The Dying Woman in the Bed With the Brand New Hip

[McCamy Taylor]

Josephine had dementia from a series of strokes. Josephine had not spoken a coherent sentence in years. She lived in a nursing home, where she got out of bed only when an aid lifted her, so that the sheets could be changed. She was spoon fed and diapered, like a baby. Being an elderly American, Josephine was well insured---she had Medicare and a supplemental plan, too.

Someone decided that Josephine’s quality of life would be better if she got a hip replacement. When I say “someone”, I mean someone other than Josephine. She was too demented to make her own medical decisions. Some guardian or family member agreed with the orthopedic surgeon that she needed a nice, shiny new hip to replace the one that could no longer bear her weight. Never mind that she showed no interest in walking, or talking, or eating or doing much of anything else.

Josephine got her new hip. Medicare and her secondary insurance company picked up the tab. Unfortunately for Josephine, she never got to use her prosthetic joint. Shortly after being sent back to her nursing home, to the same bed and the same spoon feedings and the same diapers, her wound got infected. The infection got into her blood, and from there it went to her lungs. She died of pneumonia four days after going back into the hospital.

Lucky Josephine. She died before some “death panel” could object that she did not need a hip replacement and was not a good candidate for a hip replacement and would likely develop complications from a hip replacement. Josephine was able to go into her coffin and from there to Heaven with the finest cobalt chromium and titanium prosthesis that mortal man could devise.

Health Care in the United States is a lot like a dying women in a bed with a brand new hip. It does not care what is good for the woman. It cares what is good for Health Care. We spend, on average, $5000/year per person and yet we die young from preventable disease. The federal government spends an average of $2500/year per person---exactly what the governments of Canada and France spend---and yet our inner city babies die at a rate that would put a third world country to shame. Fifteen percent of our gross national product goes towards giving us the quality of life of someone who lives in Eastern Europe---

Buddy, can you spare a dime for some public health disease prevention?

[dkf]

1. Or how's about a pap smear for an 80 year old woman.

We wouldn't want a death panel preventing that either right?

[still_one]

3. A pap smear is not major surgery. Was there a reason for the hip replacement? Was the hip broken,

and therefore causing her pain?

Not enough details, and I do know 80 year olds who have broken their hip, had hip replacement, and are doing just fine, that is walking about

Who decides who should or should not have a procedure done? It has to be the person, family, or guardian

The government should stay out of it

Also, I do not know if most of the costs for Medicare are due to "unecessary" procedures as the OP suggests. We would need to see a breakdown

[dkf]

6. The pap smear was one of 26 tests done on a dying woman in the last 2 months

Of her life. What they put her through was ridiculous.

[lunasun]

21. last chance to get her medicare/supp insurance beneies in their pocket so they ramp it up

[uppityperson]

25. Were they looking for a cause, perhaps cancer, that was killing her yet treatable?

[still_one]

41. I was on a different wave length, I thought you were referring generically not this particular case

sorry

[Smilo]

26. Really

do you honestly believe that insurance companies et al on doing the right thing?

This procedure should never have happened - an 80 year old with dementia, confined to bed, this was cruel, unnecessary and a ridiculous waste of money. And yes, if it was a loved one of mine I would have said no.

You may not want government in health care, but who the hell do you think is in that doctor's office with you at the moment.

[jwirr]

29. Exactly. I and my daughter both have a medical health insurance

through Medicare & Medicaid. It is the insurance companies that are making the decisions. I remember a man who had terminal cancer who was given a heart surgery and died two months later. I think this is a case where we need to follow the money to see who is pushing these decisions. Someone - patients, families, etc. - needs to take the initiative and start really looking at the need for the decisions made. But every time anyone says anything about living wills the rw screams "Death panels".

