Dec 16, 2009

A Concerned Baby Boomer Surveys Our Current Healthcare System and Offers Some Solutions

We need an attitude shift. We treat people with dementia as if they were potted plants to be infrequently watered until they die.

By Kathy Harmon

I’m terrified of getting Alzheimer’s. I didn’t used to be--actually, I never thought much about getting sick or old or even dying. I'm like most Baby Boomers: I prefer happy thoughts! Then I hit 55, gained weight, and began to lose my hearing and my car keys. My mother turned 80, we launched, and the door to aging opened wide for me and welcomed me inside.

Over the past couple of years I've visited more than 300 senior housing facilities and dozens of adult day care centers. I've networked and taught with hundreds of care providers, financial advisors, senior advocates, assistive device manufacturers, social workers and all manner of folks who are in some way professionally engaged with seniors. My fear? It's gotten worse.

Here are the facts:
There are 78 million-plus Boomers. Although we're better educated and more affluent than our parents' generation, we were taught that, because the planet was overcrowded, we should have no more than two children. So we did just that. Unfortunately, Social Security--what I call the Great American Pyramid Scheme--needs to be fed from the bottom to support those of us at the top. I’m no economist, but I'm sure that if we gathered up the salaries of the two generations that follow us, we still couldn’t support the burden of Boomer retirement.

When the Social Security program was enacted in the 1930s, the average American's life span was 61 years, so age 65 looked like a safe bet. Since then, of course, we've made enormous advances in medicine. Here's an example: I recently learned that babies born after the year 2000 have a 50-50 chance of living to 100! The news is also good for the rest of us: our life expectancies continue to stretch, on average to 80+ plus for women and 78+ for men. It is also true that if we make it to age 60 and are in relatively good health, we have a more than 80 percent chance of living productively until we're 90! The bad news, of course, is that our sheer numbers will bankrupt the U. S. retirement system unless we create and execute an innovative solution.

Our healthcare system has been in the headlines for more than a year and heatedly debated for decades. I don’t pretend to know how it should be fixed. But, having viscerally experienced elderly care these past few years, I know one thing: the current system doesn’t provide the kind of care I want my parents or me or my family to have when the need arises at a cost most of my generation can adford.

The care providers I've encountered are, almost to a person, glorious spirits with amazing hearts. But the cards are stacked against them. Let me be clear: I've been in some extraordinary homes, most of them housing between three and 36 individuals. The ratios of caregivers to patients may be as low as one for every three patients. The annual cost of care in the best facilities is often more than $100,000 annually, which makes it affordable only to those with solid long-term health insurance and sizable nest eggs to fill any gaps. The healthcare industry calls these fortunate folks “Private Pays.” They're the ones who make the high-end places work as businesses. Owners of these facilities can afford to pay for the level of care that we would all want to have. Both facilities and home care providers need a sizable chunk of their businesses to come from Private Pays. Unfortunately, Private Pays are a disappointingly small segment of American society. With recent downturns in the economy, housing values and long-term investments the size of this group has shrunk even more. I suspect that Boomers, who are greater in number, saved less, were greater risk-takers and less conscientious about retirement planning.

There just aren’t enough care providers to do the work. The pay isn’t great, the stress is substantial and most of them go home at night without any sense of accomplishment. Turnover and burnout are high.
I believe these problems can be easily and rapidly solved. The solutions can be easily put in place; they'll be cost-effective, but require grass-root support and implementation. Best of all, they'll be good for individuals and society. Let's see if you agree:

We need an attitude shift. We treat people with dementia as if they were potted plants to be infrequently watered until they die. Our medical system doesn't include nurturing, companionship, conversation or comforting touch in its definition of "care." We plant these sufferers but we don’t expect them to grow. Care needs to prioritize making patients better, whatever their condition. For an Alzheimer's or dementia sufferer, this means seeking out the person and engaging them as often and for as long as possible. This means more caregivers, more time but perhaps only a little more expense committed to their care. With a shift in attitude and funding it just might work.

