Hospice Impracticality

Catalyst:  Prez Jimmy C. has decided to enter Hospice (21 Feb. 2023).

1.  BILLY BEER.  btw - I can feel distinguished in declaring that, I once was the proud owner of an unopened six-pack of "Billy Beer".  Interesting item of Americana, sure to fetch some shekels on EBay!  But lamentably, such coveted libation has long since gone missing from my oversight, custody & control. 

And JC's bro, "Billy C." himself:  what a colorful character!

2.  FIRST LADY.  Once upon a time, yours truly greeted Mrs. Carter (Rosalynn) personally, shaking hands with her, while JC was running the country.  Petite, demure, and charming:  all are adjectives which combine to help describe her.

She was traveling the road (in Carbondale, IL), drumming up support for hubby.  What a nice lady!

Plus, what great people, the two of 'em!  And, nice offspring as well.   

ECONOMICS.

Now, for the grist,.....

     Who PAYS for HOSPICE?

     The shortcoming of Medicare and private medical insurance, is that they routinely exclude coverage for "custodial care".  Instead, they are aimed at treatment and rehabilitation.

     An average Hospice patient, as can be expected, is unable to accomplish, generally, our necessary, daily basics of hygiene, housekeeping, meds administration, medical devices (I.V.’s, ventilator, etc., you name it), without continual, professional intervention.  This concatenation of calamitous complications turns out to be very costly, indeed!

     Two options and prices these days obtain, as to either in-home Hospice, or, of similar result, at a remote nursing facility.  That the (principal) "nurse" is the face of Hospice means that this individual is the most expensive component of the Hospice team and paraphernalia.

     "Three weeks" is the duration of the average, USA Hospice stay?  What a mixed "blessing"!      

     [It’s] So described by me because, here’s likely how things will play out for many of us.  Uncomfortable, to say the least. 

     By connotation, “hospice” implies that the patients are on their last legs.  Their remaining time is running out, rapidly. 

     But still,....  FINANCES? 

     What's next?  Get ready.  Buckle up your seat belt.

     Choose either to lose your loved one promptly!  Or, guide their surviving, nuclear family into bankruptcy!  

     Human and monetary loss.  One is faced with what psychologists call, an avoidance-avoidance situation. 

     Which is it gonna be?  One's plight, as decision maker/ attorney/ responsible party, comes to feel like he or she is "stuck between a rock and a hard place".

     Here are current money amounts I have handy, to share.  Money, as in what this patient (thru his/ her agent(s)) will be spending on Hospice. 

     And, to achieve what?  Continue indefinitely, as a vegetable? 

     Or, that a litany of prayers be invoked to realize recovery miracle?

     Year 2023, Chicagoland MONEY data: 

a.  in-home Hospice costs $4,000.00 (four thousand dollars) per WEEK; 

b.  alternatively, Nursing home is 2/3 more budget friendly.  Comes in at around $1,400.00 (fourteen hundred) per Week.

(Subject to variation, per specific patient’s maladies and diagnosis.)

     I ask, Mr. & Mrs. average American:  who among you, has that cash flow?  So realistically, if the Hospice patient lasts a whole year, then they're looking at a $200 thousand ($200,000.00) billing fee! 

     I even know a business associate, whose mom lingered for six years.  She stayed at home.  So that way, they made her more comfortable. 

     But, do the math.  The concomitant outlay from that decision was serious money spent.  In this case, we're talking north of a million ($).  (In today's money.)  Yikes!

     Biz assoc.’s tasked answer to the challenge?  He and siblings sold her house (subject to contingency, life tenancy), to pay for her care.

     With some legal legerdemain, one economic survival strategy may be to drain off the assets of the elderly patient over time, in preparation for the inevitable, so that he or she becomes, technically (on paper), a "welfare case".  That is, by the time this scenario presents itself. 

     Then the local state's Medicaid, possibly can pick up that patient and maintain them.  Thus is obviated, crushing economic burden upon the surviving family. 

     But, if you really love this person --- probably true, don't know why it wouldn't be --- then you want the best of care for them.  Will a state-run institution be able to provide that?  Questionable.

     BOTTOM LINE is, how does "Hospice" work, feasibly, for anyone reading this?  We're not all Jimmy Carter after all, God bless him.  How can Hospice be made to serve us, and to do so, sensibly? 

     Sell your Hospice patient's property(ies), e.g. their home?  Oh-boy.  “This is one can of worms,” that’s been opened.

