rides back and forth to the hospital as the nursing home covers their ass, plus all the bills you rack up at the hospital as you're repeatedly dumped into the emergency room.
Like it or not, that system has already been heavily socialized in the US. The only time someone is on the hook to pay is if their estate has money, which is avoidable with some estate planning (5?) years ahead of time. That's the fallback option for everybody "lucky" enough to reach it. It's gruesome, but not because it's cheap.
FWIW When I was going through this with my dad, the private "insurance" company (a medicare advantage vendor) was starting a program where they had on call doctors that they wanted to send to your home, because keeping you out of the hospital saved them a significant amount of money.
And to be clear: It would be great if we had enough doctors, nurses and resources for everyone to die in their own home with all the amenities of a hospital specialized to end of life care but hat is practically impossible. And I don't mind socializing healthcare. On the contrary, I think it's a necessity for any civilized country. But given the aging societies of basically all western nations I would bet all I own that by the time I need end of life care, at home care with private nurses will become the privilege of the super wealthy.
Here in Germany, the system is already essentially collapsing and it's not even a money issue, it's a personal issue. But sure let's burn it all to the ground for the now-dying so by the time my generation needs it there's nothing left.
I don't think that doctors and nurses are the limiting factor for home care, but rather CNA's and home health aides - basically people that check in on patients around the clock and make sure they're kept clean and attended to.
In the context of the US system, your original comment is just completely off the mark. Our healthcare system is universally terrible, independent of the cost ("not my job" at every level). Consigning a elderly person to that system is basically the last thing anybody wants to do, hence the focus on dying at home etc.
I can't speak about Germany's system. But it's worth remembering that money is not equivalent to resources, and that spending an imprudent amount of money on elder care right now doesn't imply that there won't be resources left for you later. Whether the system is "burnt to the ground" has more to do with if the institution is destroyed or hollowed out, rather than how much it costs.
What's the long term plan for the UKs elderly healthcare programs that it's an aging country?
https://en.wikipedia.org/wiki/Liverpool_Care_Pathway_for_the...
As others have pointed out, it didn't cost "£0". It cost your fellow citizens the full amount. "The government" didn't pay her rent. Your fellow citizens did. "The government" didn't pay your father a carer's allowance. Your fellow citizens did. "The government" didn't pay for doctors and nurses to travel to her home. Your fellow citizens did.
Now, I, personally, would prefer to see massive reforms in the U.S. system. But pretending that any system is going to cost "£0" is just intellectually dishonest.
Because the OP was claiming it cost "£0", when it clearly did not.
> This is not a secret, there's not some common misconception that health care isn't actually paid for with money.
Maybe you should tell the OP, since he is clearly operating under that exact "misconception".
Oh? So he didn't say "it cost £0"? I just made that up?
Spin harder, dude.
No it is clickbait because it says "she died at home" when in fact she died in an expensive rented apartment. This fact is unrelated to the reality that the system is broken and people can't get the care they need.
But presumably not 24/7 = 168hr per week, which makes all the difference (and the vast majority of the $145k in costs). 168hr / week of care will require 3 to 4 FTEs, no way around that.
>Medicare should restructure hospice reimbursement to cover more of the hands-on caregiving, thus decreasing the financial burden of dying at home.
The main pitch is somewhat hidden in the middle of the article. Its a tough point to open with, but I think leading with the thesis statement is proper.
Yes. Where are all the people who were apoplectic about the Nord Stream post?
The tragedy of modern medical care if you're over 65 is that it's hard to die. Medicare only pays hospitals for results, so there are powerful incentives to limit hospital stays as much as possible - unless you're in an ICU or similar scenario, if you are hospitalized more than a week it's likely because someone fucked up, and Medicare will reimburse the hospital next to nothing as a result.
It's easy to get sick or become incapacitated, but people can and will "save" you and leave you in a situation where you are not well, but not dead. The options are 120 days of Medicare nursing home coverage, followed by a slow drain of all of your assets and ultimately Medicaid enrollment. Nursing home means you're effectively warehoused, and the more help you need, the less care you get as you become a cost center.