We need to believe and act upon the notion that prevention can readily offset the costs of long-term Alzheimer's and dementia care. Recent studies have demonstrated that more intensive care and withdrawal from psychotropic medications reduces emergency hospitalizations more than 90 percent! Ambulance attendants, emergency room and hospital staff can be put to better use administering preventive care. And drug companies? They'll encounter willing Boomers clamoring to buy any drug that can positively impact Alzheimer’s--or cancer, for that matter--and we'll gladly make up any financial deficit losses resulting from the removal of psychotropic dementia treatment from the market.

The pharmaceutical industry can allocate funds to research drugs to detect, cure and prevent dementia. The use of psychotropic drugs to keep our seniors under control must be banned. I believe, as do many others, that violent, disruptive behavior is not inevitable with dementia. Rather, it is caused by the patient's inability to make their needs known and have them met. We need to teach caregivers how to uncover these needs, provide the time to do this job, and pay them adequately for the effort.

Much of what is needed in elderly care doesn't require a medical degree or even a lot of training. It's hand-holding, conversation, stimulation, affection, laughter and the gift of time from another human being.

We can provide what's needed by simply shifting our attitudes away from our sense of entitlement. America is the best place on earth. “We the People" created this country, and we have a duty to sustain it. We have a moral obligation to care for all members of our society who are unable to care for themselves. Unfortunately, it is my belief that our systemic welfare programs have created successive generations of capable people who are willing and able to work but either don't want to be employed or can't find a job.

I'm a Boomer. I am firmly convinced that productive work is fulfilling. It creates a sense of worth and dignity both of which are essential to a healthy human spirit. Imagine this scenario: every person who is legally entitled to receive a welfare check is required to further their education by attending classes 10 hours a week and volunteer another 20 hours, perhaps in a care center, or as a member of a workforce that paints houses, rakes leaves, shovels snow or does repair work in a senior's home. I can think of no less than a hundred tasks that could be easily and enthusiastically handled by volunteers. Our society needs to systemically adopt both education and volunteerism as requirements for able citizens.

“It’s not disease that kills us, it’s the loneliness” is a quote I heard recently. We have all known senior couples in which the wife dies and the husband immediately follows; the reverse also occurs, but less frequently. What if every able-bodied senior who collects Social Security were required to volunteer? They can be the teachers who educate welfare recipients, or they can spend their time in a senior community, or perhaps a school or a veterans' home. There are tasks--feeding, transporting, reminiscing, conversing, dancing, singing, playing games--requiring only a few hours a week that would be beneficial to everyone involved. These volunteer seniors often need socialization as much as the recipients.

I’m sure it was a Boomer who coined the phrase “60 is the new 40," which suggests that 85 will be the new retirement age. Fortunately, Boomers are all about work; it defines us. Whenever I am with a group of Boomer strangers they ask two questions in the following order: "What is your name? What do you do? If my career doesn't interest them, they wander off. This Boomer behavior is part of the long-term solution. We need to continue to feed the system by working long past the traditional retirement age. Remember, our chances of living productively to age 90 are excellent, and most of us will gladly continue to be an integral part of the workforce.

Hospitals, care facilities, adult care, in-home care providers and all the other care businesses should be pleased that the prospect pipeline is rapidly filling with prospective customers--too many, in fact. You need the help that this plan would provide.

Finally, we may have to bear the cost of insuring our senior teachers and protect our companies against the risks associated with a greatly increased volunteer workforce, but it won't be nearly as expensive as paying for the care they would require if left idle. The mushrooming workload can be effectively handled by simply increasing the number of caregivers. We want to help. Recent statistics show that the majority of Americans care about our environment, their neighbors and the society in which they live, and they're willing to do something or give up something in order to make a positive impact.

We just need a plan. This one's mine!
Kathy Harmon, Great Places Inc.


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Original content Bob DeMarco, the Alzheimer's Reading Room