No matter which book on social welfare, there will be mention of Europe's human rights social welfare countries such as Denmark, Sweden and other countries, there are no so-called long-term bed-rest elderly. I couldn't help but wonder about the situation in other countries, so in the Society's invitation speech, I asked several doctors from the United Kingdom, the United States, and Australia, and their answer was: in our country, there are no elderly people lying in bed.
In contrast, what about the geriatric hospital in Japan? Needless to say, there are countless elderly people who have been lying in bed for years, unable to move, and who are taking central intravenous injections or enteral nutrition. Inconceivably, Japan's medical standards are by no means low, or even more advanced than the rest of the world.
Why are there no old people in bed in other countries?
I found the answer in Sweden. In 2007, my wife, a fellow physician specializing in disability medicine, was introduced by Dr. Tuckman to a hospital and geriatric care facility on the outskirts of Stockholm. As we had expected, there was not even an old man who had a long berth in the institutions. Not only that, nor did any elderly patient use gastrostomy or enteral nutrition.
The reason is that, in the general perception of the Europe and America, it is natural for older people to lose their appetite when they arrive at the end of their lives, using artificial supplements such as enteral nutrition or drip nutrition to prolong the lives of older people. In other words, interference in the natural development of others is seen as a violation of human rights and ethics, but also as ill-treatment of the elderly.
Local people are not given enteral nutrition or drip when they begin to be unable to eat. Even if an infection causes pneumonia, they will not take antibiotics, but only take medication internally. Of course, there is no need to tie the hands and feet of the patient.
In a single-cut way, most patients die naturally before they enter an unconscious long-lying state, a society that does not produce long-term bed-rest patients.
Why isn't there an old man in Europe and America who's been sick in bed all the year round?
Europe and America is better, or Japan is better?
The terminal medical concept of the elderly, Europe and America is better, or Japan is better, no one can determine. However, in some cases, the joints were all twisted and rigid, tying the hands of the patients so as not to allow the catheters of the gastrostomy to be crooked. It is hard to feel the dignity they deserve as human beings.
My wife and I have left written documents that clearly express our reluctance to accept extended medical treatment for various kinds of artificial nutrition, such as gastrostomy, when we enter the stage when we are unable to eat during the final period. Not only that, but also to our children again and again. Don't let us suffer from ineffective medical treatment because of our own personal interests.
Compared with the natural way of dying abroad, it is strange to think that Japanese elderly people, in the state of being unconscious, use drip drops or enteral nutrition to keep the body alive.
Since it was discovered by accident in Sweden, local seniors will not use drops or enteral nutrition at the end of their lives, in order to use their own eyes to confirm the real situation in foreign countries. Our couple set foot on a trip to local end-of-life medical care in various countries.
Sweden. Stockholm-Life goes on to enjoy life.
Before starting, I would like to give you a closer look at the opportunity to launch this series of trips, namely, the elderly care facility in Stockholm, Sweden, which was mentioned earlier. In 2007, I went to Sweden with my husband. The real purpose of our trip is to attend the European Society of respirators first and then to visit the Swedish Institute of Mental retardation and care institutions and internships at the end of the trip. The purpose of this trip is to attend the European Society of artificial respirators and to visit the Swedish Institute for Mental retardation.
In Stockholm, Dr. Annika Tuckman, who had previously met in Japan, introduced us to a number of disability specialist medical and care facilities. Dr. Anica Tuckman, a specialist in geriatrics, was the first memory therapy authority to open a memory therapy department in Sweden in 1987.
Home for the elderly with early onset dementia-STOCKSAND GARDEN
At the time, 24 patients were admitted to a home for early-onset mental retardation. The number of caregivers is one, and doctors visit once a week.
Since its founding two years ago, six patients have died here. During the year, three patients were transferred to hospital due to inhalation choking, but all returned to nursing homes within a short period of time and died in a familiar warm environment. Dementia is a disease that leads to death at the end of the day, but even if the patient cannot eat, the family will not use drip or enteral nutrition to supply it artificially.
The daily life of the old people's home is very important for walking, so there is a large courtyard enclosed by hedges, with tables and chairs in the courtyard. People who live enjoy their lives, and there are often social workers or family members here to celebrate or party for hospitalized patients.