I just gave up the guardianship of my daughter to my daughter (a respiratory therapist) and my granddaughter (an RN). One of the first things we are going to do is rewrite her living will with the knowledge they have on the subject. At the same time we are going to do mine. Since she is vulnerable I do not want anything in hers that I would not put in my own. With one exception - there are already things that I could have (hip surgery) that I will not have because I refuse to use anymore of our children's future than I already have.

[femrap]

43. Assisted Suicide should

be available to those who want it. I want a KMN order (Kill Me Now). It's not like this country is a decent place to live any more.

[DesertFlower]

47. i agree. nt

[Warpy]

42. Or was the hip severely arthritic and causin her pain?

People with severe dementia like this woman can still feel pain. If she cried out in pain every time she was moved, why the hell not improve her quality of life with a hip replacement?

Unless we're willing to euthanize our demented old people, denying them some comfort before they die is simply inhumane.

[NickB79]

49. I would think well-managed pain medication would be preferable to major surgery

Especially when said surgery is what killed her.

[Warpy]

51. Well, we don't actually know from this article whether the hip was broken

and I've seen hip fractures in frail elderly just from lifting and turning.

Absent a fracture, you'd think pain control would be preferable. Unfortunately, we live in a drug phobic country when leaving people in pain is more acceptable than giving them opiates.

[Philippine expat]

50. Actually if the 80 year old woman is still in good health then a

pap smear is not a bad idea

[SoCalDemGrrl]

2. Link please???? Where did you find this???

[patrice]

4. Or all of the good persons who think it their spiritual duty to bring candy to the Elderly.

Even the diabetic ones.

And with not that many CNAs around to be sure that their teeth get brushed when they need it, even the Elders who have relatively good minds and hips and can get around okay, can be advised to have an entire mouth full of teeth pulled all at once, even though that dental assault happens to spatter their best blouse, the one with lace on the collar, with blood.

All just because of all that candy, when what our Elders REALLY want is for someone to spend some time with them and to listen, or to take a walk outside, or to play a game.

[Odin2005]

34. I'm glad my grandma spent the last years of her life with my aunt rather than in a nursing home.

In the last 10 years of her life she needed help caring for herself after an infection (meningitis) made it hard for her to walk. Fortunately she was mentally active until the day she died and was very much into politics because my grandpa was a big Union man, she was an old New Deal Dem and loved Obama and voted for him, calling him "that fine young negro man", so that helped a lot. Being around her grandchildren and great-grandchildren (and even a great-great grandchild) helped keep her spirits up.

She died in the fall of 2009, she was 87. I miss her so much.

[patrice]

36. That didn't work out for my Dad. We started getting it right for Mom, but not without

several crises - all at home with all of the state services we could get our hands on, but it took years to learn enough to take care of her and she just happened to be tough enough to survive several BAD mistakes.

[pansypoo53219]

5. medical industrial complex.

profiteering at the core.

[handmade34]

7. another truthful and sometimes

painful discussion needed... I know this sort of thing happens and too frequently...

I cared for my husband for a number of years and we knew it was terminal... I watched as doctors did screenings and tests that made no difference to my husband's well being and cost too much... ultimately they just gave him all the oxycodone and morphine he wanted...

I see it with my elderly mother and father... many treatments and tests that do nothing to increase their overall health and/or well being.

health insurance companies have written the rules and guidelines and know what brings them the most money

[arikara]

8. My Dad has dementia. Bad.

and of course like everyone with any health issues nowadays he was prescribed statins. One of the most major side effects of statins is mental confusion. So of course they feed them to people with dementia. The other major side effect of statins is muscle pain. As he can no longer talk, how is he supposed to tell someone if he is hurting.

I mean give me a fucking break, in his condition who cares if his cholesterol gets high, we just want him to be as comfortable as possible. Thankfully when my step mother found out she told the doctor to get him off them.

[patrice]

10. My sisters had to do WAR over my mother's meds for 15 years. Luckily we have nurses in the family,

so we had good advice.

[eilen]

16. I am amazed at the overuse of statins

I see so many women on them. There is no evidence that statins prevent heart attack in women. It is shocking.