It's not just a matter of finances, it's a matter of humanity. The harsh reality is your disabled loved one will be treated like cattle unless someone who cares is directly engaged in caring for you. After the horror that my father went through after a suffering a stroke, and the pain caused to my mother after she took on full-time care, I did what most doctors do and have DNR care instructions on file with every hospital in a 50 mile radius.
My father died in Canada last year after a 9 month battle with cancer during which time he spent almost 2 months in cancer ward. He was not rich. He recieved cutting edge targeted chemo-therapy. He died peacefully with the aid of MAID in his small home town.
It cost my mother $150.
You're welcome.
Of course at this point in his life he had 4 doctors. His cancer doctor was not happy with the decision, she wanted to (and they could perhaps have), kept him strung along for several more months. His cardiologist and nephrologist (cancer was targeting his heart and kidneys) has done multiple proceedures and had plans for the rest of his life (again, we're talking months, at most). His family doctor was a wonderful provider and friend. There were no whispers from any medical staff saying "do it", "do it".
My father was fiercely logical, probably akin to many who post here. It was his choice to end his life on his terms. I have the conversations where he was assessed recorded, the only coercion was his.
I recognize MAID has detractors and is a very complex subject. We still (of course) discuss what happened and are grappling with his loss, but from my perspective it was empowering, it minimized suffering (for all of us, not just Dad) and gave someone their last feeling of agency.
Sure, but by being taxpayers, your parents already paid a substantial portion of the cost forward by paying for the healthcare of other people. Perhaps they were net takers from the system, but presumably people on HN have parents that are net contributors to the system.
Cheap though.
Finally, the day of, anyone accompanying the family is asked to wait while “the lines are put in”. The wait is far longer than the time required to put in lines: they interview the patient again, this time to ensure that they are there of their own volition and not being pressured by the people accompanying them.
The entire is graceful and professional.
I think the biggest point of contention is that reasonably well kept and healthy people are receiving little to nothing for their money in the present. eg, I got tons of push back asking for simple lab tests like cRP or dermatology cancer screening which would have been less than 10% of what I contribute to the system. Another time I literally waited in a ER room until my loss of blood made me a triage priority. The amount of resources available due to the market distortions means they have to defer you until you're worse off than when you walked in.
Compare that to fast (always <1 hr, even for non emergency things like a dislocated finger) and reasonable waits anytime I've been to a hospital in the US. Mind you I've also probably spent a total of $40k (not my portion) in ~8 yrs of residency between insurance costs and copays, more than half due to a heart attack scare and ER trip that ended up being myocarditis from the vaccine.
So what's my point in all this rambling? I think there's a ton of unlocked value in the US system to do more preventative care, but the US is anti-paternalism and often lets people do stuff that costs them in the long run (unwittingly or knowingly). But there's a hidden truth to Canada's system appearing so rosy -- at least as the payer and consumer I feel I get more for less in the US. Whereas in Canada you have better average outcomes because you take marginal care (eg preventative tests) from those who pay, and give it to those who cannot pay but may have a marginally more improvable conditions (eg bleeding out, having a heart attack).
[1]: compare to about a quarter of that in medicare on much higher earnings
I’ve waited months to be able to see a doctor. In fact, I’ve just recently seen a dermatologist after a 9-month wait. No one else had anything sooner.
I’ve learned with the US system there are a lot of hoops you have to jump through for care if you want insurance to be happy. I have to go to one or two other clinics or quick care facilities in order to get in to see the doctor that I actually need. And once I have a prescription it’s always a prior-authorization fight to actually get the meds.
And all of this, knowing that I can’t ever take a sabbatical since COBRA, on top of my monthly expenses, would be prohibitive.
So, it feels like the US system is the worst of all worlds. I’ve got the waiting and the pushback and the expense.
Even if I never use public health services my entire life (I mean I obviously already have) I'd still be happy to keep paying that tax.
