Medicare focuses on end-of-life because we do too?

The death of my father was sad, but it was also illuminating. Relatives who hadn’t paid much attention to my parents for years suddenly sprang into action, on hearing that my father had gone sharply downhill (perhaps coincidentally, but it was one week after the second Pfizer Covid vaccine shot).

People were desperate to show up in person, get on Zoom or FaceTime, or talk on the phone. The neglect of the elderly in America reached a state of perfection starting in March 2020. People who hadn’t visited relatives in retirement homes suddenly had a perfect excuse: #AbundanceOfCaution #BecauseCorona. Even when the inmates were released to meet friends and family on outdoor terraces in masks, the Coronarighteous refrained from visiting (often while posting on Facebook photos of themselves enjoying various activities with other potentially infected humans, going out to get food at/from restaurants #BecauseTooLazyToCook, etc.). All of that changed once my dad slipped toward unresponsiveness.

Apparently I am always out of step with my fellow(?) humans. I was happy to have talked on the phone with my parents every day or two for the preceding 10 years. I was happy that we’d been able to visit them (from Boston to DC) every few months, including amidst “the global pandemic”, over the same period. As it happened, I was also able to be there during my father’s final week, but I didn’t consider that essential or important compared to what had transpired over the preceding 10 years.

Folks often decry the huge expenses that Medicare is willing to incur even when it is obvious that death of the beneficiary is imminent (see “Medicare Cost at End of Life” for some data; as much as 25 percent of spending is during the last year of life). But now I’m thinking that this is a feature and not a bug. If Medicare is a reflection of ourselves and what is important to us, it actually make sense for Medicare to pull out all of the stops when the end is near and certain.

Readers: What have you seen in your own families when the end is plainly near for an older relative? Do folks who’ve not been interested in the soon-to-be-deceased suddenly come out of the woodwork?

7 thoughts on “Medicare focuses on end-of-life because we do too?

  1. In my own family, sadly, the pattern and level of interest in a soon-to-be-deceased older relative has correlated with the amount of money that person is judged to have in their estate. Thus, when it becomes known that a wealthier older relative is in poor health and the end may be drawing near, at that point many members of the extended family will discover a newfound interest in making phone calls, visits, and sending gifts to that person to bolster their spirits and offer their comfort and prayers. The less the person is “worth” in terms of material value, and particularly if they are known to be in financial distress, the more the opposite holds true.

    My maternal grandfather had several daughters who took virtually no interest (I dare say one of them despised him) in his last years of life except toward the very end, after his wife had already passed on, when it became clear that it was becoming time to handle the estate matters. I had a large collection of valuable items that he intended to be bequeath to me (which he had informed me about years before and told me were in his will) upon his death. Those items, including a rather large and valuable collection of historic and antique firearms, mysteriously disappeared in a late night robbery a few days after he died, which was never solved.

    • When you visit almost any hospital in the United States, usually in the lobby or one of the waiting areas, you can see a large wall or display featuring the names of various philanthropic benefactors over the years. I have often wondered how many of them are people who received end-of-life care at the facility, and if the family (or the individual themselves) chose to donate because of extra effort that was undertaken to extend their lives in their final days? Someone who works in the Development Department at those places should have an idea. It makes sense, conceptually at least: “The physicians and staff at St. Ignatius gave my [mother/father/sister/brother/other] a few precious extra weeks of life. That’s worth $XXX.”

  2. I’ve seen the sudden abandonment of everyday activities by a soon-to-be-deceased visit many times. I think it’s avoidance of future bad memories.

    People tell me that, when surprised by a parent’s death, they most remembered their last conversation, and if it was in any way other than completely pleasant, they regret it. So when given an opportunity to control the last interaction, they take it in order to replace whatever unhappiness they had last. Even if it was just “you know, I meant to call, but I was busy with soccer practice.”

  3. Strange behavior. Can not relate to that. With lifespans expanding and most of the later years spent in retirement, those with elderly parents are themselves in advanced middle age or already at or in retirement. Could spend more time on those who brought them into this world and brought them up. Probably do not want to think about fleeting nature of present moment and to what end life has been spent.

  4. Every year from the time I moved from my hometown I went back every year 2 C my parents. I loved them dearly. Once they aged an made their transition. The famiky that was always there. Still came thru. The o es who weren’t. Didn’t. My parents only had love. No money

  5. I have little interest in living past seventy. The decline of age frightens me more than death. I would rather my wealth go to my descendants in the prime years of their life than be wasted battling the inevitable decline of old age.

    Once I hit seventy, I’ll start mulling a good death.

  6. (Philip’s sister here): Certainly this applied to our family when our father’s death seemed imminent. I was calling Dad twice/day during his various bouts in the hospital, and in the “skilled nursing” part of his & Mom’s retirement community (CCRC). Once Dad stopped eating and drinking, about 11 days before he passed, I was calling his phone non-stop, especially as he became too weak to answer the phone, which meant that one had to be lucky that a nurse was in his room to pick up the phone for him, in order to get an update. This supplemented the occasional calls from physicians/gerontologists who had spent a few minutes with Dad that day, on rounds.

    And the grandchildren who were able to travel to see Grandpa made a heroic effort to do so in his final days, including one who rented a car and drove from Manhattan to spend two days which ended up being just 24 hours before Dad’s passing. This particular grandchild shared our father’s abiding love of classical music and literature, so by middle school age, always felt an affinity with his grandfather.

    There are some exceptions, e.g., spinal cord injuries, congenital conditions, but for my father certainly his medical care beginning Sept 2020 when he fell when getting out of bed for the day (which led to a series of hospitalizations and rehab) was likely a significant percentage of his lifetime medical care. And brought about a flurry of phone calls and visits insofar as COVID rules at a CCRC allowed. We were actually lucky compared to many Americans. Due to all staff and residents of my parents’ CCRC getting Pfizer dose 2 during the third week of January 2021, the rules for visitors were relaxed in early February. Otherwise, we might have barely been able to see Dad in his final days. I have photos of Dad when he was brought back from the hospital to be in hospice care on Sunday, Feb 21, and I have been unable to look at them again. Gotta say the retirement home employees, many long-term, were wonderful, including helping the ambulance driver and me get Dad into a hospital bed which a social service agency had delivered that morning (to be in hospice in his own apt). The grandson in question did note that all of the staff who stay for a while basically watch all the residents pass. Grim reality. Security team member Francis told me recently when I was visiting with Mom that he misses Nat, who was often taking a walk around 8 am. And that Nat gave him a tub of his minestrone soup several times when Nat was still cooking regularly (our father took up cooking in the 1980s, inspired by Jacques Pépin and Julia Child). The memorial service will be scheduled as soon as feasible. Since Dad wanted to be cremated, his ashes are in a box in Mom’s apt. A lot of my French friends had ashes in an urn on the mantel, but I was still freaked out seeing this during a visit early this month. Right behind Dad’s CD collection and his recliner chair.

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