[jwirr]

30. I suffered along with my mother through her dementia and in the end

when the specialist called me to ask what should be done because she had major hardening of the arteries - I gave a sigh of relief and told them to send her back to the nursing home and keep her comfortable. God only knows what they would have put her through if I had told them otherwise. She died two days later at 83 years of age. Sometimes it is in their best interest to be let go. Do the best you can for him - love him - but let him go when it is necessary. Cholesterol was the way out for my mother - she is no longer suffering but at peace.

[patrice]

9. Or how it can be assumed that a person who has just been diagnosed with Dementia, which is very

expensive to manage, has pain s/he is unable to tell you about and, needs, therefore, morphine, despite the fact that s/he has COPD and morphine is a central nervous system depressant that aggravates the COPD.

[grovernerdquist]

11. cha ching

working in the acute healthcare setting for about 30 years. Thousand of patients everyday have their end of life wishes ignored. Maybe they have signed a DNR document and end up on life support. One thing for certain, these patients no longer have their last wishes carried out. They are at the whim of a system that can charge up their account and then they die. Bet Josephine would have rather not acquired dementia. The bean counters think that people get disease, have trauma, and other health problems to pad their already bulging wallets. Remember, every minute in America a few people go bankrupt because of hospital or healthcare debt. It's the least they could do to ensure the obscene profits of health insurance companies.

[patrice]

12. Well, they ARE protecting themselves from law suits too, right? But the problem with the remedy to

that, i.e. involving the families, that is the families of people who actually have families, in the care decisions, exposes too much of the guess work and trial-and-error nature of it all and might also reveal the profit making apparatus, so though they like to have the families around to take up the slack, they don't actually want them involved in the blow-by-blow care decisions, which involvement would then obviate law suits, because then the families would know too much about how it all works.

[patrice]

13. P.S. Good screen-name!! & Welcome!

:hi:

[jwirr]

31. My daughter told me that if you do not have your living will handy

and the ambulance is called they have to by law put in the life supports. Then when they get you to the hospital they by law cannot take them out until the family says so. By that time the family is feeling distressed and often the life supports are left in even if you had a living will. It is a poor system.

It would seem to me that with everything being put on computers now a living will is one of the things that should go in your records. When I went to the emergency room last winter the first thing they did was pull up all the records that have been place in my computer file from the various doctors I had seen. If the ambulance crew could call into the hospital this would be info that could be relayed to them before they override a living will.

[ZombieHorde]

14. Is this pro-cutting social benefits propaganda? nt

[Chan790]

22. Depends

Is thinking that discretionary review is necessary to the system to make sure money is not being wasted to pad the paychecks of providers and abuse the infirm "pro-cutting social benefits"?

I'd say no...but I'm heartless. I think "death panels" are a somewhat reasonable idea having worked in an end-of-life setting and seeing how we abuse and flagellate the dying to keep them alive for 2 more days in agony or coma so we can keep accruing charges. I've said it before, if I ever get a chronic disease or find myself in this situation...I'm having my end-of-life wishes tattooed on my chest in big block letters.

This woman didn't need a hip replacement, it didn't improve her quality of life and it probably reduced her lifespan. More to the point, she didn't and couldn't consent to what is a risky procedure at her age and the person making the decision might have not acted in her best interests.

[ZombieHorde]

23. I don't think imaginary women are best measuring sticks we have.

Do you?

[Mojorabbit]

28. THe op does not say

if the hip was causing intense pain for the patient. Medicine is an art and a science. Every person is different. It does seem on the surface that this patient was a bad surgical risk. without looking at her chart and her history, it is impossible to make a judgement.

[patrice]

33. Medicare fucking NEEDS Reform. nt

[grovernerdquist]

15. welcome.

lurked for years. exploiting the most vulnerable among us for profit is a practice that must end.