     Complicated and daunting!  Right?

     Do there exist workable, fiscal alternatives to extricate Americans from our extant, Hospice quagmire?

     I am optimistically expecting,.... YES.  We indeed will successfully solve. 

     For one reason, since it is a problem of our own creation. 

     (Think ozone layer, which helps protect us from outer space radiation.  Was historically jeopardized by flouro carbons which we had voluntarily injected into the atmosphere, until we knew better. 

     (We fixed that.  Similarly, we can fix this?)

     Solutions here solicited, please!!!!!  ¡Por favor!  Socorro, auxilio, ayuda,..... 

     [We need] A Hospice, insurance fix, now! 

     Anyone?   

Collateral thoughts:

     (I.)    MECHANICS.  Indeed, the “what to do?,” can become so burdensome, vexing and weighty. 

     Ultimately, “the buck stops here.”  It’s gonna be your call, as to your patient’s fate.  [It’s] A most psychologically stressful corner to be painted into. 

     Clear-cut law (always subject to challenge, in our democracy) works hand-in-hand with theology, ethics (relatedly is etiquette, i.e. good manners), values, dignity, quality of life, and (cosmological) world-view.  Suddenly, this trial becomes complex, and oh-so-dicey.

     Shall I even include some fancy jargon from my med school days like, “ontogeny recapitulates phylogeny”?  It’s only that this talking point comes to mind because many of us ponder where we come from; (and where we’re headed). 

     Now, I’m talking philosophically, metaphysically, of the great beyond, whatever that may mean to you.  Not something as simple as obtains with our house pets or ourselves, that we all come from our mothers’ womb. 

     And some end up underneath the backyard, flower garden.  [They’re literally] “pushing up daisies,” so to speak.  

     What’s wrong and what’s right?  What to decide next?  Best course of action?

     Absent a living will or other trustee arrangements, by law, medical professionals are sworn to do all that’s scientifically possible, to prolong the patient’s lifespan.  And even when these legalities are in place, physicians still are required to abide by the trustee’s wishes. 

     Note well, that each Doctor serves as our employee, not boss.  That is to say, that the patient’s authorized agent is thereby possessed of the requisite potestad, to act as patient’s decision maker.  And, as I learned in Spider-Man, with great power, also comes great responsibility.

     Further, as medical science continually overcomes more frontiers, we live better and longer.  Needless to say --- then why do I say it? --- this is an extremely good thing.  Thank you, medical science.

     Unless one becomes so feeble, debilitated, that all friends and family most closely affected, are chronically confronted with:  how to act in this patient’s best interests, ongoing, that’s correct? 

     The, “what a fine kettle of fish is this!,” scenario, is what I mean.  (An expression, I believe, I originally learned from Mr. Oliver Hardy, of L & H.) 

     But never mind, Hardy's characteristic humor.  This scenario is the polar opposite.  "End of life issues" need to be confronted when the situation is dire enough!

     (II.)  NEAR FUTURE.  The world record holder for human longevity is French lady, Jeanne Calment, up thru now.  I’m talking documented and verifiable data.  She passed away the same year as Lady Di. 

     But in contrast to the fate of King Chas.’ “ex”, J.C. lasted into well,...well beyond a century.  122 years young, to be exact!  One hundred twenty-two. 

     Way to go, girl.  Inspirational.

     Aside:  check out Wikipedia on aforesaid French lady.  I am all for meditation and “chilling out” as healthful habits.  Conjointly with these practices is characteristic attitude; how one deals with the unexpected, in particular.

     Re the, “how Not to approach things” category, here’s a stellar example:  actor Joe Flynn.  His interpretation of McHale’s Navy’s Capt. Binghamton is a case study.  Ultra irascible, he feels constantly irritated, vexed and exasperated by his subordinates’ conduct and machinations. 

     That’s his act.  Ironically, in real life, such attitude harbored wide-ranging fallout, it would seem.  Which contributed to Flynn’s premature demise, at age 49.

     In this same vein, "Gomer Pyle['s]" boss, Frank Sutton, provides further food for thought, another case worth looking into.  Coincidentally, Sutton's early career breakthrough came in the film "Marty", alongside "McHale" himself. 

     Let us say that 80% of (human) stress is between the ears.  That’s a pretty good figure. 

     Versus all other animals, where I would set that number in the single digits.  It comes down to how all of us, people and furry friends, even poikilotherms, process information.

