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PT and the Greater Good

Culling the Herd

Published July 27, 2010 9:33 AM by Dean Metz

A few years back, there was a program to protect the deer population on Fire Island, NY, from starvation during the winter (similar to one employed on Hilton Head Island in South Carolina). The program consisted of hunting the deer in specific quantities to thin the herd and ensure the herd's survival. There was understandable protest and outrage from many groups on this technique.

While reading the New York Times online, I came across this article about how social services are being cut across the United States: http://www.nytimes.com/2010/07/21/us/21aging.html?_r=2&scp=1&sq=oregan%20home%20care%20cuts&st=cse.

Oregon, which had been a leader in supportive care, is making very significant cuts. The cost of home care support is only $1,500 a month compared to $5,900 for nursing home care. Many of these people will need to be admitted to a facility if they can't get care at home. It seems ludicrous to support such "cost savings" when there don't appear to be any.

Except many of these people could live at home for many years with this support. In a number of articles I've read, the average lifespan for 50-60 percent of those who enter a facility permanently is around two years. Here is one of those supporting articles: http://www.homecaregroup.eu/content/view/117/42/. Are we, in fact, culling the herd by sending disabled and older adults to nursing homes rather than providing for them at home?

A few months back as tea partiers were decrying the "death panels," there was a lot of outrage. Where is that outrage now? One of the things I've learned is that health is not solely about medical advances. It has much to do with social care as well. That is why the USA ranks only 37th in terms of overall health in the world. Here in the UK, and from my public health course of study at Nova Southeastern University, I have learned that health only improves with combined medical and social support. As health professionals whose primary focus is function, we cannot let these vulnerable people have their lives shortened as a cost measure.

Speaking of cost measures, the UK has announced some dramatic changes here in the NHS. I'll have more on that for you next week.

4 comments

Logans Run comes to mind with this data.  Perhaps it won't be too far fetched to say that once you reach a certain age you will be required to take residence in a nsg home and pass away quite quickly verses finding sactuary in your own home.  

Jason Marketti July 30, 2010 7:44 PM

Then, sadly, I can't say I'm surprised.  Does go to the underlying theme you present:  that medical is tied to social.  Our society, as a whole, has been on a gradual decline in how it reveres its elders.  The societal shift in morals has allowed us to get to the point where the majority doesn't see this as a problem.  Tie that in with the decline in our educational system - fewer and fewer who have the critical thinking skills to even figure out it is happening.  You have to be aware of what is going on before you can be outraged.

Janey Goude July 28, 2010 11:05 PM

Janey, you have the gist of what I'm trying to say. The other literature that I've read states that the majority of those nursing home deaths occur in the first 6 months. I don't have to tell you to do the math, you're rather good at it.

Dean

Dean Metz July 28, 2010 3:16 AM

Your perspective and insight never cease to amaze me.

Let me see if I am understanding you correctly:

Lifespan with homecare - 7.87 years @ $1500/year = $11,805

Lifespan with nursing home - 2 years @ $5900/year = $11,800.

Once a patient lives 7.87 years at home, he or she becomes more expensive than the average nursing home patient who dies within 2 years of admit.

So, the question is, have human bean counters determined the odds are in their favor that enough elderly will die out in the nursing home quickly enough to make a profit compared to if they had paid for home care for that same group?  Essentially, altering the arena in which we provide care is a sort of death eugenics (selective dying, instead of selective breeding) to thin out the herd?

Janey Goude July 27, 2010 11:06 PM

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    Dean Metz
    Occupation: Staff Development Specialist
    Setting: New York, NY – Newcastle Upon Tyne, Great Britain
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