And In The End…

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We’ve explored death and dying issues a number of times:

Death, Be Not Proud
The Final Frontier: Saying Yes to Death
Facing the Inevitable with Grace and Wit
Preparedness: Shedding New Light on the “D” Word 

…but there are always new wrinkles as technology matures along with the population. Startup Aspire Health has garnered significant attention and capital for its “death-predicting algorithm,” which identifies patients at risk of dying within a year. Their intent is to provide palliative care to seniors at home and in senior living communities, in order to maintain quality of life and reduce the cost of care by preventing unnecessary hospitalizations.

That’s an admirable objective. The question is, since the company contracts with health systems and payers, such as Medicare Advantage and Medicaid managed care plans, is such a prediction helping to ensure better end-of-life care — or invading patient privacy?

A Noble Goal, with Caveats

reverse mortgage newsWhile the issue of care vs. privacy is important to address, a “good death” such as what Aspire caregivers aspire to provide, remains rare in Western culture. Our technological advances invite a difficult inquiry: should we keep someone alive simply because we can? There is a propensity to prolong life at all costs, even when it’s clear the person in question is on a downward spiral.

As Harvard Medical School professor, surgeon and author Atul Gawande asserts in his compelling book, Being Mortal: Medicine and What Matters in the End: “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.”

Gawande’s thesis, like the Aspire Health focus, is spot-on, except… patients do not necessarily conform to medical predictions. There are numerous cases (some of whom have written their own bestsellers) of people at death’s door who experience complete remission and outlive their predicted demise by years, even decades, despite and with their “disease” and/or symptoms.

Comfort, Care, Compassion

Of course, if seniors know when they’re going to die, perhaps it would light a fire under procrastinators in terms of life planning. And then, opting out of the prevailing medical model, they could “go gentle into that good night” in the fullness of time.

Positive change is on the near horizon. Hospitals provide “Comfort Kits” for sick children; people at other end of life deserve the same consideration. The National Institute on Aging’s Providing Comfort at the End of Life is a useful guide you may wish to share with the families of reverse mortgage clients and other seniors in your sphere who want to give someone approaching the end a peaceful, compassionate death.

The site covers a range of physical, mental, emotional and spiritual issues, as well as practical matters such as questions to ask the person’s physician, and how to support the primary caregiver. There is also a list of links to hospice and palliative care, pain medicine, music therapy, and even a site, What Matters Now, to help the families of those facing serious illness create their own blog to keep loved ones informed.

Wishing Can Make It So

If, like many people, the HECM senior or his/her family members are reluctant to broach the unmentionable, there’s an innovative way to get the ball rolling: Go Wish, a card game (in multiple languages) that helps people begin the end-of-life discussion. It’s a good companion tool to The Conversation.

Dr. Christopher Kerr, Chief Medical Officer at The Center for Hospice and Palliative Care in Buffalo, New York, gave this compelling TEDx Talk. He observes that while those in the process of dying might have depleted bodies, their spiritual lives have become rich. Emotionally, a deep peace envelops people as they approach the end.

Another palliative care physician thinks “death ed” ought to start in high school, so she developed and taught such a class this year, using Go Wish to help students jump into the subject matter. Introducing death discussions early on, when the topic is theoretical rather than imminent, may help reduce someone’s fear and resistance to having such crucial conversations later in life.

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