unfortunately there are a lot of ppl in a situation where they did not declare that in time and we can't assume they would.
Over prescription of antipsychotics is still common in US psychiatric facilities, and even if not there are alternatives, like very high dosages of SSRIs or other specific medications with complacency as a side effect.
But it is really difficult staying enthusiastic about treating someone, long term, who is never going to repay any extra efforts. Caring for the elderly/infirm is a really gruelling experience.
It seems quite likely that there physically are not enough doctors who have the mental stamina to do that. The options the average person faces if they can't care for themselves are going to be doctors who don't really care, or nothing.
I can see that in the facility where my parents live. Overall the place is fine but it's constantly understaffed and people aren't paid well. This is a way harder job than my much better paid tech job. I can slack off for days when I feel like it whereas the care personnel never can escape the grind.
It's sad that these people get paid so little considering how psychologically strenuous their work is and how much human benefit comes out of it.
This article strikes a chord with me. After a long hospital stay, I sent my father to inpatient rehab (aka "nursing home") for two weeks. Before he went, they told me I could do daily visits outside his window. After he was there, they made me schedule visits ahead of time with their "activities coordinator" who told me I was lucky to get twice a week. They didn't bother to make him do any of his therapy, rather they just let him lay in bed the whole time. They put him on a bunch of new meds to make their job easier, double dosed his biannual medication, etc. It was of course impossible to get anybody on the phone to talk about any of the details of his care (and not for a lack of trying). I only discovered the meds after the fact when I requested the records (which was also its own ordeal, and they're not even complete).
Administratively though, they were on the ball. The intake paperwork pushed me to sign him up for a long term stay (complete with "sign here" highlights on patently unnecessary forms; I rejected them), and they wasted no time switching his insurance billing address to their own address. His stay ended abruptly one (early) morning, when they punted him back to the hospital with a dubious story. I believe it was because they knew his Covid test was coming back positive but didn't officially "know" yet, and this way they could keep their numbers down.
After the second hospital stint, I just took him home despite the extreme burden. I hired some private helpers and between them and myself being extremely involved with the visiting nurses/rehab, he did much better. I would have paid for more bona fide sessions of rehab if I could have, but that's our inflexible system.
If you have a good relationship with your family and one of them is in the position of "needing" a nursing home, it behooves you to save them from these horrible institutions that are mainly geared to milk their insurance. Even at decent hospitals and not during Covid, if someone else is not there and continually advocating, their care will be overlooked.
I don't believe that it affected his care. There were a fixed number of hospitals, inpatient rehabs, and visiting nurse associations, and they all took his plan. And I can't possibly see their behavior being different for a different payer - the incompetence was intrinsic to their deliberate bureaucracies. The only way to rise above would have been to find providers that didn't take "insurance" at all, such that the actual customer was the patient rather than another bureaucracy.
The Medicare rules were limiting by fixing the amount of rehab sessions he got per week. The length of his care would have been limited too (discharge rules), but I advocated to extend him within the system. But any bureaucracy is going to be similar, and thus the only way to fix that would be neutering the whole "insurance" cartel and forcing the industry into radical price transparency. Which is basically the line I was straddling with the private pay helpers.
What Medicare really helped with is making his copays sane and giving me solid footing to push back on billing fraud. For instance, one equipment supplier sent me a bill for 50% more than it should have been, and then shamelessly stood by their story on the phone ("you owe us this amount, so you need to pay"). I presume they successfully defraud many people that way.
I agree with the principle behind your other points though, in an ideal world we would not prescribe these medications to the elderly to ‘aid in management’
I don't know why this is, but dementia is often a continuum, and the decision making that people make seems to change in early dementia.
Unless you are proposing that others get to make this executive decision that people with dementias lives aren't worth living, this solution is not practical.
More practical would be to accept that we are far better off over-medicating with pain meds to "keep people comfortable" with the implicit idea that it will shorten their lives. Everyone can pretend we're doing it for pain. Effectively it's like what you said but with some face-saving bullshit where no-one has to admit we're killing grandpa/grandma over the course of a few months. I'd much rather a few months on opiates at the end of my life than a few years on Haldol (JFC). Ugh.
Is it really demented thinking to want to avoid approaching death? I am there right now with my mom, and if she wants to press on, who am I to argue?