At the invitation of the hospital, we stayed for dinner with the inpatients. In Sweden, where fried herring chops are sprinkled with thick cream white sauce, hot potatoes, shredded carrots, etc., the meal is surprisingly simple and plain. But potatoes are sweet and, to be honest, taste better than the potatoes we both live in Hokkaido.
And what is most surprising is that beer was brought out after the meal. Light-flavoured beer with a concentration of only 2.5% alcohol, as long as there is no alcoholism, it does not matter to drink every day. In Japan, it is impossible to allow beer to be served daily to young patients with early-onset dementia.
It seems that Swedes' drinking habits are also fully involved in the treatment of dementia, and the institution is in the greatest possible range to minimize the risk of deprivation of pleasure from the patient due to the pain of the illness. Live to enjoy, death to be crisp, see here, people can not help but feel Europe and Japan a very different mode of thinking.
A country where the mentally retarded can also walk freely.
In addition to enjoying the fine food and wine of life, people who stay in the Swedish care institution for the elderly have valuable freedoms in addition to being able to enjoy food and wine in their lives.
Since the mentally retarded will get lost, there will be a caretaker on the side of the walk to avoid accidents. An 80-year-old woman with mental retardation known at the institution walks regularly every day, but stubbornly refuses to take care of her.
She would break the window if she tried to stop her from going out alone, so after a meeting with her family, the agency decided to let her carry a mobile phone with satellite positioning, allowing her to walk alone for two hours a day. In Japan, patients with mental retardation are not allowed to take a walk alone, except for those with hard bodies and clear brains. In the event of an accident, the institution will be sued for mismanagement.
In 2007, a mentally retarded male patient (then 91 years old), whose family members and nurses were so tired that they did not pay attention, went out to act alone and died accidentally in a flat crossing accident. Jr East Sea Railway Company told his family that they were compensated. Then there was a serious issue. The 91-year-old's wife was eventually ordered to pay compensation to JR East China Sea Railway because first, family members at the second trial all agreed to care for the misdemeanor.
If the Supreme Court decides the same, there is no doubt that mentally retarded people across Japan will face the fate of being completely confined to their homes. How could that be?! Damages such as those caused by the mentally retarded should not be compensated by their families, and the victims (in this case, JR East Sea Railway) should seek compensation from the social compensation system.
In addition to going out, Japan has many other restrictions on the movement of the elderly. Some hospitals, for example, bind their bodies or hands and feet to bedbars with cloth strips when they encounter severe physical movements in long-term bed-rest patients.
Hospitals often have this explanation: if your feet are stuck in the bed column when you move, it may break, and the safety of the patient is a priority. Swedish nationals, by contrast, are willing to take risks in exchange for fundamental freedoms. The difference between nationality and social concept is also reflected in the medical treatment of the elderly.
Health and well-being of the elderly in Sweden
Sweden introduced health care and well-being reforms in 1992. This is because the entire social system is facing the aging and financial crisis, social security fiscal tight relationship. The aim of the reform is to eliminate the universalization of hospitalization and to improve the quality of life of the elderly.
The reform of health care and well-being ultimately divided medical care into the responsibility of the government, while social welfare institutions were entrusted to municipalities, townships and towns. At that time, about 540 long-term care institutions were transformed into care homes, which were converted into local cities and townships. The town system is responsible for the management and operation.
When the treatment of the patients in the hospital came to an end, local municipalities, townships and townships had to find appropriate institutions for the patients as soon as possible, because when the patients were delayed from discharge, starting from the fifth day, the medical expenses must be stipulated by the local municipalities and townships. The town hall is burdened. In this way, local cities, townships and townships will naturally accelerate the pace of discharge arrangements for patients.
In addition, the hospital stay is much shorter than in Japan, about five days of myocardial infarction, breast cancer or fracture will be discharged from hospital on the day of surgery. But as a result, a lot of incomplete rehabilitation and fall into wheelchair life, check-up and other problems, care homes in the invisible also forced to bear the original hospital responsibility for the scope. Dr. Tuckman said seriously.
In Sweden, care for older people in institutions is usually conducted in the same institution. Unlike Japan, depending on the condition of the disease, transferred to other institutions or hospitals. For example, in the event of pneumonia, the patient usually only takes the medicine prescribed by the resident physician in the hospital. Depending on the severity of the symptoms, patients who have a chance to heal in Japanese practice are likely not to survive in Europe and America's nursing home.