     Also, we can talk about duration.  Humans may fret 19 hours per day, daily.  But for other animals, it’s relatively brief.  Five or ten minutes, and the danger has passed (or, alternatively, has been realized!).  “Ignorance is bliss.”

     Here’s another one:  money.  Watch TV for any amount of time and you can’t avoid seeing numerous money ads.  Payday loans, credit cards, cash advances, loan consolidation, bankruptcy, lawyer allocations for car accidents, tax problems,.... 

     These seem to be on most people’s minds.  Evidently, it’s a hot market, nationwide and beyond.

     But the idyllic life of our dear Fido?  Although I am no mind reader, I feel completely confident to infer that Fido is not being stressed out by money worries.  Never happens.

     Ever seen the TV show, "The Millionaire"?  Now there's one amazing philanthropist:  John Beresford Tipton.  One of the program's take-aways:  how money affects people.  In this case, it's getting to live ample surplus, rather than deficit.

     Consider how Fort Worth's Dr. Mike Murdock might remark:  "maybe money can't guarantee happiness.  But you know what?  For sure, neither can poverty!"     

     Subjective, it’s largely how any one of us deals with the world.  Our perception helps dictate our reaction. 

     A worry wart versus happy-go-lucky, to cite a couple of personality types, would react much differently to the same situation.  [Are] Two different temperaments.

     As part of the animal kingdom, we all pass thru episodes of “fight-or-flight”.  It’s a good thing which augments our survival.  But here’s the key difference between humans and other sentient beings of the planet.

     Whereas any sundry animal probably escapes to fight another day, much worse is the lot of people.  Because many of us feel “stressed out”, 24/ 7. 

     It is not a five or ten minute thing, until one has attained safety.  And rock-solid fact is, that this dynamic will surely kill anyone, prematurely. 

     That is certain.  Unequivocal.    

     Contrast Grand Dame Calment’s approach to life.  Here’s an anecdote, most telling. 

     (I shall not say, “speaks volumes”, because I abhor trite, hackneyed, fad expressions.  Fact is, these squibs routinely serve only for shallow, mentally-challenged “thinking”.  Windbag gas. 

     (“Skin in the game”, is another pet peeve.  Boy, I’m glad that that one’s disappeared for now.  Some of this junk hurts my ears, to have to endure hearing.

     (They’re all like what one desperately grabs in the bargain basement, in thirty seconds, so as to show something.  Initially seem of promise, but deliver considerably less. 

     (That’s all these overused items of speech bring to the table.  Bread crumbs.

     (Or the expression, “[A]t the end of the day,” as in, after all’s been said and done; somehow, pains me less.  But at the very least, it’s another one, which could do with a rest.

     (Then why talk that way?  First, because it’s easy.  [It’s] handy for the lazy. 

     (Second, the context frequently is that one hopes to gain advantage thereby.  As in pandering to a specific demographic, hoping to appear in their eyes, as being up-to-date, “with it”. 

     (“Hear how I talk?  Yeah baby, I’m enlightened, and I’m hip,....”  Not. 

     (“I know where it’s at”, is what’s hoped to be successfully pitched, whether true or false.  Invariably, it’s the latter. 

     (Hackneyed?  That’s why the speakers are hacks.  Trite talk:  tool of the phonies.) 

     (Readers, I thank you for indulging me in my critic John Simon moment.  Quite the character, was parodied by Kenneth Mars in “What’s Up, Doc?”. 

     (Of whom comedian Carol Burnett made fun of, in defense of Liza Minnelli:  could it be that Mr. Simon suffers from heart envy?  (Hint:  think Sigmund Freud, to decipher Carol’s message.)) 

     Now I describe her (Calment’s) adventure because I consider it as fundamentally contributing to, and helping her attain world-record longevity.  It’s her being bossed around by the Nazis during WW2, and how she reacted to the predicament.

     Go check out your USA Constitutional Bill of Rights; amendment # 3, to be exact.  Essentially, here’s its proscription:  “troops may not be quartered in private homes, without the owner’s consent”.

     On the other hand, Herr Adolf and Co. marched into Paris, France, then predictably took command of the entire metropolis.  Where are his soldiers gonna sleep? 

     Well, fact is, they hold the guns.  So answer is:  anywhere they choose!

     Which included Ms. Calment’s home.  How did she weather that tribulation?  Here’s her post-war comment.

     Implying that the German soldiers were well-behaved enough, she stated:  they left all my possessions intact.  They did not mis-appropriate anything.  No stealing, nor even pilfering [happened]. 

