The goal of a more effective and efficient system of care is straightforward—better care at lower costs. The path to that goal has proven far more elusive. To meet these aims, we must focus on those who really need the system to perform better—people with advanced illness and functional limitation. We must speak with them on their terms and build plans of care that appreciate them as people, not just as patients.
According to the Institute of Medicine’s Preventing Medication Errors report, the average hospitalized patient encounters at least one medication error per day. One in five errors harms the patient. More than 40 percent of medication errors arise during care transitions (admissions, transfers, and discharges from one setting to another) when various possible medication lists are not brought together in a process called reconciliation.
A few days into my 68-year old father’s hospitalization for sepsis, his doctors determined the strain of bacteria that plagued him: streptococcus. My sister was there when they came in with this part of the diagnosis; she has a doctorate in engineering with a focus on the human heart (that engineering marvel), and she likes details.
“What strain?” she asked the doctor. “A, B, or C?”
His reply: “What does it matter to you?”
Although not an easy discussion, it is vital that we know the preferences and choices of loved ones (and they know ours) regarding the kind of support you and those you love expect long before a crisis occurs.
Our health care system ably treats sudden threats to life, prevents many illnesses and cures much of what ails us. But it cannot reliably and efficiently support us when we face serious chronic illness and disability—a predictable part of the end of life. As a result, instead of living meaningfully and comfortably, we will experience fear: constant anxiety over unreliability and gaps between silos of service; high cost from waste and mismatching of needs with services; and widespread dishonesty, sugarcoating what we face.
Dealing with the hard stuff – the very sick, the complex, the dying – is the essence of quality health care in an aging society.
Let’s not capitalize on or mourn the loss of CLASS for too long. We have work to do – and we do not have the luxury of time before forging ahead.
In many cases the health care system has determined that certain people are incapable of understanding their health issues and making their own decisions.
In many cases the health care system has determined that certain people are incapable of understanding their health issues and making their own decisions.
The Obama Administration abandoned the Community Living Services and Supports (CLASS) Act last month. This public long-term care insurance program was slated to be the country’s first attempt at dealing with an aging Boomer population that is in denial about what it costs to grow old in America.
