A Necessary Conversation

Americans Ill-Prepared for Death

Millions of Americans are working at a job most did not apply for and are often unprepared to take up; they are caregivers. Whether it is a spouse or a parent who is very ill or elderly, lives are changed in ways never imagined as they try to give the best care to their loved one. KCET's "Your Turn to Care" takes a close look at the challenges and stresses of caregiving while offering useful guidance and information that can help smooth the road.

The final episode in the 4-part series features the caregiving journey of award winning columnist and author Steve Lopez of the Los Angeles Times. Lopez recounts his family's story of caring for his ill father. He shares his personal experiences and what he learned about the high cost of health care and the obstacles to dying with dignity. Steve began writing columns about his father and his family's struggles to care for him in 2011 and continues to explore the topic in a number of venues.

"Your Turn to Care" caught up with Lopez again as he moderated a panel at the LA Times Festival of Books called "Final Choices: Extending Life or Prolonging Death?" He and the panelists decried our culture's avoidance of discussing and planning for the one thing we all will go through: death. This "head in the sand" stance leaves us ill-prepared for the high personal, and financial costs of growing old. It also results in a lack of a coordinated effort by the health care system and public policy to meet the expanding needs of a growing elderly population. The interest in the topic was apparent, with the large room nearly filled to capacity.

Neil Wenger, M.D. began by describing our medical system as one "is very good at keeping patients in adverse health states," but this is not the best use of our resources. He advised moving the discussion away from the medical procedures available to keep someone alive to what is needed to provide the quality of life a patient wants. Panelist and gerontologist Susan Enguidanos shared her recent research conducted with terminally ill patients. Her results suggest that for many participation in palliative care programs provide increased medical and emotional satisfaction at a more affordable price, by preventing re-hospitalization.

A key part of addressing the wishes of the patient is the creation and implementation of an Advance Health Care Directive specifying what medical procedures a person wants at different stages of their life/illness. Judy Citko, Executive Director of the Coalition for Compassionate Care for California (CCCC) recommended that everyone eighteen and older have an Advanced Directive and revisit it throughout their life.

Gene Dorio, M.D. received the loudest applause when Steve introduced him as "a doctor who makes house calls." Dr. Dorio emphasized the need to talk to your doctor and clearly describe your goals and choices for end of life treatment. He and Dr. Wenger, also highlighted the need for a Physicians Order for Life Sustaining Treatment (POLST) form. Similar to the Advanced Directive, it honors the patients' wishes for treatment, providing this information to medical personnel as the patient is transferred between health care settings.

Dr. Dorio emphasized seven key changes needed in order to meet the needs of America's aging population.


  1. All members of Congress 65 years and older must be required to go on Medicare
  2. Everyone must have the right to die at home
  3. Our health care system must encourage and provide incentives for house calls
  4. Medicare must be required to provide quality of life services; eye glasses, hearing aids, and dental care at no cost
  5. Seniors' fears of moving to nursing homes can and should be alleviated by staffing them with newly graduated medical doctors. Doctors who participate for a set number of years could have their student loans forgiven
  6. Create and fund more transitional services from hospital to home to prevent re-hospitalization.
  7. More and improved funding for senior community centers and services


Overall the panel was a call to action. If our health care system is to successfully address the needs of our aging population, major changes need to occur on both the macro and micro level. As Judy Citko put it, "the horse is out of the barn," the conversation has already begun, health care companies are re-evaluating how they deliver services, and the government/Medicaid is looking for ways to provide better care in a more targeted, and efficient manner. It is up to us, the consumers, to keep this moving forward.

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Funders
MetLife Foundation The Lippey Family Trust Gladyce L. Foster
California Community Foundation