Most of the health care industry, including hospitals, are in business to make money. Their business is to help people get better, but that includes being profitable.
I drove down to see DOD on Thursday and Friday this week. Since the reports were that he was at end-of-life stage, I wanted to see him one (perhaps last) time.
Fortunately, when I arrived he was somewhat alert and I had a good visit with him. That evening, when everyone left and he slept, the nurse came in and talked with me about his end-of-life “state.” She related how it appeared that he was in a typical end-of-life stage, his system in the shutting-down process and that he needed to be discharged.
DOD’s wife had asked me to be in a meeting Friday with the medical team and social worker to discuss next step options. During the meeting, the head doctor reiterated that they did everything they could do for DOD to help him get better. The only thing the hospital can now, they said, was to provide comfort.
But hospitals are not in the business of comfort. They don’t get paid to provide comfort. They get paid to make people better. As well, hospitals don’t like people dying there. It doesn’t help how they are measured. They said that DOD has got to be discharged.
Not many of us can control how or when we will die. Ten years ago, two very good friends of mine both had fathers dying at the same time. One in New York, the other in San Francisco. I listened to the stories of their dying process over a period of six months. Both died slow deaths, much like the Tuesday with Morrie type death, long and drawn out, shriveling to nothing, needing to be diaper changed, completely dependent. Both their dads died at home. But both were relatively well off as they required full-time care, which doesn’t come cheap. Or, it takes able-body family, around the clock. In both cases it was a painful process both for the person dying and their families.
DOD is not going home, unless an unforeseen recuperation happens. He is completely dependent, i.e., bedridden. His wife is not able to provide full-time care herself. And normal health insurance doesn’t cover comfort. The medical team won’t give a definitive “terminal” determination as they’ve learned to cautiously error on the side of “anything could happen.” In their opinion, he is in the needing comfort stage.
Bottom line, being discharged will require non-health insurance funds. How much depends on how he is evaluated and the level of care. It was somewhat clear in the meeting that DOD’s wife thought they had insurance for comfort care. They don’t. So now it’s on to their next hurdle.
For many, the level of end-of-life dependency comfort care is commensurate with the available funds. But such is life. And dying. Dependency at end-of-life is significantly more comfortable with supplemental insurance, plenty of funds, and/or a supportive family. With our ability to install stents, tubes, replacement parts and the like, we make the possibility of dependency at the end much more likely.
Luckily for DOD, his wife’s granddaughter (and her mother) have helped navigate and research the discharge options. With their good and able involvement, he’ll end up in a place which will provide the right amount of comfort care (their) money can buy.