Well, I'm following the UK election even if no one else in the USA is.

[AlwaysHungry]

The problem with the Liverpool Care Pathway was that it was intended to ease the passage of those in their last hours, not their last days.

As with many well-meaning innovations those applying it didn't read the small print that detailed the restricted circumstances in which it was appropriate and helpful.

Then administrators added financial incentives to using the Liverpool Care Pathway and those incentives increased its application far beyond the few for whom it was a reasonable medical response to a terminal phase.

Dying isn't always easy and painless. Palliative care for terminal cases is a specialist medical discipline and best practice is not always understood by staff untrained in dealing with dying.

That's one way of looking at it. Another is that it became a way for bureaucrats to cut budgets by encouraging costly patients to hurry up and die. Here in the US we have what are called HMOs or Health Maintenance Organizations, which are privately run on a for-profit basis, and they are notorious for this sort of behavior. Every dollar not spent on providing care for patients is another dollar of profit that goes to the shareholders. Unfortunately, the Obama plan more or less turned our entire health system into one giant HMO.

 

[oggbashan]

That's one way of looking at it. Another is that it became a way for bureaucrats to cut budgets by encouraging costly patients to hurry up and die. Here in the US we have what are called HMOs or Health Maintenance Organizations, which are privately run on a for-profit basis, and they are notorious for this sort of behavior. Every dollar not spent on providing care for patients is another dollar of profit that goes to the shareholders. Unfortunately, the Obama plan more or less turned our entire health system into one giant HMO.

The Liverpool Pathway wasn't designed as a cost saving measure but as a way of making an inevitable death more tolerable.

BUT it was then recommended as a way of saving money. It had already been used more than it should have been, and the financial incentives added to the pressure to adopt it. It became a political disaster because managers tried to influence medical decision making (and before then it was being misused on patients for whom it was never designed).

 

[UnderYourSpell]

I posted about this on Facebook and had one friend come forward whose Father was put on it without anyone's permission and the family were not even told, they found out by reading his notes. The poor man was asking for food and drink and being denied. The family fought tooth and nail to get it reversed and were feeding him themselves, he recovered from his ordeal and was discharged. Another's Mother had Alzheimer's and couldn't speak, or feed herself and when she left the food they brought it was taken away and the nurses were saying she didn't want it. Her husband got her out of there and nursed her at home for several more years to come. Someone should be made to pay for causing suffering, but I doubt they ever will.

 

[AlwaysHungry]

I posted about this on Facebook and had one friend come forward whose Father was put on it without anyone's permission and the family were not even told, they found out by reading his notes. The poor man was asking for food and drink and being denied. The family fought tooth and nail to get it reversed and were feeding him themselves, he recovered from his ordeal and was discharged. Another's Mother had Alzheimer's and couldn't speak, or feed herself and when she left the food they brought it was taken away and the nurses were saying she didn't want it. Her husband got her out of there and nursed her at home for several more years to come. Someone should be made to pay for causing suffering, but I doubt they ever will.

These kinds of stories are common in the US. I have known people who had elderly relatives in the hospital, and these family members were put under tremendous psychological pressure by hospital staff to sign "do not resuscitate" orders. It is always presented as a humanitarian decision to relieve suffering, and it is usually a cover story for an entirely different agenda: it is expensive to provide care for old people with serious illnesses, and the accountants will argue that it's a poor investment because they haven't got that much longer to live anyway. And the accountants answer to the shareholders who want to maximize profits.

I won't deny that there are some cases where a patient is genuinely in agony and wants to die. But the for-profit health care industry has taken on a rather ghoulish cast over here. It is useful to study the history of the Third Reich -- the genocide did not start with Jews. It started with the mentally retarded and the elderly, who were described as "useless eaters" -- but not to the public. For public consumption, the Nazis depicted themselves as the most compassionate humanitarians you ever met, concerned only with relieving the suffering of the serious ill.

 

[oggbashan]

The Liverpool Care Pathway is now discredited and should NOT be used.

Those who designed it meant well for a very few patients. But it is a horrible example of what organisations can do if they oversell success stories and apply that successful solution without reading the small print and the warning messages.

Another more widespread example in the UK is 'Care in the Community' for mental health problems. It was pioneered in Kent where there were far too many people long term resident in Mental Hospitals. Care in the Community was far better for most patients with stable conditions and could produce a much better quality of life.

BUT - there were caveats. It was NOT appropriate for ALL resident patients. Some still needed full time supervision in a managed environment. The warnings in the report that advocated Care in the Community were "It isn't necessarily cheaper. It can be, but it could also be more expensive. It is better for many patients but not for the accountants. There must be emergency places available for people in the community who have a crisis." Those warnings were ignored when Care in the Community closed Mental Hospitals across the country.

Funding for Mental Health and for Care in the Community has consistently underestimated demand.