Although most Americans aspire to healthy aging, they will probably grow old and accumulate diseases for a long time before dying. The author lays out the framework of an approach to reform for the health care system so that people can "live well while very sick and dying." She discusses three trajectories of decline — long maintenance of good function with a few weeks of rapid decline (e.g., as with most cancers); slow decline in physical capacity punctuated by serious exacerbations, with death coming rather seriously (e.g., as with heart failure); and long-term dwindling of function, needing years of personal care — and shows how society could build care arrangements based on each trajectory. Finally, she discusses the shape of a reform agenda that might make the last part of lift as meaningful as possible at a cost the community can sustain.
Reprinted with permission from Hastings Center Report Special Report, Vol. 35, No. 6, Nov.-Dec. 2005, pp. S14-S18, © 2005 The Hastings Center.
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