Prime Time - Jane Fonda [121]
Even though palliative care is currently offered in 70 percent of our large hospitals, not enough patients are accessing it, because doctors have not been trained to understand its value and patients and their families have not yet learned to ask for it. This is more important than ever now: A recent study showed that cancer patients who get palliative care along with standard cancer treatment actually lived quite a bit longer than patients who received only standard care. If palliative care can help patients feel better, perhaps it’s not surprising that it also prolongs life!
Where and How Will You Live?
Then there’s the issue of where you live. Maybe it’s time to make changes to your home that will make it easier and safer for you as you age. Having had a hip and a knee replacement, I know that in a few years’ time I will want a home without stairs. I’m aware of the hazards of falling at my age, so I’ve gotten rid of all throw rugs that might slip. I also make sure there’s nothing lying about at night that I could trip over. Ted Turner has installed grab rails in the showers and baths of his homes and was generous enough to offer to do the same for me. I’ve known too many people who’ve fallen in the shower, and I don’t intend to be one of them.
There are a variety of housing arrangements for people who cannot or no longer want to live alone and be responsible for all that it entails—cleaning, cooking, gardening, and so forth. There are independent senior communities with private apartments and twenty-four-hour emergency-call services, as well as social activities. Continuing-care retirement communities agree under contract to provide residents with housing and services for life; these usually require a one-time entrance fee and monthly payments. Assisted living facilities can be nursing homes or part of a retirement community; they cost on average $32,000 a year. A semi-private room in a nursing home costs $65,000 a year. As I said, Medicare covers the expenses for only a limited time, while someone recovers from an accident or surgery. Start saving and budgeting!
Only 5 percent of people over sixty-five are in special-care institutions, and that number has been dropping since 1982. Dr. Marion Perlmutter told me, “I think we are moving away from institutionalization, which is good. People do much better at home if they can stay at home. What we know now about the memory system is that it is so context-dependent. If I can’t remember something I was going to do when I was in the next room, all I have to do is go back into the other room and that context reminds me. Well, if you move to a nursing home, you have lost the entire context of your life. It’s so disorientating. and they get into this vegetative state. But this isn’t a necessity of old age. We know that now.”
Elderly people who are confined to nursing homes do remarkably better, physiologically and psychologically, when they have some control over their day-to-day lives. Homes should, perhaps, allow patients to keep a pet, have some say over their schedules, and decorate their room. “It’s not responsibility that kills, it’s the lack of control,” says Dr. Estelle Ramey, a professor of physiology and biophysics at Georgetown University Medical School. “The driver isn’t under as much pressure as the passenger.”
End-of-Life Care
You should also prepare a health care power of attorney document, which will appoint someone to make decisions about your end-of-life care or cessation of treatment. This would go into effect when your doctor determines that you are no longer able to make such decisions yourself.
A Living Will
Another important document is a living will, in which you state what life-support procedures you want or don’t want. This is extremely important if you want to avoid putting your loved ones in a situation where they may have to fight with the doctors about what to do. When developing a living will or power of attorney document, you will need to know what your state’s laws say about such end-of-life advance directives.
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