February 4 Forum

Walt

For clarification purposes, I want to return to the matter of scope. Most people associated with end-of-life issues are engaged in palliative care and hospice care. These services have grown a lot in recent years, in part because they are now covered by health insurance. Until recently, there wasn’t a whole lot of end-of-life support. We’ve changed that. This type of service has grown, it’s matured, it’s been formalized. That’s really wonderful. A very difficult, challenging situation is manifested and is now being addressed. However, what I’m hearing from Bill is: “Let’s back it up. Let’s provide services at an earlier point. It’s not just that someone’s giving you a prognosis of six months and you’re going to die. Or two years and you’re going to die. So, instead, the prognosis is now that you’re older”.  So, what happened. Medicare came up with providing financial support for an annual wellness visit. Thirty years ago, Medicare did not pay for any preventive care. None, zero.  And that was part of the growth. Let’s get out ahead of this and not just be a healthcare system that is a sick care system—that only treats you when you’re sick.

Let’s get out there and see if we can get ahead of this thing called aging.  How can we assist our older adults? We artificially identify older adulthood as beginning at age sixty-five.  That line was drawn during the 1800s. It came up just because Germany could afford to have people retire if these set this age as the point for legitimate retirement. This was because only one percent of people lived beyond age 65. That’s where we got sixty-five as the retirement age.  Totally capricious.  And obviously now it’s much different because people are living a whole lot longer.

Depending on where this conversation goes, I’m thinking that it could integrate very nicely with the things that are being done in healthcare right now. Because it’s required that everybody at this age has an annual wellness visit. They address late-life issues with their patient every year. And there’s actually a structure in place where you ask questions that weren’t even thought about before: Are you falling?  Are you incontinent?  Are you blah, blah. You are getting out ahead of aging with these questions. Do you have end of life ideas?  Have you got a formalized plan?  All those things were almost forbidden to ask in the past.  So, if it’s really evidence based, the late-life doula service could be a really wonderful way to enhance what is now in place. Serving the medical needs of older adults has been a big improvement over the decades.

It could be a really nice way to help improve what’s going on ten years from now.  Well, Jack, in some ways, I’ve actually agreed with you when you say. This is the stuff that we should have started much earlier.

Bill B

I also agree with Jack in the sense of saying that we should be dealing with these issues much earlier in our life—rather than during the last six months when someone’s dying. Maybe we need to work on these issues a lot earlier. If I’m struggling with death, this is not a great time to inquire about what I do with my possessions, Et cetera, et cetera.  So maybe we should push consideration of these issue way back. All the way back to our twenties.  Perhaps, we can at least push our concerns about late-life issues at least ten, fifteen, twenty years.