Vaya a Dios, Vieho

There was a recent letter published in our daily newspaper from an MD who bemoaned the fact that 70% of health care dollars are spent on the elderly, those over 60. His recommendation was to restrict expensive medical procedures, even life-saving, from older folks. (Full disclosure: I am one of those "old folks.") He suggested the return on investment was too little to warrant spending all that money on the elderly, especially since medical costs are so high and rising.

Professor Peter Singer at Columbia University, who is the philosophical guru for the pro-abortion movement, openly advocates assisted suicide and the withholding of medical procedures from the elderly who, in his opinion, are unproductive and not worth the cost.

Obamacare incorporates medical advisory panels responsible for issuing "guidelines" concerning the cost effectiveness of medical procedures. These are not the so-called "death panels" widely discussed by some opponents. I am not in favor of Obamacare, mainly because I don't trust the government to do much of anything right, but the "death panel" accusation is unwarranted, at least for now.

Elderly parents suffering from strokes, Alzheimer's or just general infirmity, are routinely shunted off to nursing homes and often virtually forgotten. Heaven forbid that caring for the old folks should interfere with our lifestyle. I have seen the insides of two well-rated nursing homes and witnessed the neglect to which many residents are subjected. I heard the granddaughter of a 104-year-old resident curtly inform the lady, in response to a plea to go home, "No, Geneva, this is your home for the rest of your days." Geneva lived out her days in half of a semi-private room.

I saw ranks of white-haired old folks, mostly ladies, lined up in wheelchairs against the wall where they spent most of their days except for the occasional visit by an activity person and mealtimes. This was truly warehousing. Family visits were rare, usually on holidays or the occasional weekend. I've been told by someone who worked in nursing homes for years that once-a-year visits by the children are not uncommon.

Caring for the elderly and infirm at home can be daunting, as I well know. In many other cultures, respect and obligation to elderly family members is simply a given. They are permitted to live out their days in familiar surroundings with loved ones rather than in a sterile institution tended by underpaid and often indifferent staff. I have seen this first hand. Even in so-called "good" nursing homes, care is minimal. My wife was of necessity in nursing homes for a period of a few months. I visited with her for most of every single day. Even with my close presence, she ended up with a bedsore and two rather nasty heel ulcers which took months to heal when we finally got her home. Incidentally, I was the one who detected both problems, not any of the staff. (I noticed blood seeping through her socks.)

Most of the elderly are parents who raised children. They loved, nurtured, fed, clothed, housed, educated and protected them through their growing up. Sadly, too many become, in the words of the Pete Seeger folk song, "obsessed with the mania for owning things." They become wrapped up in the daily demands of their own little lives and are wroth to allow anything or anyone to interfere with their hard-won lifestyle. Mom and Dad are fine so long as they are self-sufficient. When that is no longer the case, "out of sight, out of mind" comes into play in too many instances.

To illustrate the attitude toward elderly parents in other cultures, let me relate an example from personal knowledge. A very close friend, an observant Jew (observes all holidays and festivals) with dual U.S.-Israeli citizenship, had his elderly and infirm mother living with them in Texas. Travel requirements necessitated by family issues out of state made it difficult to continue to care for Mother. Mike then travelled to Israel to other family in Tel Aviv, a sister as I recall, who were able to care for the lady. He transported her to Israel and settled her in the sister's home. She lived there until she died at the age of 100, among family who loved and cared for her. Mike was there when she passed on.

From a purely practical standpoint, the cavalier attitude toward the elderly in this country is quite understandable. After all, effort expended to care for aged parents must be taken from the precious little time available in most families today. Financially, lawyers and advisors are hired to set up finances so that the old folks' assets are transferred early enough that they quickly become indigent and the county pays for their long-term care. Private pay in nursing homes is rare. (I know. I private-payed for my wife, Joan, for one month and it totally screwed up their accounting system to the extent that it took six months to send me the bill. And then it was wrong.)

Many older folks have conditions, usually involving arthritis, that incur chronic and severe pain. By way of example, my wife, Joan, has extremely severe lumbar spinal arthritis (lower back). All five lumbar vertebrae and the one sacral are involved. There is significant stenosis which resuls in extreme pain. She has virtually no discs left. This situation is inoperable and there is no effective therapy. She has been on major pain medication for many years--the notorious oxycodone. Before her stroke, it allowed her to function. (Despite what you may have read in newspaper articles, the stuff does work.) And yes, she is addicted. So what? At her age, this is irrelevent. Her situation is not unusual, yet our daily newspaper and a number of other do-good organizations are crusading to make it difficult for non-cancer patients to obtain pain medication. No-one suggests an alternative; let the old folks suffer.

The stated goal here is to reduce prescription drug abuse by addicts. The fact is, most illicit pain medication is not prescribed, but rather obtained through a thriving black market supplied via the hijacking of bulk shipments. Some drug store chains have resorted to camouflaging their trucks to reduce the chances of being hijacked. Since law enforcement is unable to stem the hijacking epidemic, the (mostly) liberal "fixers" resort to the easier target of the law-abiding elderly under the theory that "we have to do something."

The hard truth is, old folks are a problem in this country. They threaten to bankrupt Medicare, already nearly 50% subsidized by general tax revenue, take too many medications increasing demand which justifies higher prices, and overload clinics and emergency rooms.  Worse, they do not pull teir own weight or produce sufficient wealth and contribution to society to justify their expense.

Am I exaggerating? Perhaps I am a bit today, but the trend is there. Rationing of medical care, limitations on drug prescribing and cutting Medicaid payments for long term care are on the horizon. Medicare funding is being cut, somehow magically not impacting service.

Much of this would be solved if we had a culture of caring for our parents and grandparents instead of trying to find ways to duck the responsibility and dump them off on someone else, like government. Most opioid pain medication is generic and not a major contributor to the overall cost of medical care. Unnecessary tests often justified to protect against litigation needlessly increase costs.

Nevertheless, the bottom line is we have a responsibility for our elders. Personal sacrifices made to care for them can be rewarding. I speak from experience. Besides, we owe them! We neglect them at the peril of our souls.

P.S. Translation of the Headline is left to the reader.