Dr. David Green on the rising need for custodial care
The inspirational French woman, Jeanne Louise Calment, once commented on the occasion of her 110th birthday, saying “I had to wait 110 years to become famous. I wanted to enjoy it as long as possible.”
Born in 1875, Madame Calment, who outlived her husband by 55 years, lived until 1997 and the age of 122-years-old. She attributed her super longevity to eating more than two pounds of chocolate every week, treating her skin with olive oil and riding her bike until she was 100 years old.
The reality for most of us, however, is that getting old, and becoming very old, may be hard. Few among us will live to be 100 years old, much less 122 years, but more of us will live into our 80s and beyond at a rate that is greater than at any other time in human history.
We are more than halfway to fulfilling the prediction by the University of Massachusetts’ Center for Social and Demographic Research on Aging that our 85 year old and older population will grow by 34 percent between 2000 and 2030 to nearly 212,000 individuals.
“In the past, this segment of the older population has been at the greatest risk for acquiring chronic disease and disability, predicting greater future demand for services that enhance health and enable independence among the Commonwealth’s older residents,” said the Center in a 2013 study.
Our “oldest old” citizens will also require more assistance to navigate the routine tasks of everyday life such as getting to the bathroom and feeding themselves. For some, there may be a sense of isolation as friends pass on and their families live some distance away.
What lies just beneath those numbers is a rising demand for custodial care that will continue to reshape our approach to caring for our frail and oldest citizens. Most people have a strong preference to remain at home and should do so as long as they remain safe. They tend to feel better in familiar surroundings. But the rise in the number of people who will celebrate their 85th birthdays will require a corresponding increase in the availability of 24-hour supportive care.
With regard to residents in skilled nursing facilities, we review the health status of all residents to assess who can safely return home and what assistance will be needed to do so. Attending those weekly meetings are physicians, nurse practitioners, nurses, a physical therapist and a social worker.
As an example of those status conferences, we recently discussed the case of a 92-year-old woman who was discharged from the hospital into our care in Concord. After a three-week stay, receiving daily physical therapy, we agreed to her request to return home as long as she was closely monitored and temporarily had visits from a visiting nurse. She did quite well. In another situation, we were very concerned about an elderly patient who insisted upon going home. In spite of all the services provided, she required hospitalization and was again discharged back to us for long-term care. She needed that unsuccessful attempt to return home.
Unlike a generation ago, the collaboration among doctors, skilled nursing facilities, hospitals and homecare agencies is better coordinated today. The financial pressure to discharge people to a safe, appropriate and least expensive environment demands excellent communication.
The goal should always be to have patients in an environment where they will be safe, thrive and be most comfortable. It is also worth noting that the system we put in place for this current generation will largely shape the system that awaits us all – at least those of us who have the stamina and good fortune to live to a ripe old age.
Dr. David Green is the medical director at CareOne at Concord and a pulmonologist.