Wednesday, April 09, 2008

The recent death and illness of my brother-in-law highlights recent evidence about the high cost of care for Medicare recipients in the last years of their lives. He broke his hip in November and has been in the hospital, rehab or a nursing home since the incident occurred. His recent care in a nursing home and hospice care in California cost over $300 a day.

The cost of care for the last two years of life for a chronically ill Medicare recipient varies considerably with location. Those who are chronically ill are those with cancer, kidney failure, heart disease etc.. The overall average cost for the last two years of life in these folks is $46,412. It can be as much as $81,143 in Manhattan vs. $29,116 in Dubuque Iowa. New York, New Jersey and California are the highest and places like Utah and Oregon are the lowest. These figures represent Medicare cost and are only part of the expense. The cost for things like Medicaid and long term nursing care are additional huge expenses. Hospitalization is the killer on the expense. The average length of stay in the hospital in New York is 34.9 days vs. 10.6 days in Oregon.

With the incredible cost of healthcare, that is going to get much worse, and the expense of the war and other lavish government spending, I shutter to think of the debt my grandchildren are faced with. The other problem is there are a decreasing number of workers paying into the system to fund Social Security, Medicare and all these costly programs.

Not only is the expense bad, but the care is even worse. One of the main problems is getting decent help in nursing homes. More and more people are getting long term care insurance and the age of the population is increasing dramatically. There is going to be an incredible demand for nursing home service with no one to deliver it. In the case of my brother-in-law the family delivered most of the care rather than the nursing staff. You get much better service in a motel and he was paying five star hotel rates.

The care by the physicians is even worse. They are inaccessible and the nurses are reluctant to call them. The days of the family doc sitting by the bedside of a dying person are long gone. The family doc couldn’t do anything for the dying patient, but the modern physician does very little more. At least the family doc provided an ear with tender loving care.

I hope I am able to die quietly on the porch with my brain intact. Other options I’m considering are checking into a motel or a cruise ship on a long-term basis.


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