Oscar Nod to Aging; End-of-Life Debate
1. OSCAR’S NOD TO AGING: Florida Documentary Gets Academy Award Nomination
2. GEN BEATLES NEWS: Stan Hinden’sSees Fourth Edition Released of How to Retire Happy; *** Grandaughter’s “Ammachi” Site Follows “Cantankerous” Elder in America
3. MEDIA “CURES” SERVE (OR DISSERVE) END-OF-LIFE DEBATE: San Jose Mercury News; *** Dr. Emanuel in New York Times; ***Laughable/Regrettable “Intelligence Squared”
1. OSCAR’S NOD TO AGING
Florida Documentary Gets Academy Award Nomination: The highly touted French drama, Amour, won’t be Oscar’s only nod to gray hair at this year’s Academy Awards. San Francisco-based filmmaker Sari Gilman got the news of her nomination in the Best Documentary Short category for Kings Point.
The half-hour program, to have its national TV premiere on HBO on March 11, is the directorial debut for the Primetime Emmy Award-winning editor. (Gilman has also produced audio segments for NPR’s All Things Considered.)
In 2012, Kings Point won the Grand Jury Prize Sterling Award for Best Short Film at the AFI-Discovery Channel Silverdocs Documentary Festival 2012, and was selected Best Short Documentary at the Cincinnati Film Festival. The film’s next stop on the festival circuit will be at the Atlanta Jewish Film Festival, to be held from Jan. 30 to Feb. 20.
Gilman tells the stories of five seniors living in a South Florida retirement resort–men and women who arrived there years before and now” find themselves grappling with love, loss, and the changing nature of relationships,” says a website description of the film. Kings Point “explores the dynamic tension between living and aging — between our desire for independence and our need for community — and underscores our powerful ambivalence toward growing old.” The production asks such questions as, Who do we want taking care of us when we are no longer able to care for ourselves?”
She is currently editing an ITVS-funded film about the campaign against Proposition 8 in California, directed by Christie Herring. Gilman edited Christy Turlington Burns’ documentary, No Woman No Cry, which premiered at the Tribeca Film Festival and aired on OWN.
For more information about Kings Point or to set up an interview with Gilman, contact Adam Segal at (301) 593-4247 (his Washington, D.C. office), (212) 618-6358 in New York, or on his cell at (202) 422-4673. His e-mail is adam@the2050group.com; website: www.the2050group.com.
2. AGE BEATLES NEWS
*** How to Retire Happy just made author Stan Hinden happy with the book’s fourth revised edition. McGraw Hill first published the volume, subtitled The 12 Most Important Decisions You Must Make Before You Retire, in 2001. The newest edition contains relevant Social Security and Medicare numbers for 2013 along with other updates.
Hinden, who was a Washington Post financial reporter for 20 years, then wrote a Pulitzer Prize-nominated column on retirement for the paper until 2003, says he added a not-so-happy aspect to this new edition-the story of his wife’s illness.
Hinden e-mailed GBO, “My wife, Sara, and I have been married for 59 years. About five years ago, she developed Alzheimer’s disease and aphasia, and she now lives in a group home where she gets 24-hour care. My book was always about my retirement and her retirement. When it came time to write the fourth edition, I needed to tell my readers how a couple’s pleasant, well-organized retirement can be totally thrown off track by the illness of a spouse. Because of my experience, I have tried to tell readers what they can expect if the same sort of thing happens to them. I hope that what I have written will help some people anticipate the type of challenges that I faced.”
Currently, Hinden writes a weekly column for AARP Bulletin Online. (Scroll down until you see his photo and a link to the column called “Social Security Mailbox.”) You can also find more about him at www.stanhinden.com.
*** Grandaughter’s “Ammachi” Site Follows “Cantankerous” Elder in America: “Life coach, storyteller and curious granddaughter” Julie Varughese started photographing her ammachi (pron: ah-MAH-chee, or “grandmother” in Malayalam, one of 22 official languages in India) in 2008, and has decided to start 2013 with a Kickstarter campaign to produce a photo and video documentary called The Ammachi Project.
