In the early 20th century the average person lived into their early 40s. That meant that most people did not live long enough to need someone to care for them as they grew old and as they experienced the misfortunes of disease and decay. Doctors pursued the cure quest to keep people alive longer.

In the early days of organized medicine surgeons became the heroes and they would cure by cutting. Although medicine has evolved and become more sophisticated, the models for reimbursement are mostly based on the surgical model as the most worthy of the most money.

One would think that as health care systems evolve they would recognize the need to address the problems of an aging population and give quality of life just as much, if not more, importance than quantity of life.

Yet here we are in the 21st century and, as life expectancy is rising every year, not enough is being done to address the need to care for people as they age. Insurance companies still pay more to doctors who do more procedures, more cutting and more repairing while sixty percent of health care dollars continue to be spent on hospital care.

It seems as though we are still living in the early 20th century when it comes to health care priorities and that is creating a huge problem for too many of us. Most people would prefer to age in place in their own home and, although nursing homes and different levels of care homes offer excellent care, they are often not the best option for aging people.


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I have been hearing the agonizing stories for decades of people who are trying to care for loved ones at home who find they cannot afford to do so, either because of cost or time or usually both. There are state and federal programs that provide that kind of support but they generally are available only to people who fall into the low income Medicaid category.

What happens to the rest of the population who work hard, have a few assets and try to be productive members of society when a spouse of parent needs 24 hour care? The options are difficult to face.

In Vermont it costs about $3000 a month for a person to live at an assisted living facility if they are not Medicaid eligible. That figure can vary a lot, depending on the facility and its location. Families often have to use up retirement savings and sell off homes in order to afford such care. Once they are at the poverty level of income and assets, then their care may be paid for by Medicaid.

Nursing home level of care can often cost $100,000 a year and often more, depending on the facility and location. That is a chunk of change that very few people can afford. That means that not only the person who needs the care, but many other family members, may be impacted financially to provide care in a nursing home.

If a family wants to care for someone at home they may be eligible for some program support, but that is usually income dependent. Working middle class families have to make tremendous sacrifices to care for someone at home. If they work they may need to hire private caregivers at $15 to $25 an hour.

All of this raises the question of the priorities of our health care system. Should we be spending more on chronic care? That would mean that insurance companies and federal and state programs would have to change their rules? There has been talk for years among health care professionals about the skewed reimbursement system and that is slowly beginning to change. But we need to have a broader public discussion about how we care for people as they age and as they encounter the problems that result from longevity.

We need to hear more stories from caregivers struggling to meet the needs of family while they care for a child, spouse or parent at home. Until the pain and suffering of these noble people who sacrifice their own lives on a daily basis is made public, we will never have the spark we need to figure out how to move away from a system that only allows the wealthy to have the care they need.

Richard Davis is a registered nurse and long-time health care advocate. He writes from Guilford and welcomes comments at rbdav@comcast.net.