Sink or Swim: We Urgently Need Better Care for Frail Elders

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This post is the first in a series aimed at describing MediCaring, a new, better, and more affordable model for providing medical care and social services to frail elders and their families. In the next several weeks, we plan to post dozens of articles describing why we need such change, and how to make it happen. These materials will be the heart of a forthcoming book by Dr. Joanne Lynn and the Center for Elder Care and Advanced Illness. We invite you to read, comment, and share, as we build the ideas–and the momentum.

On a family rafting trip several years ago, I found myself bruised and battered after tumbling from a raft  into the raging waters. I was left standing on a rock in the middle of the river–my raft and mates ahead, trying to hold steady and not panic. Desperate though I was to get to them, the last thing I wanted to do was  jump back into the turbulent waters. My initial relief about the safety of my rock was doomed to be temporary. My only course to safety was  to plunge into the dangerous current and swim.  Convinced that I had no other choice, I jumped.

That experience may illustrate how so many of us feel when it comes to navigating the increasingly difficult currents of living to be very old in America. We cling to a false security created by programs like  Medicare, Medicaid, and Older Americans Act, and other social services that have  kept so many afloat for so long. And yet although there are millions of us now, and millions more on the way, we too often find ourselves alone in the currents of a  steadily rising current–one full dangerous and deadly undercurrents of poorly funded supportive services, medical overtreatment, and multiplying health care costs. No way  can we all cling to the same rock, or jump and hope to make it.

We simply cannot keep on this way.  If we do, we will force one another from the rock of current social arrangements. And for as long as the rest of us insist on clinging to that rock, hoping for a miracle rescue, millions of our fellow travelers will experience devastating consequences, as services shrink and costs explode. And we will not sink alone, but will take the fabric of society with us, as essential and important investments in healthy children and a healthy economy become impossible.

Even worse, if we fail to  tackle the challenges of right-sizing services for a much larger population of very old people, we are likely to be forced to   pick and choose who to pull from the river,and who to leave behind. We could attempt to sustain the illusion of helping some by providing the existing supports and services to an ever- shrinking percentage of those in need, while learning to accept that others will not have adequate housing, food, and health care.

That path is unacceptable.

Who among us wants to be saved from suffering and destitution while our friends and loved ones are swept away? Tradition and culture guarantee that we are all in this together. We will have to take our chances, jump in, and swim to a safer but unknown shore, despite our fears and uncertainty about what we might encounter.

We did not, of course, plan for this journey with the idea that we would wind up stuck on a rock in an increasingly threatening environment.  Decades ago, we designed a health care system that was well-suited to the needs and realities of those times. But circumstances have changed, and our systems must now change, too.

The first jump is to understand  a new set of facts and develop a new set of understandings. We can build our future in a way that treats us all fairly as we age, and achievesreliability and efficiency. Success is possible. We can get through the next fifty years of a rapidly aging society, having cared well for one another, and having avoided slowing our overall economic development.

However, the journey will entail some risks, and failing to get underway will only make it harder to succeed. When I plunged into the rapids, I had some strengths to build on. I could swim; I wore a helmet; and my loved ones were cheering me on. I  successful re-emerged on shore. And so too, our society  will improve our chances of navigating to the other side if we build on  our strengths, marshall our resources, deliberately plan for what’s ahead, and encourage and support one another along the way.  We may occasionally wash up in a spot that turns out not to be the best, but we can learn from that, and move on.

Doing nothing, we can continue to tread water and keep afloat a while longer. But eventually, even that hard work will fail.

 

We have a long national tradition of joining forces to solve seemingly intractable problems and challenges. We have never shied from taking on threats to our health, well-being, and security. And although the facts of aging seem so remote, so far away, the risks inherent in doing nothing are hitting us even now. One by one, family by family, we need to jump in and swim.

 

key words: Dr. Joanne Lynn, Medicaring, frail elders

 

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