Geriatric Crisis in Process

WHEN SUSAN BLOCK, a professor of psychiatry and medicine, started practicing medicine more than three decades ago, there was no formal field of palliative care. Today, it is an established specialty with a growing presence in the U.S. healthcare system. The number of hospital-based programs nearly tripled between 2000 and 2010, and most large hospitals now have palliative-care teams, according to the Center to Advance Palliative Care, a national organization aimed at expanding these services. Still, Americans living in certain geographic regions (for example, where small hospitals are the norm) have limited access to this comfort-centered approach to serious illness.

We all can see how the relative numbers of people over the age of 65 has expanded in the past three decades.  This is not only due to  aging of the baby boomer demographic, but also due to great strides in treating chronic disease and the recognition of life style and nutrition upon the aging process. Will we live longer ? Perhaps not, but the goal actually is to live a good quality of life, then die quickly.

Everyone wishes to live healthier and longer live , hence the overwhelming menu of snake oil medicine, herbs and substances which has become a multi-billion dollar business.

Statistics reveal that for the aged infirm options are becoming narrower due to the lag in providing suitable living arrangements for many.

Palliative care emerged with the hospice movement of the 1960s, but it wasn’t until 2006, after a strategic campaign led by Block and other advocates, that hospice and palliative medicine became a defined medical specialty. The move marked “a critical step in achieving legitimacy and a seat at the table in American medicine,” says Block, chair of the psychosocial oncology and palliative care department at Dana-Farber Cancer Institute and Brigham and Women’s Hospital. “It has raised the stature of the field.

There are now nearly 100 hospice and palliative-medicine fellowship programs around the country; Harvard’s fellowships in palliative care educate about a dozen doctors, nurse practitioners, and social workers annually.

Palliative care is associated with higher quality of life and lower costs through fewer and shorter hospital stays, less intensive treatments, and more hospice use, so it’s an attractive option in the context of healthcare reform. But experts worry about the future. There’s already a serious national shortage of hospice and palliative-medicine physicians (one study estimates a gap of at least 6,000), and demand will likely grow as baby boomers age, the number of Americans with chronic conditions (such as heart disease, diabetes, cancer, and dementia) soars, and more providers in community settings, like outpatient clinics, aim to offer palliative care as well. The global demand is rising, too; according to the World Health Organization and Worldwide Palliative Care Alliance, only one in 10 people who need these specialized services receives them—and most palliative care is provided in high-income countries.

In addition to the lag in numbers of  professionals there also is a deficit in  bed capacity for the aged infirm. At the moment we are caught in the effort to reduce hospital admissions, length of stay, leaving many to find suitable respite.

Medicare does not provide long term insurance.  Long term insurance must be acquired elsewhere. Hospice care is for the terminally ill, who have assigned medicare medical benefits toward hospice care. 

Most patients do not have long term insurance due to costs. And there are no provisions for long term care in the affordable care act, thus far.

How will the void be filled. I am interested in  your comments.