Her aim, by depicting “how my cantankerous grandmother came to be and ended up in a nursing home” in the Bronx, is to explore the trend in eldercare facilities “popping up throughout the United States that are dedicated to the aging South Asian community. (South Asia encompasses Bangladesh, Bhutan, India, the Maldives, Nepal, Pakistan and Sri Lanka.)”
Varughese started the project over four years ago shortly after buying her first dSLR camera. “What started as casual picture-making quickly morphed into a project.” The video documentary, now in it is early stages, “will examine how South Asian diasporic culture and evolving family dynamics have altered senior care. Ammachi was raised in a traditional culture. She plans to examine the trend in the United States of developing senior facilities dedicated to South Asians in the United States. She will also delve into what it means “when a woman from a traditional South Asian culture — where elders are cared for by relatives until death — ends up in a nursing home because of her cantankerous personality?”
As the elder population becomes more diverse in the U.S. (projected to double by 2050 to over four in 10 people here ages 65-plus), Varughese’s project might well help illuminate America’s accelerating culture clash. Contact her at julie@theammachiproject.com.
3. MEDIA “CURES” THAT SERVE (OR DISSERVE) END-OF-LIFE DEBATE
By Paul Kleyman
The current spate of media on the cost of end-of-life care might make one think we really did fall off the fiscal cliff. National debate on the subject in recent years has ranged from attacking as “death panels” the 2010 proposals for Medicare to cover a doctor’s talk with patients about their preferences at life’s end, to endless reversion to the national budget burden in the last year of life. Discussion of how best to provide such care is too often disserved, as heard in one national broadcast at the start of 2013, by hysterical claims or those with ideo-political agendas. But, also, there are signs of new life in the media coverage.
The news was welcome last week that the National Institute Of Medicine (IOM) is assembling a panel of experts to recommend improvements in the disjointed and dismaying approach to end-of-life care in the United States. According to Lisa Krieger in the San Jose Mercury News (Jan. 10) the panel is charged with recommending changes in federal policy, financing and hospital practices that will bring care into line with, as IOM put it, ” individual values and preferences to promote high-quality, cost-effective care at the end of life.”
*** Reporting America’s Disconnected Nightmare
The current disconnect between this nation’s highly institutionalized approach to mortality and people’s desire for dignity and comfort a times of at times of serious or terminal illness has been highlighted by series of surveys and papers by the California Health Care Foundation about the public’s understanding of palliative care. Their surveys clear show that people don’t want to be a burden on their loved ones and do want appropriate medical interventions provided as needed, but high tech invasions kept at a minimum rather than as a systematic default.
The rather oblique term “palliative” care is a broad locution for well-managed and comforting treatment of patients. Palliative care may include “hospice” care, which is offered only in the very late stages of terminal illness, such as through Medicare. But palliative care, provided in close consultation with patients and their caregivers to extremely ill people without denying them medical interventions, has been shown to actually lengthen many patients’ lives in some cases. More assurance and sense of control go a long way to dissipate debilitating fear and depression.
Like so many journalists Krieger became aware of the discontinuity of U.S. end-of-life care approach through her own close encounter with the system. In mid-2011, her father became very ill and ended up in the nightmare of U.S. health care. Krieger explained during a panel held last week (Jan. 10) by the Northern California chapters of the Association of Health Care Journalists and the Society of Professional Journalists that the article’s response was so large-over 240 in the first few of hours– that she and her editors decided to develop a series.
Krieger, a veteran health and science writer, spend almost a year on what became a nine-part series titled The Cost of Dying, which earned a 2012 Excellence in Journalism award from SPJ NorCal. She concluded the series on Dec. 30, 2012, with “Discovering a Better Way for Final Days”–a prescription of eight “cures” for the system. She gleaned that prescription from “our yearlong examination of the emotional and financial cost of Dying. It is not a drug or a device, a test or therapy. It is a different way of organizing our ending — so that we live our last days better and pass more gently.”
Among other recent articles is one by my New America Media colleague Viji Sundaram, on this issue is the recent article on the burdensome cost of the current system-and ethnic cultural challenges–for terminal-care patients, As End Nears, Cancer Patient Struggles with Cost of Long-Term Care .
