Friday's Odds and Ends

A recent story in the Dallas Morning News reported that the reservoirs serving the Dallas-area are 10% lower than a year ago and the continuing drought does not indicate that it's going to get any better. The area is more than 30 inches shy of normal rainfall over the last six years, yet nobody has taken really serious action toward a long-term solution to the water problem, other than looking at ways to bring in more water - pulling from East Texas reservoirs for one.

People still pour gallons and gallons of water on landscaping and lawns every year, in many cases trying to maintain greenery that was not meant to grow in this hot climate. Perhaps people should think more about whether their grandchildren or great-grandchildren might have a glass of water in their future instead of wanting the most luxurious green lawn today.

Jonathan Rauch, contributing editor to The Atlantic, wrote an interesting article about health care for the very elderly who too often end up in intensive care units at hospitals for the last weeks or days of their lives. He believes that is an unnecessary and extraordinary use of healthcare facilities and money. He wrote, "Hospitals are fine for people needing acute treatments, like heart surgery, but they are very often terrible place for the frail elderly."

The article was promoting the idea of home-based primary care, and to highlight the benefits of that approach, Rauch mentioned a program called Advanced Illness Management at Sutter Health, a giant network of hospitals and doctors in Northern California. Brad Stuart has worked there for the past 15 years, developing home-based care for frail, elderly patients, and he estimates that using that type of program and keeping patients out of the hospital saves Medicare upwards of $2000 a month on each patient, maybe more. "For years, many people in medicine have understood that late-life care for the chronically sick is not only expensive, but also, much too often, ineffective and inhumane."

Because Medicare is not set up to work with this type of program, that is one of the reasons that home-based medical care is not widely used across the country. The layers and layers of rules and requirements and policies for using Medicare seem to be cast in stone and don't leave room for a doctor or a patient or a hospital to figure out a more cost-effective way to handle a medical issue. For example,   there were people in the extended care unit of a hospital at which I worked who were receiving 6 to 8 weeks of IV antibiotics. I don't recall the exact cost of daily hospital stay, but it certainly was a lot more than had these people been allowed to go home with a visiting nurse coming in every day to administer the antibiotic, check the IV port to make sure it was working properly, and tend to any other medical needs the patient might have.

One time, two gentlemen who were stuck in this extended care unit decided that they would use that time to appeal to the government to rethink policy. They gathered statistics from the medical social worker on cost comparisons and then wrote letters to political leaders, starting at the state level and going all the way to Washington. The letters, with all the statistics and a recommendation to change the policy, were also sent to the people who manage and administrate Medicare. The responses that they receive back were often just a form letter that simply stated "We are sorry that our program does not allow for this type of in-home healthcare that you are requesting."

Nobody seemed to be able to look at this idea and say, "Hmmm, maybe we should figure out a way to implement this cost-saving measure and save the taxpayers a whole lot of money."

I know, I know. Government bureaucrats don't seem to understand simple and efficient. And from all outward appearances, they don't seem eager to figure it out.

Isn't this a better setting than a hospital? Photo courtesy of My Elder Advocate

It's been a while since I've done Literary Lessons, and this is a good one from Tennessee Williams' classic play "Cat on a Hot Tin Roof." The line belongs to Big Daddy, "Ignorance of mortality is a comfort. Men don't have that comfort, he's the only living thing that conceives of death, that knows what it is, the others go without knowing. A pig squeals, but a man, sometimes you can keep a tight mouth about it."

That's kind of depressing, so let's end on a joke.

"How is it that we put man on the moon before we figured out it would be a good idea to put wheels on luggage?"