
Think you want to die at home? You might want to think twice about that - DoreenMichele
https://www.latimes.com/opinion/story/2020-02-16/doctor-patients-send-home-to-die
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gumby
My mother in law died at home (in the same room in which she had been born
sixty years prior in the middle of WWII) and despite the twice-daily visits
from the _Diakonie_ nurse to change dressings and feed her (German home visit
paid for from church tax) the burden of caring for her in her final months
fell harshly on her two youngest daughters.

Compare that to my paternal grandmother who could see the writing on the wall
and moved herself into care so her kids wouldn't have to deal with it. As her
vision and hearing decayed, and then she started to lose her short term memory
she told me she realized she was just hanging around to get a letter from the
Queen which she decided was pointless so offed herself* before she became
unable to do so. She told me that she couldn't have done that at home -- too
hard on her (by then senior citizen) kids.

* (Unfortunately euthanasia was not legal in South Australia so she had to starve herself to death at 98).

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refurb
As the article states, every situation is unique.

Would I want to die a home if I had a brain tumor that was causing me to act
violent and I wasn't lucid? No, I would want to be a facility.

Would I want to die at home if I had a heart issue that would leave me
bedridden but lucid and I would likely just fade away? Sure.

~~~
a-dub
The problem is that it deputizes your loved ones as stand-ins for professional
medical staff. End of life care is hard for the professionals, don't put it on
your loved ones.

~~~
refurb
Agreed! Obviously I’d take my loved ones into consideration.

If the only people around are my 80-year spouse, I’m not going to put that
burden on them whatever the cause of death.

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erikerikson
We could optimize for quality of life rather than length of life. It'd sure
help that be a more positive experience if we inverted that.

Give me a good life over a long one, within responsibile parameters, it was
always temporary. Frankly, I'm glad for that.

~~~
hackeraccount
Sadly we aren't given a choice. My Mom's mom went from perfectly reasonable to
dying at home amazingly fast in hindsite - 3 to 6 mos. I think.

My Dad's mom lived to be 90'something but the last 20 years were in
increasingly assisted living. I don't think she even knew where she was the
last couple years of her life.

That said - dying at home is work for family no two ways about but.. I think
it helps with grieving in some ways. I was there for a lot of that time and it
dispelled any illusions I might have had about what was going on. It made me
think that dying is an incredibly inwardly focused thing.

Your millage may vary though. :-)

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kylec
I feel like more people should consider euthanasia. If caring for you is a
huge physical and financial burden, and you're basically waiting to die
_anyway_ , why not just get it over with?

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chx
I am.

I have decided years ago and I do not see this changing significantly that
once my mortgage is paid down -- which is approximately in eight years -- I
just want to die, I will be 53 by then. By then the so called "bucket list"
will be empty. I am living alone and this I can't see changing any time soon.
Do not think I am suicidal or depressed -- I have three international trips
booked for this year already and so on. I am just utterly practical. Nothing
frightens me more than living with a slowly fading mind in a much more rapidly
failing body.

Canada where I live has allowed medical assistance in dying since 2016 doesn't
allow for this. I do not expect to be terminally ill and so I can't just
decide, not even if I make a declaration ten years beforehands, that I want to
end it in dignity and without pain. You can't. You _can_ extend it far beyond
where life is enjoyable, it is indeed the default expectation to do so but
ending it, that's not allowed.

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riku_iki
53 looks young enough to be active, enjoy life and add value to society if you
take care of your health.

~~~
chx
> if you take care of your health.

Yeah. See, I was diagnosed with T2 diabetes not long ago (AFTER I made the
decision on when is the show over) and I can fully maintain a non diabetic
blood sugar level with just diet and for the time being , I am doing so. It
however greatly limits one of the biggest enjoyment in my life, namely food.
_THAT_ is the future -- as I age , more and more things I could do I won't be
able to. I bought a rolling carry on for the first time today because I
recognize running around with a stuffed backpack is not cutting it any more.
Already I needed to limit how much I can sightsee on foot. All this. I am SO
not interested in walking this path down to the bitter end.

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TehShrike
I've had the privilege of seeing my parents take care of two of my
grandparents in my parents' home after my grandparents couldn't take care of
themselves any more. (In one case, for their final week, in the other case,
for over 5 years.)

I look forward to taking care of my parents in my home whenever they get to
that point.

~~~
vageli
> I've had the privilege of seeing my parents take care of two of my
> grandparents in my parents' home after my grandparents couldn't take care of
> themselves any more. (In one case, for their final week, in the other case,
> for over 5 years.)

> I look forward to taking care of my parents in my home whenever they get to
> that point.

I am living this privilege and wouldn't trade it for anything. But something
in you changes the first time you have to help your parent out of clothes they
pooped in and into the shower. I wasn't prepared for it when it happened, but
I believe it has made me stronger (and if anything, dealing with an adult with
a decaying mental state feels like good practice for dealing with a teenager).
I am so thankful to work in tech where my physical presence is not a necessity
and so I can be more present with my family, but sadly this is not true for
too many.

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epx
Had an uncle that died at home and the family suffered a lot more than if he
went to the hospital. Changed my mind about this topic.

My plan if I get a terminal illness is to put the paperwork in order and
disappear into the forest or sail into the sea :)