*** Dr. Emanuel’s NYT Script
Soon after Krieger concluded her series, New York Times op-ed columnist Ezekiel J. Emanuel, MD, former White House advisor (and brother of Chicago Mayor, Rahm) posted Better, if Not Cheaper, Care (Jan. 3). In proposing four improvements to care at the end of life-“even if they won’t save money,” Emanuel challenged common misperceptions about the price of dying in the United States.
His piece begins, “It is conventional wisdom that end-of-life care is an increasingly huge proportion of health care spending. I’ve often heard it said that people spend more on health care in the year before they die than they do in the entire rest of their lives. If we don’t address these costs, the story goes, we can never control health care inflation. Wrong.”
The actual numbers, Emanuel explains, show that about 6 percent of Medicare patients who die annually do make up 27-30 percent of Medicare costs: 27 to 30. He goes one, “But this figure has not changed significantly in decades. And the total number of Americans, not just older people, who die every year — less than 1 percent of the population– account for much less of total health care spending, just 10 to 12 percent.
The more important issue is that just because we spend a lot on end-of-life care does not mean we can save a lot. We do know that costs for dying patients vary widely among hospitals, which suggests that we can do better. And yet no one can reliably say what specific changes would significantly lower costs. There is no body of well-conducted research studies that has proved how to save 5, 10, much less 20 percent.”
Emanuel continues, “Even if we can never save a dime, however, there are good reasons to think about changing end-of-life care practices. While end-of-life care has improved considerably over the last 30 years, many Americans still die in hospitals when they would rather die at home. Nearly 20 percent of deaths occur in an intensive care unit or immediately after discharge, and too many patients experience symptoms like pain that are controllable with appropriate palliative care.”
*** “Intelligence Squared” Flattens Debate
In what GBO found to be a flabbergasting example of national-media malpractice on this most sensitive of subjects, many public radio/TV stations around the country began the year with a rebroadcast of an October 2012 “Intelligence Squared” Oxford-style debate on the question of whether the United States should Ration End-of-Life Care.
“Intelligence Squared,” also shown on PBS stations and available online with a full transcript, frequently offers engaging, well-balanced and informative debates a many issues. Typically, four experts square off, two for and two against the proposition of the hour. The live audience is asked to vote at the beginning and then again at the end. The “winning” team is the one that swayed the most votes to its side.
Certainly, organizers of any debate can’t be faulted for selecting debaters for their provocative and original viewpoints-but in the context, one would hope, of an honest and well-framed representation of controversy at hand. It might, for instance, be fascinating and great for ratings to have Wayne LaPierre of the National Rifle Association argue in favor, say, of “no child left behind” policies, but his selections would hardly be representative of debate on the educational concerns involved.
But if a debate is miscast to begin with, the audience — as happened with this disputation–may never hear the primary discussions going on nationally and can even be pulled to support a slant many normally would not, if they’d heard the prevailing terms of discussion.
I waited at the start to hear who might be debating. Perhaps, on the con side they would have someone like Dr. Joanne Lynn, whom Bill Moyers interviewed over a decade ago for his four-program series on death with dignity, or Dr. Ira Byock, whom Krieger quotes in her series. On the pro-rationing side maybe a recognized combatant, such as Dan Callahan, author of Setting Limits. So many other choices.
But no. One of those speaking against the idea of rationing at the end or life on “Intelligence Squared” was Sally Pipes, president of a think tank called the Pacific Institute. She used much of her time to attack Obamacare (also the subject of her last book) and, more broadly, criticizing government bureaucrats.
Here inappropriate selection for this national panel became painfully evident at one point when the series moderator, ABC-TV’s John Donvan, had to admonish the audience– “Let’s — let’s show some respect to this.” The studio audience had just burst into laughter at one of Pipes’ remarks. Donvan had followed up on a Pipes comment that the British National Health Service says no to paying for some procedures that are not considered cost-effective or not effective enough to justify the cost. He asked, “Don’t insurance companies do that all the time?”
Pipes responded, “Yes, insurance companies make decisions based on actuarial evidence. Would you prefer the government to making decisions about what drugs and treatments you can’t, or would you prefer the private sector and insurance companies to make those decisions? I, personally, want insurance companies [audience laughter]. I prefer insurance companies.