But little and no too many medical environments, which depend on the country's own health-care system, are ideal for all, and it can be said to be even more difficult to achieve an ideal health care. Health care for older people in Sweden may be too little, but it also has its advantages.
Sweden, for example, is unlikely to see a Japanese-bound patient in a hospital bed. At the end of life, no longer eat people, hospitals will not use drops or through intestinal nutrition intervention, patients can eat, drink the amount of primarily, let life in accordance with the pace of nature gradually withered back. And China (Japan) can be said to be the control group.
When the occupant dies, the doctor does not need to rush to the scene. The remains will be kept in a nursing home for two to three days, during which time the doctor will be able to confirm that a certificate of death has been issued.
Originally, I thought that Sweden did not do extended medical treatment, so the average life expectancy would be shorter than that of Japan. After reading the census data, it was found that in 2012, the average life expectancy in Sweden was 81.7 years, and in Japan it was 83.1 years. Unexpectedly, the average life expectancy was 81.7 years in Sweden and 83.1 years in Japan. The gap is far from as large as it was supposed to be.
In other words, Japan's life span has only been extended by one and a half years after all stages of heavy end-of-life medical and life-prolonging measures.
We always think of Sweden as a society with a high social welfare environment, but it doesn't seem to be common to the elderly. In an ageing society, the care budget of the older population is constantly being cut. The reason is that the living environment and health of the elderly are not the top priorities of the country.
Through an elderly home, the hospital is celebrating the birthday of a 96-year-old female occupant. Dr. Tuckman said at the time: in Sweden, you have to be sick enough to live in a home or a nursing home, "Dr. Tuckman said at the time." To be honest, the patient arrived too early. If people of this class can check in, the homes will soon be full.
Under the eligibility system, Sweden's Association of families with Mental retardation has lambasted quite discontentedly that people with mental retardation will almost never be admitted to public care institutions, which is an excessive burden for the families of patients with mental retardation at home.
I thought this was a country of high social welfare, surprising. In fact, the proportion of people over the age of 80 in care homes has fallen considerably, from 28 percent in 1980 to 14 percent in 2014. In addition to social welfare budget cuts, in order to live in a familiar environment, the trend of care for the elderly has shifted from moving to institutions to home-based care.
However, it is still an indisputable fact that the community needs to take care of institutions and that many elderly people are eager to receive care services.
There are many elderly care institutions in Hokkaido where our couple live. In addition to special care homes for the elderly, mentally retarded patients are eligible for admission as long as they are not seriously ill. Unexpectedly, the social welfare of the elderly in Japan is much more advanced (of course, many cities in Japan do not have such well-developed resources).
During apprenticeship in Stockholm in 2007, mentally retarded care institutions were rarely single-family buildings, mostly in a single corner of a large care facility. Because the economic efficiency of a single building is too poor.
Japan's aging society is growing rapidly, the elderly population is expanding, and the budget for health care and well-being can be expected. While the budget is still available to improve the health and well-being of the elderly, it is necessary to speed up the development of future solutions.
Extended reading: pension is an unavoidable problem for everyone, and it is worth pondering.
Have you ever wondered how your old life will be when you get old? Stay at home and be looked after by children or babysitters; public homes can afford to live but may not be in good condition; private homes are nice but expensive.
Every old-age way is real, and when one day we are too old to move and can't cook and wash our own clothes, we all have to face the question of how to support ourselves.
Of course, friends do not need to worry too much, after all, happy life today is the most important day!
Old and dead, which is worse?
If old and dead, if compare, which kind of ending is more terrible? I thought, death, isn't it scary? It's not scary, because since there are humans on the earth, there have been nearly 100 billion people. Besides, most of the people who can walk on the street can't survive for more than a hundred years. They all have to go to heaven, and the people who can walk in front of the world will always accompany you and me to heaven one day. What's so terrible about it?
Normal life to death, in a twinkling of a second. Death is inevitable, death is a kind of relief. Old, it is terrible, especially old enough to take care of yourself, when all you are young and strong, it is easy to take care of yourself, eat, drink, and sleep, and after all the ability to maintain your survival has been lost, then only then is that terrible, terrible enough to what extent? Fear to life is better than death; terrible to time is the devil who torments you, terrible enough not to have the basic dignity of being a man.
You can't do anything, you're panicked all day, and you rely on the gift of pity and rebuke. If unfortunately run into unfilial children or cold-hearted babysitter, it will be life-long despair like a knife. Therefore, in the face of everyone's ultimate, I can not help but issued a deep sigh: I am not afraid of death, I am afraid of old.