Why? For the same reason that I don't mind as a gay man who will never have kids that my taxes also go to: welfare/benefits for families in need, helping children, building/benefiting infrastructure I will never use.
All of humanity is in this together, on this tiny blue sphere. If people are focussed only on maximising things purely for themselves and not others at all, then have we really progressed at all as a species?
IMO Rejecting someone preventative care ($1k tops), when they give $18K to the system is a broken balance. The claim/demand is not $18K in, $18K out.
Someone like that shouldn't be denied but I guess it begs the question of what happens if in a certain year demand for medical services outstrips allocated tax. I suppose govs should really have a slush fund for that sort of thing rather than national debt/constantly feeling they have to spend all tax money, every year.
I would rather die a few years earlier than live my last few years this way. It'd sure cost less too.
So it does depend on the individual and their specific circumstances.
We're taught that death is the worst thing that can happen to you, that when you die you might go to a place full of fire and burning and torture forever, that trying to extend your life (exercise, nutrition, psychology, cosmetics, etc) is the ultimate goal. We are not taught to get the most out of life when we're young, we're not taught the practical skills that would give us more contentment through life, and we're not taught that death is a natural and normal part of life.
We need a class in school called "don't fear, just plan: organize your way to a happy life and be fine with dying sooner." Teach people how to stop sitting around wondering how to be happy, and just give simple practical skills and workbooks. Things like "how to pick your career", "how to choose where to live", "how to actually manage your finances", "how to make friends", "how to get a significant other", "how to manage your emotions", "how to deal with conflict", "how to deal with a life change", "how to enjoy life for free", "how to balance work and life", etc. There are answers to all these things, but they aren't taught in school; we're just expected to bump into them somewhere in life, after decades of grasping around pretending like we know what we're doing. We waste so much of life because nobody has taught us what to do.
By the time you're 60, you should have already had a vivid, exciting life full of friends and opportunities and special moments. But many of us haven't! I put it down to simply not learning how. If we expect every kid to learn completely useless shit like Calculus, we should definitely teach them the more important life skills sooner.
Terry Pratchett, after being diagnosed with early-onset Alzheimer's, made a documentary called Choosing To Die, which you might be interested in. He had stated that he wished to die by assisted suicide, but ultimately Terry died at home from Alzheimer's.
That being said I think assisted suicide should be an option and everyone should have this option.
I recall my grandmother in the hospital with pancreatitis, in serious pain, saying she was ready to die, but her doctors reassuring everyone that actually her situation probably wasn't life threatening. She was in her 90s already. She had outlived her husband by decades by that point. She had outlived multiple batches of friends at her retirement community. She did live for a few years after that incident, but I understand why she was ready to accept death.
This is under-reported but there is a very high number of suicide in this age category.
I don't think the desire to live vanishes, but some of us are simply not willing to live miserably for months or years.
At some point it is clear that there is no turning back, being stuck in bed for a few days or weeks can be acceptable, but not if there is zero hope of regaining autonomy.
Also, I am not found of the business side of this, I think this is extorsion, preying on the weak.
People plan and choose to exit early all the time. Some people don’t want to live, even when death is nowhere near, but stick around because they don’t want to devastate their family.
Honestly, you sound like someone who likes to pretend to have insight into the human mind, but you can’t be bothered to actually invest the time listening to people you don’t understand.
Not true.
My father wanted to die for the last 6 years of his life.
He would talk about it and obsess about his death in eager anticipation.
His last words that followed by three days of not eating or drinking were "Can't this go any faster?"
Just not wanting to live, and not being depressed about it, made transition easier for me personally.
He was never in pain during this time, so I didn't feel compelled to help him die.
When she could no longer care for herself, a hospice nurse came twice a day. When the end was close, family moved into the house, and children were taken out of school. She pass in the comfort of a familiar setting surrounded by loved ones, and everyone witnessed her last breath and death rattle.
It was a very wholesome experience and how I would want to go.
What's your plan?