Unbelievably to me, the other person opposing the idea of rationing care in life’s final frailty was attorney Ken Connor, founder of the Center for a Just Society. It was Connor who served as Counsel to Gov. Jeb Bush in Bush v. Schiavo.-the notorious case in which a young woman named Terri Schiavo was in a hospice in a persistent vegetative state for years following an accident.
When Schiavo’s husband and parents viscerally disagreed on whether to remover her from life-supporting technology, their legal maneuvers gained national attention and Gov. Bush, with Conner’s expertise, took a right-to-life stance aggravating, not illuminating or helping to resolve the issue. (Several years ago I wrote a piece based on an extensive discussion with the director of that hospice, whose father had died in the same bed as Schiavo would, and who described the insanity and death threats against nurses flamed by the politically fueled media “circus,” her word.)
On the broadcast those in favor of rationing were bioethicist Peter Singer, which was a Callahan-like choice and okay, and Dr. Arthur Kellermann, who holds the Paul O’Neill Alcoa Chair in Policy Analysis at the RAND Corporation.
The problem is not that these people didn’t make sometimes intelligent, even insightful observations. Kellermann is well regarded, and a bona fide expert on palliative care I know commented that he handled himself well in the debate “even though he doesn’t know much about it” (the subject).
Also, Connor was the only panelist to argue that the idea of rationing care in this country can’t be based on a claim of scarce resources when the U.S. spends vastly more on health care than other countries and could find significant savings for better care throughout the current system. But even the debate’s thoughtful moments were lost in the clamor of people talking past each other-even people supposedly placed on the same side at times.
Connor’s point about illusionary scarcity is apt. The framing of whether or not to ration health care, while sadly posed too often, automatically grounds any such discussion in the scarcity of resources and, inevitably, in public funding. That, as one knowledgeable friend comments, always backs the discussion into a conservative corner.
The “Intelligence Squared” blurb on this debate states, “The U.S. is expected to spend $2.8 trillion on health care in 2012. Medicare alone will cost taxpayers $590 billion, with over 25% going toward patients in their last year of life. If health care is a scarce resource, limited by its availability and our ability to pay for it, should government step in to ration care….” (See what Ezekiel Emanuel said earlier in this article.)
Journalists may well argue that this is fair framing. Perhaps, but as structured in this case, the forum failed dismally to enhance the needed national discussion. It wasn’t as disruptive as, say, “death panels,” but it was surely a missed opportunity in the usually intelligent realm of public radio.
Listeners to the “Intelligence Squared” program never heard such critical arguments as that far more than getting too much high tech care– as the late Pulitzer Prize-winning geriatrician Dr. Robert N. Butler often stressed–elders more commonly suffer in the U.S. from denial of treatment by health care providers who have had not geriatric training and assume a senior is ailing because he or she is simply old. The audience didn’t hear that although a great deal is spent in the final months of life, even today’s medicine often can’t tell who won’t get better within six months or a year. Ration care? To whom exactly, and when? Just think of the ups and downs of patients with congestive heart failure or advanced Alzheimer’s disease.
Those are the kinds of unexplored concerns in this program that might have gone to heart of what’s so difficult to grasp in the interface between our mortality and modern technology-and in the very human complexity that cries out for thoughtful articulation by very knowledgeable people on the topic and why they might disagree.
The unintelligent hour, which culminated in a significant audience swing toward support of the idea that the U.S. begin rationing care at the end of life-is merely one media production that will mostly recede into the shallows of the Internet. It remains for journalists like Lisa Keiger of the Mercury News to be alert to the need for thoughtful and compelling storytelling that can enlighten a confused public on this issue.
THE OPPS FILES! Thanks to Cleveland-based Eileen Beal for catching this editor at his paltry math skills.In the final GBO of 2012 (Dec. 29), I’d cited an article by social insurance authority Henry J. Aaron in which he noted that only 40 percent of babies born in 1900 lived to age 65. That is, a century ago, only six in 10 people born made it to 65, but today eight in 10 do so. It should have said that six in 10 people born did not make it to 65.