The Power of Geriatric Medicine: How My Dad's Final Chapter Changed My Career Path
My father’s name was Steele, and luckily for all those who knew him, he lived up to that name. In all the best ways, the man was as solid, reliable, and as strong as steel.
My dad was a successful engineer who understood how things work right, and he could design all manner of things in that way – I’m not just talking about mechanical pieces. It was how he lived his life.
He and my mom had nine children, and he made it a point to be physically healthy. This is, I believe, because the man who’d been his greatest influence, his uncle Mike, had ended up dying in a nursing home, curled up in a fetal position, oblivious to the world around him. My dad felt like he’d failed Uncle Mike in letting his last days be like that, and my dad’s biggest fear was ending up the same way.
So he played handball every day until he was in his mid-50s; he ate a Pritikin-like diet before that was even a thing. He suffered from heart failure, but he had all his pills lined up everyday, so he’d never forget. And even after my mom died, he got into his 90s still driving and living on three acres of his own.
His body finally started to slow down, but he still loved socializing. One day, when he was 95 and walking into his lunch spot, he fell and broke his hip. From there his story fit a familiar pattern. He went to surgery. My siblings and I traveled to Texas to be there with him.
After surgery, his heart failure exacerbated, but the surgeon didn’t address it and immediately referred my dad for inpatient rehab. Sadly, my father couldn’t do everything they asked because of the swelling that made his legs twice their normal size. So they kicked him out. I don’t blame them; they were doing the best they could to help patients and were following their guidelines. But, they sent him to a nursing home late on a Friday night, where he languished in bed for two days without seeing a doctor. He suffered so much in that state that he ended up in the ER.
My dad’s cognition got worse; he fell again, and he needed several more surgeries. At this point the worst elements of our healthcare system kicked in. Facilities shuttled him out to less costly settings as fast as they could because he didn’t meet someone’s criteria for staying in a more expensive one. Again, it wasn’t the people; it was the system. Every institution had its own competing financial incentives, and sadly, those incentives left precious little room for my dad’s overall welfare.
Thank God my sister and I both worked in the industry, because that meant we actually knew enough to fight back. Like when a facility tried to discharge him late at night or on a weekend, we’d ask to see the discharge plans to show that they could vouch for the patient’s safety. Often there was no meaningful plan.
For the next two years, we never left him alone again, because we knew we had to compensate for the healthcare system’s failures. We took turns taking care of him, and we used all our vacation time – gladly.
A year after that first surgery, my dad was suffering, intensely. Everything he did was excruciating. My sister convinced him to choose hospice, which was something he’d strongly resisted. Like many people, he thought it was a death sentence.
In fact, it gave him new life and a fantastic final chapter. And little did I know at first, but his hospice team was actually made up of geriatric specialists who understood how aging bodies like my dad’s worked. And at the center of the team was a genuine physician quarterback who could see the whole picture and could have the right clinical conversations to navigate on my dad’s behalf. Unlike my siblings and me, this geriatric specialist could advocate with clinical expertise.
Just as importantly, this clinical team was operating in a value-based care framework, where they could make spending decisions with an eye to my dad’s overall wellbeing, not just the task in front of them.
These things, all together, made a huge difference.
Dad’s strength built slowly, and within months he was lifting his legs as we rolled in his wheelchair to the grocery store for Saturday samples and to visit with the clerks. Even at his advanced age, he brought our family together and taught us things that gave his life meaning, and still give our lives meaning.
He died peacefully after a good breakfast in his own apartment when he was 97, without ever going to the hospital again.
But here’s the thing: the only way this could happen was because my siblings and I compensated for this system that was working in silos, too often against his best interests.
At the time, I was a healthcare product designer, but it was the first time I really saw how our system’s payment incentives can miss the bigger picture, and how geriatric care can be a game-changer.
This is why I’m here.
My whole career had been about removing waste from the healthcare system, and this was waste of both resources and human potential. But my understanding of what we need to do suddenly became crystal clear. That’s what we’re designing at Welcome Health: a system where every incentive is pointed toward understanding and serving the patient’s goals – full stop.
We need to spread the word that this type of care is available for seniors and their families, so we know to ask for it when it becomes time. Had my family had that kind of support and know-how from my dad’s medical practitioner, we wouldn’t have had to compensate for the contradictions and complexities of the health care system. We could have just been his loving children, visiting him without having to play a medical role.
How many of us have found ourselves thinking “what can I do to make this better for the patients and families my organization serves?”
So consider this is an invitation of sorts to healthcare executives, and all others. Let’s not wait until we; personally confront a situation like this to understand the need to find a better way. Let’s spread the word that great geriatric care is already available. Let’s create the demand for it. Let’s help people know what to ask for. Because it’s out there – not just from Welcome Health, but from other places too. Our parents deserve it, and we deserve it.
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