Our aging crisis: the need for a dignified death - September 14, 2013 : 6:14pm In his final published work, “Mortality,” written while succumbing to esophageal cancer, Christopher Hitchens captures in one sentence the unavoidable truth of the dying process: “I don’t have a body, I am a body.” No one understands this truism quite as well as journalist Katy Butler, who witnessed the prolonged process of dying that her once-formidable, war-veteran father underwent after suffering a stroke in 2001, devolving into dementia and then finally dying from pneumonia seven years later. As doctors pushed life-support surgeries, new medications and cutting-edge interventions, Butler and her mother didn’t pray for a cure. Instead, they wished for his death, all of which is chronicled in her troubling investigative memoir “Knocking on Heaven’s Door.” The “end-of-life crisis,” or as Butler calls it “the caregiver crisis,” has hit epidemic levels as the number of Americans over 85 doubled to 6 million since 1990. Baby boomers, like Butler, must now wrangle with what to do with sick elderly parents, asking questions of themselves they probably thought would never be fathomable: What can be done when a person lives too long? And has science gone too far in its mission to ward off death? Through her experiences with her father, Butler is unwavering in her answers. “Our optimistic science-worshiping culture wants to medicalize aging and make it nothing more than a collection of specific diseases that medicine can prevent or fix,” she writes. “But no matter what deal we make with the devil, nature outwits us. Dying can be postponed, but aging cannot be cured.” These are bitter pills to swallow and many might fall in the trap of citing Dr. Kevorkian, death panels, and agism in health care as reasons why these end-of-life conversations should never start. But Butler argues that this very fear, our culture’s unwillingness “to engage with death until it is in our faces,” is what has gotten us so deep in trouble in the first place. For example, 75 percent of elderly patients would rather die in their homes, yet 44 percent of them will die in hospitals, she writes. Last-ditch defibrillators, surgeries for incurable cancers and chemotherapy that only buys a few days continue to be the norm; while what she calls “Slow Medicine” �" home and palliative care �" remains on the fringes and is rarely covered by Medicare. Meanwhile, about a third of Medicare patients will have surgery in the last year of their life and a tenth will have a surgery done in the last month of life, she writes �" costing us an estimated $158 billion to $226 billion in medical overtreatment costs. But what is perhaps worse is the emotional and traumatic toll continual care for a dying relative takes on the survivors, which is the true core of her book. When Jeffrey, Butler’s hyper-intelligent Wesleyan history-professor dad, who lost his left arm while fighting in Italy during World War II, suffered a stroke at the age of 79, he was reduced to something much, much less: “With the memories, mind and reading comprehension of a highly educated 80-year-old; the spoken speech of a 4-or 5-year-old; and the physical dependence of a boy of 6.” He could comprehend his shortcomings, and it made him “miserable,” she writes. At one point, he even commented that he had “lived too long.” The stroke devastated not one, but two lives. “The day before [the stroke], my mother was a talented amateur artist and photographer, a woman of intimidating energy, and a spectacular housewife . . . After the stroke, she cared for my father the way she cared for my brothers and me when we were 3 or 4.” At 77, her mother had become one of the 29 million “unpaid, politically powerless, and culturally invisible family caregivers,” while Butler herself joined the 24 million baby boomers now tending to sick parents. When it became necessary for Jeffrey to undergo hernia surgery, his cardiologist suggested that they implant a pacemaker. The family agreed, unaware of the downsides of what was such an (they would only later find) unnecessary preventative treatment. Now, Jeffrey’s heart would tick on, long past his time should have been up. “Not having a pacemaker would not have guaranteed my father a quick or easy death,” she writes. “But having a pacemaker deprived him of his best chance for one.” Despite the surgery �" or perhaps because of it �" Jeffrey quickly got worse. Like about one third of those over 80, he suffered from dementia. His eyesight went, then his mobility. He began misspelling words. Then he began to see things that weren’t there. He became bladder and bowel incontinent. “I woke up some morning in a fury. Why had his doctors not let nature take its course? If the pacemaker had never been implanted, I thought, my father might well have been out of his misery, and so would my mother and me,” Butler writes. The family begged his cardiologist to turn off the pacemaker, but he refused. Other cardiologists refused, as well. In 2008, Butler’s father contracted pneumonia. Knowing that sending him to the hospital would only prolong his suffering with “life-saving” procedures, they avoided calling 911. He eventually became sick enough to be accepted into hospice care, where he finally died. Here is a link that might be useful: Our aging crisis: the need for a dignified death

I don't think it will affect me at all, I am fully insured already and I don't have prescription insurance at all, haven't needed it.

Monica -- Sorry. I 'presumed'. Because your supplementary pays 100% of the Medicare approved costs beyond what Medicare pays...I assumed that yours is a "Plan F" and that it would be as high a premium as we were quoted for one for 2014. We took "Plan F- High Deductible" with a $2K deductible for 2014. It is $165/mo total premiums for two. The 2014 "Plan F" premium with no deductible was much more. Our plans certainly lost money on me in 2012-2013, but I don't anticipate many medical problems for either of us this year --hence the deductible gamble. I did hate to give up the 100% coverage, partly because I could ignore incorrect bills. Whatever was really owed would be paid by Medicare + the "Plan F". It's only six or seven months until Seniors get to go through the selection process all over again for Medigap and Part D plans. Ugh! What a backwards system!

Hi Yoda who uses a ruler, Not being familiar with your system, I can't give any suggestions as to what reasons there may be to have separate bank account for taxable and non-taxable assets. In Canada we have accounts looking toward retirement where deposits are tax-deductible and the income over the years is, as well ... but every dollar coming out is taxable, and, after about age 70, there are minimum amounts required to be withdrawn annually. They must be in different accounts, of course. When I borrow for regular living expenses, consumer loans, which I plan almost never to do, I have one line of credit that I use for that. I was a personal financial consultant for years and recommended to folks that they have 3 - 6 months' worth of income as a financial cushion, available when needed, and in recent volatile times in the economy am more inclined to suggest 9 months' equivalent to a year's worth of income available in case of need, emergency, layoff, or whatever. I didn't always have such myself, which I told a number of clients, having used much of that fund for investments ... but had a credit card which I rarely used, which could be used in case of emergency, or whatever (I was self-employed, so could usually see an equivalent to a "layoff" coming before it happened). I had a line of credit, fully secured by stocks/mutual funds, some of them that I'd purchased with the "emergency fund", at the bank or, preferably, credit union, which I could draw on in an emergency. I would make a loan using that consumer line of credit to pay off the amount owing on the credit card for the emergency, just after the first billing, to avoid paying their high interest rate (about 4 times the rate on the line of credit, or 6 times if it were a store-issued card: I don't have any of them!). Then I'd make extra savings strenuously for a time to pay off the loan on the line of credit. I don't like using someone else's money to live on now ... and having to pay it back, later ... with (non-deductible) interest. Sometimes, after a bad time in the stock market, when things began to improve, I might make a loan to make further investments, and, as the interest paid on most investment loans is deductible, I'd set up a separate line of credit for that use, using the investments that I'd purchased using the "emergency fund" (along with some others, as the financial institution will only loan about half of the value of the security held), so that the interest rate on the loan would be lower. That's a place where I keep my deductible and non-deductible financial issues separate. Good wishes as you plan your retirement .. and implement the plan: I hope that you have no/few unpleasant surprises. Which you can usually reduce by careful planning, preferably ahead of time. ole joyful