You'd rather die than have a tube stuck up your arse for 5 minutes? A colonoscopy is really not that big a deal
You can now chose to be on life support for 2 more year at the cost of pooping pants and being on drugs. I bet, life support does not sound so bad.
Which parts of your body are you willing to let degrade just to continue breathing and reading reddit about stuff that you will never live to see happen anyway?
We treat animals better than this.
I hope by the time it's my turn my family is able to end my life once the outcome is certain instead of watching me waste away day after day in a hospital bed until my body finally fails.
It’s not for everyone but she is much happier here than in a nursing home.
1. Kid(s) that will take care of you, or at least hands on supervise your care and fill in gaps in staff.
2. As little time as possible between being in rehab/hospital, and hospice.
3. Money
If you have at least two out of those three, you won't have a horrible experience dying. Otherwise you end up in the state-paid nursing home gristmill, where you can at least take solace that they've checked the boxes on the paper saying they're turning and cleaning you.
Once you've been down there for 5-10 years, why would you come back? There are huge communities of retired expats in Mexico. We're talking 5-10k expats all visiting the same grocery stores, churches, etc.
My parent's best friends down there grew up in the same era they did, often in the same regions of the US. I don't know what my parents would come back to the US for?
Sure. Once you have a community in another country, there are very few reasons to return back. But not everyone can build a lasting community. For them, returning back is still an option.
That said, I agree that even hospice and LTC is cheaper in other countries. Just take your money and live there in peace.
A really worthwhile read are some of the essays online with basically the same title: How Doctors Die. Doctors, who are familiar with the process of dying in a hospital, typically do not wish to die there (it is miserable), and choose to die at home.
I wish our society had a better ritual around death. Having an option for the dying person (if they are of sound mind) to choose euthanasia would be very merciful.
I'd like to know what this actually means. Where did the money come from? Was her grandmother destitute and so the money was pooled from other family members? Was this debt that her grandmother accumulated that was written off when she died? Or, was this paid out of her grandmother's retirement funds?
If you're including rent in the cost, did grandma have a home that she sold? Would she have been paying that much in rent anyway if she wasn't sick? Would it have been cheaper if she didn't live in one of the nations more expensive cities?
I would be willing to wager that the 'cost' was in a reduced inheritance.
Assisted death will get a lot of callout as its becoming popular but its not 100% the answer either. Legitimately wondering how older generations dealt with this problem. Did old people just die randomly and then they were buried and that was that?
In most places on earth the elderly live with their children. The children care for them, then yes they die.
They’ll often be buried in the yard if they have land or in a plot designated (graveyard). Alternatively, they’ll have some sort of cremation ceremony.
Pretty much been that way forever. The last 70 years in the US has gotten exceptionally weird, looking through a historical lens. Frankly, it looks like we hate our elders.
Leads to interesting debates/arguments on what is living versus simply being alive
edit: Wouldn't have thought any of that was terribly controversial. I'd be interested if those having a negative reaction would post some response so I know what makes that opinion problematic. No need to get into an argument, I'm just genuinely curious.
>unless they have family members who are willing to give up their own lives to be caregivers
Where my ancestors are from, this is what happened. 99% of the time, this responsibility fell on women, because they had no option.
I have no interest in seeing my wife or daughter or sister (or son) suffer the same fate, so suicide (preferably assisted) is the answer in my view.
Now, for the most part, both spouses work and neither has any interest, or ability in providing that care because their own living expenses are such that they can't just forgo one salary to be an at home caretaker.
My grandfather had a heart attack and bypass fifteen years ago. He's been pretty much bedridden for the last two of those, needing my mother to look after him full time.
My grandmother passed away after 6+ months of needing more and more oxygen. The last three months she needed full time care.
100 years ago they both wouldn't have lasted more than 2-3 months, and would have needed very little care for most of that time.
Being "on hospice" when you are in your last months (again I don't remember the medical term), in Massachusetts is free. The family is responsible for the round-the-clock care, though. The real difficulty isn't the money: The state is very good at placing people who can't pay. The people who get squeezed are those of us who want an inheritance, or the spouses who need to keep money for their own end-of-life needs, yet are unable or unwilling to take time off from our lives.