On Monday I will be an Intel Principal engineer again - but there's some Monday where I may need someone else's help to get the shit off my bum. From the perspective of that next Monday the indignity of the latter one is astonishing and humiliating, but there will be many intermediate stages where I get used to the idea that I am not what I was and to see that life is still quite pleasant.
If it's reasonably certain that I will die soon or there is no chance for recovery I would like to try all kinds of drugs like heroin, cocaine and others. Why stay sober?
More likely it is that theoretical death sometime in the future is something much different then real death sometime soon. Which is much different to actually doing it and following up.
The exact same thing happens in physical danger situations. People are brave and daring and when faced with actual situation, the start making real decision differently.
Personally I think I would prefer euthanasia if I knew I was developing dementia and likely to end up in a care home similar to the one described in the article, or even one much better than that, so perhaps selfishly I would prefer a society where such is legal even though there would end up being abuses like you describe.
We can think of care homes as like suppliers in a captive market, and we are the consumers - but it is even worse that a captive market in the sense that at least in a captive market you have the option not to buy, whereas we will be forced to. The existence of assisted dying as an option may even economically incentivize the care industry to improve.
If they are fabricating schizophrenia dx, then they would also likely to fabricate medical cause for euthanasia.
Antipsychotics are supposed to be the last resort in geriatric care due to obvious effects on patient quality of life and functionality. Not even sure they're approved by the american FDA for such uses. If they must be used, pretty much anything will be better than haloperidol.
Reminds me of lobotomies of old. "Make the patient easier to care for."
I feel like this industry for the care of elderly in this country just bears 0 responsibility.
I developed tardive dyskinesia from use of antipsychotics over a period of 8 months. It's been over 6 years since I've taken them, but it still has not gotten any better...
You can still develop TD regardless of the drug, given that pretty much any dopamine antagonist can cause it in the long term.
"Haloperidol is relatively inexpensive, being up to 100 fold less expensive than newer antipsychotics"
This is what convinced me to have as many children as possible. Hopefully at least one of them will care about me enough to not let this sort of thing happen to me.
Have kids, raise them right, and you’ll be fine. It’s worked out pretty well for a couple thousand years.
If your kids aren’t suicidally depressive but also don’t love you enough to take care of you in your old age, there’s probably something else they resent you for other than being born in the first place. Which isn’t necessarily your fault—some people are just irrationally resentful. But that is probably the bigger risk to worry about. It’s just that, compared to trusting nursing homes not to become abusive, it’s still a better bet.
It’s also not necessarily about obligation, at least not in the negative sense of the term. I took care of my father during the last year of his life, not out of obligation but out of love. (One might define love as the act of willingly accepting the obligation to care for another, but a willingly accepted obligation is not really the same kind of obligation.)
In any case, the goal is to go into old age having people in your life who are capable of taking care of you and who will choose to do so out of love. Having kids and maintaining a strong relationship with them gives you a good chance of reaching that goal. Institutions, on the other hand, will never love you and will instead just fuck you up with psychoactive drugs for their own convenience.
This is a common misconception, and completely incorrect. https://en.wikipedia.org/wiki/Antinatalism . This is a possible valid philosophical judgment that implies nothing about depression.
It's kind of funny, my wife's mom abused her horribly and is now upset my wife and I won't take care of her. Treat your investments better lady.
If you’re not abusive children tend to remember the 18 years you gave them fondly and provide assistance for your last few years.
I’m bullish on that strategy, even if there is no contractual guarantee that those kids will return the favor.
Others consider bearing children a gift of life.
That's right - it cannot be given.
Life expectancy is a bit of a misleading metric in that regard, since life expectancies are just averages. If a population has a life expectancy of 50, that doesn’t necessarily mean that 50-year-olds are dying of old age and no one makes it to age 80. It could mean that there are a lot more children and young adults dying and bringing down the average. So if you’re living in a society with a life expectancy of 50 years and you turn 50, your personal life expectancy is probably going to be closer to 70-80 because you’ve already managed to survive the causes of death that affect younger people.
And you may very well develop things like dementia. The concept of people becoming elderly enough to lose their mental faculties isn’t some unprecedented 20th century discovery. It is becoming more common, but that’s just because deaths from childhood illness, infectious disease, violence, and occupational accidents are becoming less common.
The fact that some people were prescribed haloperidol as the first line of treatment instead of a newer, safer antipsychotics also blows my mind.
I'm terrified of growing old in this country.