     Which provides insight into how she must have conducted herself on a daily basis, while thrust into their midst.  And is part of the reason she was able to walk our Earth until age 122.     

     As someone who had mastered much of medical school (the M.D. program) before I opted to detour into something else, I shall posit.  The human body is practically competent to provide at least 150 (one hundred fifty) years of healthy service to any of its inhabitants. 

     We’ll all be there before you know it.  Oh yeah! 

     Count on it.  You heard it here first (well maybe second, that #, (150), was not originated by me).  Should you need more convincing, then pause to consider our never-endless parade of technological breakthroughs.

     We’ve already vanquished smallpox (my maternal Uncle Joe succumbed at age four---WWI era), TB, and polio.  Ditto as to AIDS (Liberace and Rock Hudson, famous victims). 

     We successfully control diabetes and heart disease.  (As to the latter, So. Africa’s Dr. Christiaan Barnard, first human heart transplanter, was one of my early influences to study medicine.)  Cancer is another “pest” against which we’ve made great inroads to improve human existence.

     And you’ve heard of Covid 19, right?  Again, med science comes thru, to save the day. 

     Perpetual result of research and clinical doctors’, and their teams’, efforts?  For all of us, [we get to enjoy] increased longevity and good health.  Obvious, right? 

     Again, I say thank you, to these key, health professionals!  A sentiment which deserves highlight.

     It is nothing less than gratitude, another good thing for which I am appreciative.  [It’s] a real virtue to possess.  And, we being human, it takes regular practice. 

     Which serves as potent antidote against envy, (of Proverbs’ seven deadly sins).  This last, “A Must to Avoid”, as Peter Noone might turn the phrase.

(III.)  ASSISTED LIVING.  This variety of remote facilities is not the grist of what I wanted to address today.  But, as a related matter, I shall touch upon it.

     [It’s] a mixed bag, to me.

     Excellence is what I encounter generally, as to physical plants and professional staff, everywhere.  But here’s the rub.

     I detest the endgame.  This is where bad psychology enters in, unfortunately as a visceral component.

     How you gonna get outta there?

     When I attended college, we started as inhabitants of the dorm or
Greek house (fraternity, sorority).  Then, for the assiduous enough, in predictable time, he or she exited with diploma and acquired skills.  Thereby were launched into the world, into promising careers.

     But assisted living?  For any inhabitant not afflicted with Alzheimer’s, they’ve got to be mired in sulking from time to time, something akin to what I heard in the flick, “Castle On The Hudson”.

     There, a news reporter needles prison inmate John Garfield about warden Pat O’Brien’s strict regimen.  Garfield, full of himself, conceited, declares that no place like that can hold him very long, before he escapes.

     Chides the reporter.  “Before anyone’s sentence is completed [at Sing Sing], there’s only one way they’re getting out.  In a two dollar, pine box!”

     For anyone with a functioning brain, this has to be some of the parallel thinking, part and parcel of one’s sojourn while ensconced in any of the well-intentioned, if not fully fulfilled in mission, senior institutions. 

     Thinks the patient:  “Okay, I’m in assisted living.  Now, what do I have to look forward to?  Heaven? 

     “Well maybe I qualify.  Sounds like a nice place.  I’ve heard lots of good things about it.”

     (Not snide remark, but key question:  who do you know who has visited Heaven (to hear tell about it)? 

     (Not to digress into epistemology (the theory of knowledge), but note well, [it’s] always good practice to introspect and identify:  how do you know, what you (think you) “know”?)  

     Concludes patient:  “But God put me here first, and I kinda have gotten used to Earth.  So many wonderful friends and experiences.  Can’t this party continue?”

     Conflicted and dispiriting psychology obtains.

     Comes to mind my Pop’s counsel (to me), during one of his frequent, court litigations as lawyer.  “Let opponents talk all they want.  It’s only argument (opinion)”; (as practicable tactic, during certain stages of any given proceeding). 

     And that’s the crux:  established fact versus someone else’s spin.

     When lawyers inquire, state under oath, “to the best of your knowledge and on informed ‘belief’”,....they are asking for evidence which is verifiable, or at least capable of being objectively evaluated by a reasonable trier-of-fact.  (Be that judge or jury). 

     Lawyers utilize the concept, “belief”, in a different way than people from most other walks of life may be accustomed. 

     Call that as secular as you want.  But since the cradle, Pop’s method has always made sense to me. 

Posted:  28 February 2023