In my case my dad was under quite a bit of emotional stress, and when he's in that state, he gets irrational and can't make a decision. My mom was clearly in her last few days, but he was afraid he'd have to pay for many weeks or months of onsite hospice stay out of his own pocket. Even if that happened, he still had her brand-new Lexus and his own 1-year-old Highlander, a much larger house than he needs...
You just said the quiet part out loud, and is my biggest gripe about sob stories like this - it is almost always about the children resenting the fact that some of their parents money is going to be spent on their elder care when they would prefer 'someone else' pick up the bill, so that they get a bigger inheritance.
They determined that we should pay. The (cough) mistake that we made was we gave her painkillers before the visit because she was writhing in pain. If the social workers saw the writhing, they would have picked up the tab. (The hospice later retroactively admitted her so we paid nothing.) Edit: And I don't regret giving my mom painkillers.
But, I had to make a point to my Dad that the social workers saw his nice, well kept house, all of our nice cars, pictures from nice vacations, ect, and decided that $400-$1200 to keep Mom comfortable was well within our budget.
And a brand new Lexus sells for much more than $30k.
So my general point is that someone not wanting to have their own financial situation severely destroyed by long term care of an ailing spouse isn't categorically unreasonable. And as far as the next generation - you can either accept that medical vultures will devour your parents' estate and you'll get nothing, or you can step up and take responsibility for their care when the time comes, and perhaps inherit something. Your parent's quality of life will generally be much better if you do step up, but it's not the kind of job that can just be outsourced as we've become accustomed to with everything else these days. (and obviously this advice is modulo one's specific relationship with their parents)
I'm sorry for your loss, and hope things are going alright between you and your dad.
He's started to realize he can't take it with him.
There's the world's smallest violin playing for these people. The amount of delusional privilege to be in a position where you not only expect an inheritance, but also expect a certain amount of the inheritance, and yet refuse to care for your elderly is mind-blowing.
It's on par with parents who kick out their adult children out at 18 years out of the house.
Those 2 groups of people will firmly be labeled as pieces of shit in my mind and no amount of arguments will ever sway that position.
But the point remains. If you can’t agree with the hyperbole then you’re in the wrong making grand blanket statements about the way things work and saying nothing can convince you otherwise
You don't get to magically negate my argument with a strawman you invented, sorry.
If you don't want the described case to be your own case, then make the necessary arrangements where the doctor isn't making such decisions.
> Those 2 groups of people will firmly be labeled as pieces of shit in my mind and no amount of arguments will ever sway that position.
But are now implying that you would be agree with my example if it were true. Thus demonstrating that your statement is wrong. You are willing to engage in cost benefit analysis for elder care. This case is simply easy and improbable to arise.
We can play with the numbers until you think it’s realistic and unreasonable. The point remains.
Straw men are dumb. But not as dumb as absolute sweeping statements of certainty.
There are many, many cases of expensive medical treatments that extend life in a miserable fashion. There are many cases of expensive medical treatments that extend life in a non miserable fashion. Doesn’t mean they make sense to do. Doesn’t make you an asshole to think about it.
I married a doctor. That doesn't happen.
What does happen is that the loved ones, or social workers, push for the doctors to do everything possible, even when the doctors know that it's a futile situation. When people encounter loss they do not behave rationally.
> Personally I would find the cost benefit not worth it for any situation that has me lying feebly on opioids until I die.
"lying feebly on opioids until I die" is what happens when someone's body is shutting down from a painful condition like cancer. Hopefully you're lucky and die in your sleep of old age.
Unfortunately, assisted suicide is illegal in most places.
Generally what's legal is to let nature take its course, and your caregivers, (who can be trusted family members) decide how often to give you opioids. It's well known that painkillers at the end of life accelerate death, so as long as your wishes are known to the people giving you painkillers, the "lying feebly on opioids until I die" can be very short. (Read between the lines.)
My point is simply that it’s reasonable to make cost benefit analyses when deciding end of life care, and that you’re not an asshole for doing so.
