Suggested Reading: He Just Wanted to Die at Home

Last month’s report “Dying in America” by the Institute of Medicine was an analysis of the shortcomings of U.S. health care at the end of life, as Nina Bernstein knows only too well. Writing in the New York Times, her account of one man’s last months was a poignant tale of how things can go so wrong.

In “Fighting to Honor a Father’s Last Wish: To Die at Home,” Bernstein tells the story of Joseph Andrey, 91, and his daughter, Maureen Stefanides, who desperately tried to liberate him from the nursing homes where he had been an on-again/off-again patient against his will. All he wanted to do was go home to die, but the system – “hospitals, nursing homes, home health agencies, insurance companies and the shifting crosscurrents of public health care spending” – conspired against him and thwarted his daughter every time she tried to fulfill his wishes.

Andrey had been discharged repeatedly by a hospital to a nursing home supposedly for rehabilitation, but his stays had left him weaker and more likely to get infections that complicated his ability to go home, and for his loved ones to take care of him there. He endured a cycle of poor care no one should have to experience.

As much as anything, the profit motive was responsible for his misery.

“As for dying at home,” Bernstein wrote, “‘you can’t believe the forces of the system that are arrayed against it,’ said Jack Resnick, once a health system executive and now a doctor with a geriatric house-call practice on Roosevelt Island. ‘The way the reimbursement system works, these decisions are not made on the basis of what the individuals need. They’re based on what the institutions need.'”

Read the whole story here. To learn more about how this sort of situation arises, and how you can reduce your chances of repeating it, see Patrick’s newsletter this month, “Medical Care at the End of Life.”

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