Who's gonna take care of you when you're old?
A recent social app article recommended by Zhou Yunwei, vice president of a Beijing company, is indeed thought-provoking.
Compared with a few years ago, when I read the sad songs of the Old Age written by the writer Qulan many times, it was another article that touched me. I suddenly realized that if there was no accident, when I was too old to take care of myself, I could not afford to take care of myself when I was not surprised that kind of normal age was too old to be able to take care of myself. Is it already a state of despair waiting for me, or could it involve you?
Why would you say that?
The writer Qulan said this:
No matter how handsome you are when you are young, how good-looking you are, how healthy your body is, but you are old, and you are normal old, you must go through a period of pain and hopelessness, in this period of pain and hopelessness. Everyone has to accept the care of others to survive.
So who's gonna take care of your old age? This could be your partner? Your child? The society provides the old-age institution and so on.
But what if your partner left before you did? Or your only child, because of work and career busy really can not take care of you, then what to do? Isolated and helpless, you can only face the old-age institutions.
Nursing home, can you afford it?
Just before I saw this recommended article, I still fantasized that I was still determined not to bother my children, and that I wanted to go to the time when the old-age institution was preparing to provide for the aged in the future. I saw the grim reality I was stunned about in the article: "when I started looking online for information on nursing homes, I found that in first-tier cities, public beds were limited, public beds were not in line for several years, and private fees were expensive." Bed fee, meal cost, nursing fee, 6000 yuan to start, medical expenses separately. The pension apartment with the background of international cooperation is as high as 10,000 yuan or more. "
"the nearest guest-style pension center is a Chinese, American, European, Korean, Japanese, Southeast Asian style room with an international hospital with a 36-square-meter standard room and a semi-self-care 5800 per month," he said. Non-self-care monthly 8600, do not include meals, if you need special care, there are one room and two rooms one room two options, up to more than 15000 yuan. This is ten times my mother's pension. "
The warmth of the family may eventually be ruined by the lack of money.
The article went on to say: "Mother silence for a moment, said that there are poor conditions in the home of the nursing home, only 1500 a month, the old warehouse changed." Or go to a more ecclesiastical nursing home. There was no reason for her hesitation, for she knew that the environment and the quality of life would not be comfortable. "
"then I calculated the cost of supporting her at home. If she can't take care of herself, then the cost of asking nursing workers will also be more than 5000. The nursing union will accompany the elderly, massage medicine, feed food, assist in urinating and urinating, and push the wheelchair out for a walk. And if the family is busy with work, then hire a babysitter to buy food, cooking, washing, laundry and floor, at least 3000 yuan. It's not cheaper than living in a nursing home, and it also provides room and board for caregivers and babysitters. "
What have I read from the last passage? Read a kind of future sorrow and despair. If my old man lives long and healthy until he can't take care of himself, I'm likely to encounter a similar situation. If my mother wants to live at home or in a nursing home, I won't have the financial means to support myself. This kind of Chinese-style old-age care, after all, its "family warmth, ultimately destroyed in the lack of money."
Being a nursing slave is a desperate effort
When did I start thinking about this pension? I've been thinking about this since I was about 45 years old. This is very much like before I was unmarried, in order to find a loving and righteous woman to stay together for a lifetime, I also made relevant psychological and intellectual preparations.
I began to ponder over the problem of old age because after I had read the Sorrows of the elderly, I also made some material and psychological preparations for it, because when people were approaching their old age, they could not help but think about it.
However, the current reality of cruelty lies in: in order to get married, young people can have a house, had to borrow to buy a house to become a lifetime of "house slaves"; The old man who is busy working all his life is not easy to start thinking about his or her own affairs, he has to take care of the next generation at the request of the child and become a child slave.
Now, while you're still working hard to look after the next generation, one thing is worse than the next, what advocates mortgage housing to protect against aging, and what else will continue to pay for health insurance after retirement to receive a pension? When it comes to you, you suddenly discover that your future pension costs, like house and graveyard price increases, have made it impossible for you to use your existing pension and go to the public or private pension institutions to pay high pension costs.
"to be an old-age slave is a desperate effort." How am I supposed to sniff out that old-age care is more terrifying than getting a terminal disease to the hospital and letting you lose your family?