[Ineeda]

17. Things like this happen to those on private health ins., too.

My husband, who had a terminal illness, suffered a catastrophic event due to a reaction to an expensive medication (that was also not helping his condition). He ended up in ICU. Despite our clearly expressed wishes, in the middle of the night when I was home (five minutes away), they put him on life support. When the hospital called at dawn to tell me this, I rushed there and had to fight for hours to have him removed from life support. There was absolutely no chance of his survival, never mind recovery. One doctor insisted that I allow him the "chance", that to take him off life support was not "God's will." Even in my panic and grief, during the worst moments of my life, I knew machines were not doing "God's will", so I fought. They had no legal standing and no one played the Terry Schiavo card, so he was reluctantly 'unplugged' and died several hours later. When I got the hospital's billing statement a few weeks later, I noticed all the pharmacy charges -- glaucoma, blood pressure, and cholesterol medication among other things, all administered after he was put on life support. He was dying - either slowly and comatose, or quicker by natural means. Call me crazy, but it seems to me that glaucoma, high blood pressure, or high cholesterol would not be significant problems to a man on the brink of death. I'm quite sure that if he'd been prescribed Viagra, they would have been giving him that, too. I should have protested all these ridiculous charges, including everything related to the unapproved life support, but our health insurance paid for pretty much everything, and I just wasn't up for that battle. I never occurred to me that profit was a factor in this life support debacle. I attributed it to overzealous religious beliefs of the doctor. Now, I believe it was both.

[arikara]

27. More likely the "belief" was a convenient excuse

for the scam. Which is what it was. I am sorry you had to go through that, its hard enough losing your loved one but the pain is most certainly aggravated under those conditions.

:hug:

[patrice]

35. THAT's one of the weird ass things about it re the care of the Elderly!! Money does NOT necessarily

get you what you need.

Elder care involves sometimes the tiniest little things, pillows shifted regularly, more water, 10 minutes of moving . . . on and on stuff like that that depends on WHO it is who shows up to figure out what is needed and WHEN. It's stuff you can't fix with pills, though they keep throwing the pills at them and then the pills get to fighting with one another which requires hospitalization in itself, as my family learned. It's a nightmare! Staffing shortages amongst nurses are systemic and CNAs are also in short supply because they earn about $10. and hour and get treated like dirt.

The nurses in my family say they don't need higher pay and more benefits, what they need are better working conditions, better staffing ratios, and better scheduling SO THEY ***CAN*** DO THE JOB THAT THEY HAVE THE SKILLS TO DO. All of their problems are controlled by the Medical Corporations they work for and the ones who don't work in for-profit are under the thumb of a "management" ruse called Risk Management, some of which is done by highly paid consultants who actually teach "care" facilities how to get around CMS inspections and such, you know, "Government BAAAAAAAAAAAAAAD!!!"

[Danchi]

18. The Surgeon should be sued....

The surgeon should be sued and have his medical license revoked. This woman was a cash cow to him and no more. My mother had Alzheimer's and was bedridden for the last 4 years of her life and the procedures they'd got my father to agree to were ridiculous. It got to the point a family member had to go to Dr. appts. with them to make sure my father fully understood the nature of the procedures they were recommending and to make it clear to him that there was no procedure that would improve her state. They prey on the hopes of family members by telling them the patients quality of life would be better. With Dementia/Alzheimer's patients the best quality of life is to keep them safe from predatory doctors and treat the various aliments as they appear to make sure the person in comfortable.

[bemildred]

19. +1.

And it's always the same excuses about protecting themselves from lawsuits and other such bullshit.

[izquierdista]

20. Hey, don't diss Eastern Europe

Life there has gotten a lot better in the last two decades, the quality of life is catching up with Western Europe. The "one remaining superpower"? It's going in the other direction.

