Assisted living vs. Hospice:  Who is in Charge?

The New York Times is right on the money and we applaud them for discussing this.

To be fair we believe you need to add many players to the list of

who is in charge?

We would add Doctors, Your Doctor, and the financial entities that pay for your medical care and control to various degrees “your Doctor”  into the mix.

This is precisely the issue, no one, Doctor, Assisted Living, Hospice, Hospice Doctor, the Home Care aide or the office manager who runs the Home Care Company, Family Member, The Government, The Insurance Company — WANT TO BE RESPONSIBLE FOR THE VERY CHALLENGING AND EXPENSIVE TASK OF PROVIDING CARE TO A SENIOR.  When it comes to being “responsible” few want that job.  That is expected since it is a very difficult and under valued job.  While Medical Care use to have a high Value, much of the value came from relationships, continuity of care on both sides, “provider” and “Senior”.  However, we have seen a stead decline in the value both sides places on relationships and continuity of care which has gotten us to the assembly line, less personal, style of care we now see.   Why, How, that is a discussion we are ready to have and need to have as a society.

NYT article


nyt article 2

The issue is lack of continuity of care.

 This is a lack of responsibility by the patient and the provider.  To have a responsible party you have to have a person, family, or patient who is participates and respects that responsibility.  If the Patient jumps to a new insurance company because a stranger, a sales lady, promises them something new they can’t expect to build and earn a trusting relationship.  We believe that health care requires that relationship especially as people age or acquire chronic illnesses for any reason.  30% of people on Medicare are less than 65 yrs old.  Accidents do happen, illness is not only for the old and all of us will need health care someday.  We need to value it, invest in a cost effective, humanistic, system of care and the basis of that will undoubtedly be Continuity of Care.

The power struggle is between financial entities, corporations trying to get your dollars and delegate the work and responsibility.   While that is a very good business system and works great when building inanimate cars or objects it fails miserably in dealing with people or providing Health Care which by definition has Emotional Health, Feeling, Depression, Satisfaction, and all the human emotions included in the service or product.  If we all were VCR’s then we can roll out care down the wide Assisted Living , Nursing Home, or Hospital Hall and go do to door making the patients wait until our assembly line was turned on.  However, in fact the bowl and bladder and entire body and mind work on their own time table making assembly line much less efficient  in providing high quality heath care.  Do not let the sales lady convince you that her best care, care she will not provide, care she has little interest in once she signs you up, will be as compassionate as care you get from someone you have a professional relationship with.  Look for continuity of care.

of course the ideal person to be in control is “your Doctor”.  They use to have more control but now have had that dissolve.  Families, insurance companies, politicians, have all come between the care providers, Doctors, RN, and Caregivers and the patients.  As those relationships were lost it stands to reason some care and caring went with them.  Now the financial institutions want to be “responsible” for your premium but want to delegate are to unknowing doctors.

By Shawn McGivney MD, RFA

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Shawn McGivney MD, RFA

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