Dying in Your Own Bed Isn’t Easy

I‘ve been posting quite a bit about end of life issues.  I wanted to be sure everyone saw the story in the NY Times on September 25, 2014 about one child’s struggle to honor her dad’s wish to die at home.  Unfortunately, this isn’t a new issue, and clearly one that isn’t near resolution. The story, Fighting to Honor a Father’s Last Wish: To Die at Home tells the story of Joseph Andrey and his daughter’s efforts “to fulfill her father’s dearest wish, the wish so common among frail, elderly people: to die at home…But it seemed as if all the forces of the health care system were against her — hospitals, nursing homes, home health agencies, insurance companies, and the shifting crosscurrents of public health care spending.” On many occasions her dad had been discharged from the hospital to a SNF for rehab.  This time she wanted to have him discharged to home, but was unsuccessful and her dad was transferred to a SNF, again.

The blog post illustrates the catch-22 within which Mr. Andrey and his daughter found themselves. The post also explains the recently-released Institute of Medicine report  on Dying in America (we blogged about it earlier).  Returning to Mr. Andrey’s story, the article includes  a short biography of his life (including a brief tenure as a child in Vaudeville), his wife’s decline from Alzheimer’s, his up close and personal…and ongoing…experience with the U.S. health care system, and ends with  his final years.  He had frequent stays at SNFs because of the inability to secure home health care in a system where there were financial incentives for SNFs but not the same profitability, if you will, for the home health agencies.

Despite all of his daughter’s efforts, Mr. Andrey didn’t die at home, but in a hospice within a hospital. If you read the entire article, by turns you will be appalled and saddened. If you assign this to your students, there are many opportunities for discussion about the U.S. health care system as well as end of life care in our country.