[secondwind]

24. Huge K&R

[Odin2005]

32. Shit like this would not happen if we had a system likie Canada's.

In Canada it would simply be determined that giving a woman who is close to death a hip transplant is simply not worth the resources. Unfortunately if you went that sensible route in the US people, even Progressives, would scream bloody murder about "rationing" and "death panels". Americans are selfish and too many of us cannot understand what "limited resources" means.

[patrice]

37. After passage of the ACA, Bernie Sanders, discussing the coming Medicare Reform, said

if it goes well it will protect Medicare for future generations and it could also make Medicare, by means of administrative rule-writing rather than new legislation, into Medicare for All.

[patrice]

38. And the reason they're going to fight Medicare Reform tooth & nail is that a reformed, more efficien

t Medicare could then become the standard by means of which Private Health InsCo products & services can be justifiably critiqued.

[murphyj87]

52. In Canada, however, ....

In Canada the issue is not age. The issue is whether the procedure is medically advised. There was one of those "rationing" "death panel" things not long ago, when the parents of a brain dead child (as determined by 6 world renowned specialists in neurology and pediatric intensive care) wanted the child (only kept alive by a respirator) to have a tracheostomy. Americans were all up in arms when the hospital decided that the brain dead child would not have the tracheostomy, based on the recommendations of the 6 world renowned specialists. As it was, a bunch if Americans took the brain dead child, respirator and all, to the US, and they did the treacheostomy at your expense.

On the other end, in Canada .... 1200 hip replacements are done each year on people 85 years of age or older, but these are not people who are on death's door, and have the hope of several years with a better quality of life because of the hip replacement or other procedure. The issue in Canada is not age, but whether the procedure will result in something advantageous for the patient. My mother had bypass surgery at age 72, aggressive treatment for strokes at age 76 and 79, here in Canada, but in every case, she had a reasonable chance of, and did, return to a good life until the age of 82, except for the last 8 months of her life, in which she had severe dementia and congestive heart failure which no medical intervention could help, yet she was examined by specialists to determine if anything could be done which would be advantageous even then. The determination was no, and I was fine with that. It was clear that she only had a few months left.

[McCamy Taylor]

39. Just want to clarify one thing. This is NOT about Social Security cuts. It's about universal health

The dying women in the bed with the brand new hip is emblematic (to me) of our broken health care system that denies preventive care for the first 65 years of life and then wheels you to the smörgåsbord of expensive tests and surgeries and tells you "Dig in!" often when it is too late to actually do any good. The Medical Industrial Complex makes $5000/person per year off us---and gives us so much less than the nationalized health care systems in Western Europe which make only half as much.

The voices screaming about "death panels" include the manufacturers of drugs and durable medical goods who want to see their products used and overused among the nations elderly. They include hospital ICUs which want the dying elderly to spend their last two weeks on earth on a ventilator, because it helps makes them money. And it includes the folks who make all the equipment, IV tubing, drugs, Xray machines, catheters, A-lines, central lines, EKGs, EEGs etc which will be utilized during that last two weeks in hell.

If they raise the Social Security and Medicare ages, we can expect to see even more profits for the Medical Industrial Complex, because we will have two (or three or five) more years of medical neglect for severe (but preventable) medical conditions to arise. If, on the other hand, we lower Medicare, a whole lot of preventable diseases will be prevented.

[Odin2005]

40. BINGO!

[demigoddess]

44. I've heard sometimes it is a pacemaker they install just to

do something they can bill for on a dying patient. In my opinion, it is a CYA move.

[Shanti Mama]

45. Sorry, but does the bed have a brand new hip?

I don't mean to give you too hard a time, McCamy T, but I get a kick out of the grammar on DU sometimes.
Love the book Eat, Shoots & Leaves.

[DesertFlower]

46. and we wonder why medicare is in trouble.

[Hoyt]

48. Yet, If Medicare had denied the procedure, people would scream about the unfair "rationing."

Sooner or later, we are going to have to make some tough decisions on our health system.

[trotsky]

53. There are also welfare queens who drive Cadillacs.

I heard a guy say it once so it must be true.