Then an inevitable conclusion is reached: being a homemaker is like being employed but not compensated.
The point is taking care of your family is something people want to do to maintain family relationship, connections between generations and self-identity. It's a choice, not a forced expenditure.
And it's not meant to be pleasant or easy. It's not a hobby. It's a fabric of a well lived life.
We've had this talk with both my parents and my wife's parents. All four of them insisted they do not want to be a burden to us and we should never allow them to move in with us. Most of our parents took care of at least one terminal person in their life and experiencing that changed their opinions radically. It can be an almost impossible burden, no matter how much you love someone.
Thankfully in our country we have both the law and basic insurance that takes care of all those costs in the last (terminal) phase of our lives, but you still have to design your testament and other documents in such a way that your money cannot be claimed for these costs.
When the time comes, i want to be put in the Euthenasia Coaster ( https://en.wikipedia.org/wiki/Euthanasia_Coaster ) , but if they have not built that yet i might settle for the $20 heroin overdose.
The question that society seems to be encouraging is "how are we going to pay people to take care of the old?".
The question we should be asking is "why are we paying strangers to take care of you when for most people, their children should be there at the end of life helping, showing love, and thanking mom and dad for all they've done?".
There's a significant cost to the direction that society has gone in the last hundred or so years.
> Deemphasizing the importance of family bonds by encouraging government to be the social safety net. This problem will only be exacerbated by increasing the social safety net further.
> Compelling nearly all women into the permanent workforce, ensuring that most families are in no position to be able to do anything other than maybe get in debt to pay a stranger to care for their elderly parents.
> Encouraging women to have fewer and fewer children even while encouraging mass migration to replace the existing population, ensuring that the problem will be even worse the more time goes on.
Speaking to the possible point that kids 'owe' their parents for their upbringing: As a father of 5, I strongly disagree.
Fatherhood is, by necessity and actuality, service. Children don't ask to be born; I believe creating them into a position of debt is a poor rendering of that service.
The point is that every parent should treat their children well enough that they love and honor their parents so much that they want to do all they can to help when the parents need help.
Even the worst psychopath parent has a bit of incentive to treat their children well if they knew that this was the difference between having some comfort in their old age or being forgotten in some dreadful government facility being half taken care of by some stranger who doesn't give a fuck if they lie in a pool of their feces for hours.
In Canada a growing in popularity option is to kill yourself.
This is Denmark.
Yes it was a sacrifice. But it was a sacrifice that was worth it, and nothing less than what we owed to our parents.
Offering advice on the provision of goods and services without cost information is stupid. It’s like one grade schooler telling another “yeah, you should totally buy that real life Ferrari.”
> The problem is that the bulk of the hands-on care in hospice — including changing diapers, feeding and giving medications — still falls to the family.
Amazingly, she acted as a salesperson for services whose service level she didn’t understand. On top of that, instead of learning a lesson and sharing better approaches with others she promoted additional subsidies to the existing dysfunctional system.
It did require having nursing help at home and it did cost some money - but it was still cheaper than being admitted in a hospice or a hospital.
You mean like what Grandma or Grandpa did to bring life into this world. Your life I might add. You owe them so much and you haven't clue. It is worthless and shameful.
I don't agree that my children should be responsible for the obligations that follow my choice to have sex. Further, decades of parenting taught me that as far as there is a debt, it is mine to pay. Parenting is service.
ref: Father of 5. https://news.ycombinator.com/item?id=34724289#34725607
But more specifically...
Leviticus 19:32
Exodus 20:12
Ephesians 6:1-3
It is more than a restrictive immigration policy. Many other caregiver policies exist as well. I have an acquaintance that runs an adult foster care home with 5 rooms. When he added a second facility he went from providing care to being a paperwork pusher for the federal, state and local governments. This is the real reason is costs so much.
This article left me fairly confused. Why is the author talking about dying at home and in a hospice interchangeably?
I'm just speechless about all of that at this point and very glad the I live in Europe, where we have things like these figured out.