~~~
bhhaskin
Just keep in mind that if you just disappear your family won't be able to get
a death certificate for at least 7 years if they don't find a body. With out a
death certificate they won't be able to collect life insurance, inheritance,
or deal with the estate.

~~~
HenryBemis
Exactly that. Your family will have to deal with a lot of bureaucracy. I am
also in favour of settling your affairs, make a last round saying your
farewells and end it in a "clean" manner. Disappearing in a forest will get
you to the missing persons list. Then if/when someone finds you it will be a
whole new ordeal for your loved ones, DNA tests, burials etc. Why upset them
1-5-10 years later?

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chkaloon
Just went through this with my dad. Fortunately he was financially able to be
in an assisted living facility which gave me and my sister much needed
assistance and help during the process. As mentioned in the article, hospice
covers very little.

Unfortunately nursing home or assisted living costs $200-$800 per day
depending on the place you live and the assistance needed. If your loved one
doesn't qualify for Medicaid, they are responsible for that. Medicare does NOT
cover it, contrary to what many think. The only option for many is to drain
their savings until they are destitute enough to qualify for Medicaid. One
could argue that one reason you save is to take care of yourself in old age,
but when the draining of savings actually happens it adds to the emotional
toll.

Long Term Care insurance is an option if you plan ahead, but it has become
VERY expensive and hard to get now that the LTC providers have realized that
their actuarial tables were way off years ago.

Tough situation.

~~~
HenryBemis
I don't support/agree with all his opinions, but I've watched the "Dave Ramsey
- Financial Peace University" and one of the things he insists on (at least I
picked up on that) is to make sure you slowly invest on a package that would
cover you at old age. Especially if you don't have kids to be a burden on.

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stillbourne
I recently had to go through the passing of my grandfather. In addition to
having Parkinson's for the last 5 years of his life that progressively got
worse, he also had stage for rectal cancer that was inoperable. He had a DNR
and also an advance directive about prohibiting aggressive medical
intervention. He ended up with pneumonia and refused to be ventilated to clear
the mucus. He told me and my grandmother after an extremely bad night in the
hospital that he was, "ready." I called family from all around to come say
good bye, We were planning on doing in home hospice but his condition was
deteriorating and I couldn't manage it on my own. We ended up taking him to a
very nice hospice center, they stabilized him enough for everyone to get to
say their last good byes and then he passed a few days later.

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HenryBemis
Just a thought, but here it is.. humans were living for far less years. We
used to die at 20-30-40, 50 at best for thousands of years. Then hygiene,
healthcare, comforts kicked in and we ended up living up to 100+.

I think that "in the past" our species didn't have to worry about "senility"
(and what comes with it) because people were dying while their brains were
still at full capacity/capability and it was only the body that was "failing".

The jump from the lifespan of 50 to 90 to just a few decades must have made a
huge difference in the appearance of this "new problem" of having 3-4
generations being alive at the same time.

I remember a Great-grandparent was a very rare thing. Now with people living
up to 100 and people having kids at an earlier age, we get to see it far more,
and this will most likely continue.

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AstralStorm
Really the problem is that the care facilities are few and far removed, the
other being that old people really prefer the familiar.

Alternatively that live in professional care is really expensive, and for good
reason that it takes a big toll on people performing it in addition to special
skills

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a-dub
I'm very familiar with the concept of in-home hospice, and personally it
resulted in one of the most horrifying experiences in my entire life. I would
not wish it on anyone.

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pmoriarty
Is there any way to read this article without enabling javascript?

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xook
It's a series of images, so if you're sporting uMatrix or similar, just allow
images from brightspotcdn.

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lonelappde
Extremely biased article, bordering on propaganda. Not everyone dying is an
ongoing expensive burden, and care facilities aren't miracle cures. Many
people need somewhere to rest on their way out.

~~~
JshWright
How can someone relating their personal experience be "biased"?

Anecdotally (in my experience as a paramedic), I agree that many people
significantly underestimate how hard it is to care for someone who is dying.

~~~
prepend
> How can someone relating their personal experience be "biased"?

Aside from all stories we tell being biased there are many ways a story I tell
about my experience can be especially biased. Exaggeration, omission,
conflation, and then there’s outright deceit. There’s also the possibility
that what I believe is real is not [0].

I don’t like assuming the worst or accusing people, but I certainly don’t
think that all personal accounts are completely neutral. People usually tell
stories with some motive and I think it’s valuable to be politely cynical, a
bit.

[0] [https://www.ncsc.org/microsites/trends/home/Monthly-
Trends-A...](https://www.ncsc.org/microsites/trends/home/Monthly-Trends-
Articles/2017/The-Trouble-with-Eyewitness-Identification-Testimony-in-
Criminal-Cases.aspx)

~~~
JshWright
> Exaggeration, omission, conflation, and then there’s outright deceit.

That's not bias, that's lying.

For what it's worth, the author's experience certainly matches my own (working
as a paramedic). There are a lot of people out there who have significantly
underestimated how hard it is to care for a loved one who is slowly dying.

