Law should allow choice of death over dementia
Mike Thomas, Orlando Sentinel, April 25, 2011
We need a physician-assisted suicide law in Florida.
Only we should go beyond the laws approved by voters in Washington and Oregon.
They allow people with terminal diseases to obtain a lethal prescription of drugs from a doctor.
This does not include dementia patients. Our law should.
Individuals should be able to choose now that they would rather die with dignity than be shipped off to die of end-stage Alzheimer's in a for-profit Medicaid warehouse.
This is not a sensational or even unreasonable sentiment.
Florida nursing homes were a national scandal in the 1980s. They were warehouses. An Orlando Sentinel investigation found countless cases of neglect, infected sores, sexual abuse, malnourishment and deaths. All too often, the victims were incapable of reporting the crimes. Despite numerous infractions, the state allowed some of the worst homes to stay open.
Legislators promised to "clean up the hellholes,'' while the hellholes demanded protection from lawsuits.
Gov. Jeb Bush seemed to resolve the situation with this compromise. He put limits on how much a jury could award in lawsuits while increasing funding to beef up staffing at the homes.
Things seemed to get better.
But in 2004, Florida TaxWatch reported that nursing homes here, while ranked third nationally in staffing and 11th in overall quality, faced Medicaid cuts that threatened to undermine quality.
The report spelled out why this is important.
"Almost anyone that is working or middle-class will end up in a Medicaid-funded nursing home, due to the great drain on personal resources required," wrote Tim Lynch, the author of the report. "It's not just the poor. It's you and me and our parents we're talking about."
Seven years after Lynch's report, the situation is much worse.
The way it works if you go to a nursing home is that you start out on Medicare. When that runs out, you burn through your life savings, and then end up flat broke on Medicaid.
The Legislature is proposing deep cuts in Medicaid funding for nursing-home patients. This comes on top of federal Medicare cuts to nursing homes.
The homes have long used the higher reimbursement rates from Medicare patients to offset their losses on Medicaid patients.
Now there will be bigger losses and smaller offsets.
The homes argue their budgets will be so thin that they can't afford the cost of litigation. They say the money spent fighting lawyers and paying abuse claims will be money taken away from patients. So lawmakers are pushing more tort reforms that basically will eliminate most of this litigation.
Unfortunately, as imperfect a system as it is, litigation does serve to keep the homes somewhat honest.
With that check ending, Gov. Rick Scott and lawmakers also have moved to limit state oversight of the homes in the name of deregulation.
We are bringing back the hellholes.
To pretend anything else is an exercise in seeing no evil and hearing no evil.
It's only going to get worse as baby boomers age and put more pressure on the system.
The cost of Medicaid is projected to grow much faster than tax revenues. Those with the smallest voices, those without the lobbyists, will get left further and further behind.
I can tell you who they will be.
About 75 percent of nursing-home residents suffer from dementia. Most are poor elderly women. Those who do not have nearby family members serving as their advocates will be prime candidates for neglect.
Nationally, there now are about 4.5 million people with Alzheimer's disease, a number expected to grow to 14 million by 2050.
Alzheimer's makes up a little more than half of the dementia cases.
So you can see the scope of the problem, particularly with Florida's aging population.
I'm not blasting Rick Scott or the Legislature. I'm not arguing that we pour unlimited funds into nursing homes. Our plundering of the next generation has to stop somewhere.
All I want is an opt-out clause in my living will.
If I become incompetent and my family no longer can care for me, I want to move on. I should be free to set up my own death panel of family and friends.
With my advanced and very strict instructions, I would trust them to make the call.
If you chose to hang around, I respect that and good luck to you.