A Good Life Until the Very End
Old age is not a disease, though modern medicine has been treating it as one, argues Harvard Medical school professor and surgeon Atul Gawande in his compelling new book, Being Mortal: Medicine and What Matters in the End.
“You don’t have to spend much time with the elderly or those with terminal illness to see how often medicine fails the people it is supposed to help,” he writes. “The waning days of our lives are given over to treatments that addle our brains and sap our bodies for a sliver’s chance of benefit. They are spent in institutions — nursing homes and intensive care units — where regimented, anonymous routines cut us off from all the things that matter to us in life. Our reluctance to honestly examine the experience of aging and dying has increased the harm we inflict on people and denied them the basic comforts they most need. Lacking a coherent view of how people might live successfully all the way to the very end, we have allowed our fates to be controlled by the imperatives of medicine, technology, and strangers.”
Strong language from a medical professional. And useful information for reverse mortgage experts, or for anyone who serves people in the Third Age.
Once upon a time not that long ago, Gawande explains, life went along at a relatively even keel until something happened and the bottom dropped out, like a trap door opening. One minute you were healthy, the next you were felled by an illness or accident, and usually died shortly thereafter.
Assisted Living Was Designed to be Different!
Today, we’re often able to stave off even severe health conditions such as cancer or heart disease for quite a while, so while the downslope levels off after each drop, patients rarely return to their original degree of health and well being. That’s one main reason assisted living facilities have exploded in popularity — though they were never intended to be an intermediary step on the road to nursing homes, says Gawande, but an alternative that would eliminate the need for nursing homes. Although it may seem like assisted living has been around a long time, Keren Brown Wilson only originated the concept in 1983 with Park Place in Portland, Oregon, which she called a “living center with assistance.”
Wilson’s design did not resemble what we now term “assisted living”, however. Her pilot project was a 112-unit apartment building where tenants (not “patients”) had their own units with doors they could lock, their own kitchens, bathrooms, furniture, even pets. The only differences from a regular apartment complex were an onsite nurse, call buttons in each unit for emergencies, and help with all the basics: food, personal care, medication.
Widely attacked as dangerous, the assisted living experiment proved to be an unqualified success: five years after move-in, the residents of Park Place had maintained their health status (physical and cognitive functioning actually improved), life satisfaction had increased, depression had declined — and the government-subsidized cost was 20 percent lower than it would have been in a nursing home. Clearly, independence with support enables older adults, even those with serious disabilities, to enjoy quality of life right to the very end — which is why aging in place, within community, is an ideal model — and why a HECM can be one key to creating and maintaining a rewarding senior lifestyle.
Paying Attention Pays Off in Improved Health
One of the biggest keys to successful aging is simply being able to talk about their lives with someone who actively listens and cares, says Gawande: in one study, patients who saw a geriatrician for eighteen months versus a general practitioner were “a quarter less likely to become disabled and half as likely to develop depression. They were 40 percent less likely to require home health services.” These are stunning results.
He writes, “We’ve been wrong about what our job is in medicine. We think [it] is to ensure health and survival. But really it…is to enable well-being. And well-being is about the reasons one wishes to be alive. Those reasons matter not just at the end of life, or when debility comes, but all along the way.”
Thus, the importance of having what Gawande calls “hard conversations” at life’s bifurcation points cannot be overstated. “People die only once. They have no experience to draw on. They need doctors and nurses who are willing to say what they have seen, who will help prepare for what is to come — and escape a warehoused oblivion that few really want…If end-of-life discussions were an experimental drug, the FDA would approve it.”
Wherever you meet them on their life journey, encouraging seniors to talk about their lives and what matters most to them is a positive, crucial step.
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