(edit: yeeeeaaaaaah, not everything is perfect in Europe, either, but nobody will be left with a bill of 150k € if your grandmother wants to die in her home.)
A 24/7 _at home_ and _medical_ care will cost a fortune anywhere in the world and is never covered unless you have a very expensive private insurance to begin with
Also, there are different healthcare systems around the world. I don't know why you would be so sure about the impossibility of at-home nursing.
Hospitals and health systems are at capacity pretty much everywhere, they can barely keep up with people in them, they won't dispatch nurses and docs around.
And my example was in France, far from being hell on earth when it comes to health
My father passed away last year and towards the end he had carers at the house 24x7.
> Currently, Medicare only covers an average of two hours per day, five days a week, of home health aide coverage for a patient in hospice care.
But yeah, if you've got the money to take care of yourself, you'll have to pay it. My grandparents had a low-enough income that the care takers (twice a day) were free for them.
Also, check with your local council as there's a lot of support that is not well publicised (particularly for making modifications to your home - which can lead to reduced council tax bills). Unfortunately GPs often don't seem to be aware of what is available - it could be worth talking to your local hospice (even if you aren't end of life) as they tend to be much more clued in.
i'm not complaining about the nhs here - in general the help and treatment i've received has been exemplary.
I seriously doubt that.
That’s what this person spent on their grandmother. There’s a huge difference between “wanting to die at home” and “wanting round the clock care at home”.
You can die at home for effectively free.
You could do that. I have seen it before, back in Spain. It is expensive, but not $13,000 a month.
It would not make much sense to pay this much, when nurses themselves make, on average, a small fraction of that.
In the US you have a lot of different options depending on financial ability and your choices. Some aren't choices, and some are. In this case the individual choose to spend an in-ordinate amount of money - their choice and they have to pay for their choice.
Do you have the luxury of choosing in your country or does the government choose for you?
I'm unsure where this belief originates from, but it's not true that state provided care is the only care in countries that offer it. There's very few places on earth where money cannot be used to improve quality of care: the state guarantees provision of a minimum level of care, rather than impose a limit on the maximum.
Watching someone pass away is never pleasant, but there are limits to public generosity.
She was fortunate enough to afford the constant care and was basically employing a full-time nurse. That adds up.
OP's grandmother had a team of support people giving her medication, changing diapers, monitoring equipment for an undisclosed period of months.
No where in Europe is 24hr support available for free in your own home. That simply isn't scalable.
Moreover, it should be noted that none of the family was willing to do this - so they were forced hire outside care.
The US healthcare system isn't great - but this article smells like spoiled rich people annoyed that they have to pay for rich-people-level service themselves.
As everyone knows, most of the US budget goes into defense. Most Americans are not keen on that fact, but I don’t see Europeans complaining about it when countries like Russia go on the rampage.
- article from CNN
Some of this is driven by ideology - low tax, small state. And some of it is driven by greed - lobbying by large US healthcare groups, or more obviously owning shares in those groups.
This has led to an almost deliberate policy of mismanaging and underfunding in real terms the NHS.
In the USA, my grandma died in my parent’s home 10 years ago and there was no bill. She was upper 90s, refused treatment, and doctors prescribed morphine for us to give her so she could die peacefully.
I think a nurse came everyday just to check on things.
Honestly, if I lived well into my 80s and a last few horrible months was going to cost over $100K of money I didn't have to spend and eat up 2-3 peoples full time efforts, I'd probably just opt out.
For a 30-day month, that's $16.77/hr to the worker plus $1.28 to SS/Medicare if you allow for 0 minutes of shift-hand-off, PTO/sick, etc.
How much less than $16.77/hr do we think that care should cost? (Note that Massachusetts has a $15 minimum wage. This care cost less than 12% over minimum wage.)
That being said the corruption in the us system is insane, insurance companies being protected by regulations against competition, big pharmas regulatory capture and media control, etc.
The answer is a more competitive marketplace, including non profits. Not a eu socialized model.