"Not Our Problem": A Good Death Gone Wrong

It still surprises me that with all the safeguards our country has put into place to make sure patients have access to a good death that there can be such sad failures. Mr. Smith (not his real name to protect his identity) is a 46 year old man with laryngeal cancer. He's had several surgeries and has undergone multiple rounds of chemotherapy that left him frail and weak. He had a feeding tube placed in his belly and a breathing tube (tracheotomy) placed in his neck. He was living with his brother's wife's sister who didn't participate in his care. His brother lived a few miles away but participated little in his care as well.

I saw Mr. Smith on a weekend to admit him into our hospice program. It was clear that he had not been cared for. He was too weak to get out of bed, to give his own medications, or to feed himself the tube feedings. He was cachexic, skin and bones. He was soiled and smelly. He needed 24hr care. Luckily, he had Medicare to pay for hospice care and Medicaid to pay for a nursing home, or so I thought. The brother agreed to stay with Mr. Smith through the weekend to help administer medications and to feed him. We had a home health aid make a visit to clean him up and an on-call nurse scheduled to check in on him. Once Monday came, we would just get him moved into a nursing home.

Monday came and the game of patient shuffle began. The brother wanted to pass him off to a nursing facility and go home. Every nursing home we called didn't want to take him. They all had different excuses but the bottom line, as it always is, was money. Medicaid wasn't going to pay the nursing homes enough money to make it worth their time to care for him.

After a week of searching, we found a shelter run by nuns who were glad to take him. Talk about seperation of church and state.

What failures have you witnessed in our healthcare system that effect a persons right to a good death?

What is Hospice?
The Medicare Hospice Benefit