Posted on 11/26/2012 2:55:29 AM PST by Cincinatus' Wife
TAMPA Dr. Inna Sheyner cupped her hand to speak into the ear of her 91-year-old patient, pledging loudly to answer all his questions about his constellation of problems, from heart failure to constipation, requiring a dozen medications.
"The problem is, you're not taking half of that list," she gently scolded Everett Haehnel. "You know that, and I know that."
He promised to do better. Sheyner offered to have a pharmacist help him, and put in orders for a physical therapy session at his Sun City Center home and a consult for dementia.
Two University of South Florida medical students scribbled notes vigorously. But neither wants to follow Sheyner into a specialty that cares for the oldest, most complicated patients.
Anyway, they can't locally.
Geriatricians are in alarmingly short supply, yet USF closed its geriatrics fellowship last year due to lack of interest. While other Florida schools are hanging on, they aren't training anywhere near as many geriatricians as are needed.
Yet experts think more geriatricians like Sheyner could be the key to fixing a health care system that spends too much on too many doctors, drugs and surgeries for frail seniors who don't benefit and may even be harmed by excessive care.
"We are entering into a new era of medicine where the role of a geriatrician could be very important to a health care system," said Dr. Ken Brummel-Smith, chairman of the geriatrics department at the Florida State University medical school. "You will have doctors who need to be expert in increasing quality while decreasing cost that's where geriatricians shine."
(Excerpt) Read more at tampabay.com ...
My grandmother, on the other hand, lived independently into her late 70s. She was a very strong and very difficult woman. She lost most of her eyesight due to macular degeneration in her 80s. I'm sure her 60 year chain smoking habit didn't help. As she entered her 90s my father and aunt sent her into a nursing home because she developed dementia and needed round the clock care.
It would have been physically impossible for her 70 year old “children”, who had their own health problems, to take care of their mother.
My MIL similarly lived alone and I used to go to her house to take care of her several times a week for several hours at a time while working a full time job (neither my now ex-husband nor his sister nor her grandchildren wanted to deal with her or the increasingly difficult and dangerous problem, pretended that everything was just fine, so her care was pretty much left to me). Evelyn was IMO, well past the point of taking care of herself anymore and was similarly delusional. She also had developed an aversion to bathing or using the bathroom, preferring to piss and shat herself where she sat and clean up with tissues that she stuffed into the sofa cushions and most days refused to eat anything even when I cooked for her she was skeletal in appearance and she and her house stank to high heaven despite my best efforts to keep it clean, doing her foul laundry and getting her into the shower and into a clean night gown. I recall the epic fights trying to get her to bathe.
It started with me sitting with her and talking and watching TV for a while when Id casually mention You know Evelyn, this would be a good day to take a shower after a shower I can make you Dinty More Beef stew and cheese and Ritz crackers (one of the few things she would eat if I made them for her). Then Evelyn would curse at me like a druken sailor, shake her cane at me, and threaten to throw things at me, she actually stuck me a few times. So wed talk and watch TV together for a while and Id wait for her to calm down and then I suggest again, You know Evelyn, I bet youd feel better if you got a shower and changed into a clean night gown and this could go on for hours until I finally broke her will and got her bathed.
I kept telling my husband and SIL that their mother should not be living alone but it wasnt until she was admitted to the hospital for stomach pains that ended up with gall batter surgery that a hospital social worker finally convinced my husband and his sister, after I told the social worker about her living conditions, that Evelyn couldnt go home.
For a time my ex wanted to move her into our home but this was simply not possible with both of us working full time Evelyn really needed round the clock care and the type of nursing care that I couldnt provide and truthfully was not mentally and physically prepared to provide 24-7 even if we could have financially afforded for me to quit my job and care for her full time, especially considering that I had already figured out that I would get little or no help from my husband or her family.
After being discharged from the hospital Evelyn went to a nursing home and I visited her several times a week, continued doing her laundry and looked out for her care and comfort. But her mental and physical condition continued to deteriorate to the point she had to be put on a feeding tube and she eventually suffered a stroke that put her in a locked fetal position for the last two years of her life unaware of her surroundings, unable to communicate, living on a feeding tube. Even though she got excellent nursing and medical care, better than I expected actually, I really hope I never put my family through that sort of thing, Id much rather die from natural causes than live out the last years of my life that way.
Then they will proceed to take care of the feebleminded and those with other mental and physical defects, including children, and various other lebensunwertes Leben.
I think the main program is found in Section T4 in the Obamacare Law under the name of Gemeinnützige Stiftung für Heil- und Anstaltspflege and is administered by the newly formed Erbgesundheitsgerichte.
We needn't worry about government "waste". It is very efficient and shows quick results.
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