Palliative care usually includes a lot of pain medications such as morphine drips or serious opiates.
That could be a show-stopper in the DR.
I had a Hospice/Home Care for many years. We also had several infusion pharmacies so we could control drug regimines professionally with infusion pumps, clear chain-of-possession, etc. Those procedures are a pipe dream in a country where red lights are suggestions and senior care centers are few and far between. Are Advanced Directives even a thang here?
It's a nice idea, but I'm not so sure the time is right in the DR. I suspect many die in pain.
That said, if I had $20-30 million, I'd bring correct home care/hospice/senior care to the DR properly. I wouldn't care about a profitable business model. I'd cut some deals with the state and private ARS's. Cost reimbursed, like Hospice & Medicare home care used to be.
The best suggestion I could make is to have a serious sit-down with a group of forward-thinking family and specialty physician in the DR and come to some agreement about coordinated palliative care if and when necessary.
Not the case at all. The drugs are readily available.
It's the coordination and care delivery, including high tech infusion pumps for non-institutional settings.
When my mother was in HOMS not long ago she was on an infusion pump. I asked the infusion team about the pump, if others were available with lock-outs, etc. She said that was the only pump the hospital used.
A non-institution pump is diffeent than a pump in a hospital. It's designed for the home environment without the complexity of a one-pump-for-everything institutional pump. I don't know the price today, but 20 years ago they were around $1000 for the least expensive model.
I asked the nurse how common PICC or central lines were (semi-permanent venous access devices) and she said very rare, that peripheral lines is what they used even for chronic patients (think end-stage AIDS.) I asked about poor veins, and she said it was a real problem for them occasionally, especially with elders.
It's nearly impossible to do palliative care with peripheral IV lines. Peripheral lines in a typical Dominican dust and microbe-rich home environment with caregivers with little education? You're asking for massive infections that can be worse for a compromised patioent that their base disease is!
Thank you for these EXCELLENT and what should be, eye opening posts for many.
Without getting too technical, what scares the hell out of me is your observation and statement above which I will partially requote here with my own emphasis:
"I asked the nurse how common PICC or central lines were (semi-permanent venous access devices) and she said VERY RARE, that peripheral lines is what they used even for chronic patients (think end-stage AIDS.) I asked about poor veins, and she said it was a real problem for them occasionally, especially with elders.
This is HOMS, . . . in Santiago, . . . which according to many here, is one of the BEST medical facilities in the ENTIRE COUNTRY.
Again, without getting too technical, ANYBODY in the medical field will know, and many with general knowledge of medical procedures should know, that the use of "Central Lines" should be a common and integral part of ANY competent hospital or health care facility in a "metropolitan" area and especially one that has this supposed "reputation" that HOMS in Santiago seems to enjoy with so many here.
Although it shouldn't surprise me, as I have personally seen how even the placement and care of "Peripheral IVs" is "questionable" in many "clinics/hospitals" throughout the country. Your first hand experience and eye-opening post serves as part of what is the true and stark reality of the of the level of the MAJORITY of medical care generally available here in the Dominican Republic. And the nurse's statement as a scathing indictment of HOMS' supposed "higer level" of available care. I now wonder, compared to what?
I know there will be posts of how "I had robotic prostate surgery" at HOMS and it was "equal to or better than the medical care I get in my home (first world) country" or how "my well-to-do neighbor who lives in the United States flew to the Dominican Republic and had her open heart surgery in "so-and-so" clinic in Santo Domingo and is fine and wouldn't think of having any procedures done "anywhere else." As well as many others here who have had "positive" personal experiences. These are nice, wonderful stories, but they are anecdotal and certainly not a representation of what is generally and easily available to the average person living in the Dominican Republic.
The areas of "Elder Care" certainly overlap, and Palliative Care (Hospice), Home Care, Institutionalized Care, Senior Care, End of Life Care, etc. are not mutually exclusive and share modalities of medical care common to all of them. Just one example mentioned in this thread, the issue of effective, efficient and consistent pain management alone, generally available here in the Dominican Republic, fails across a wide spectrum of medical care from dentistry through trauma medicine, and obviously the care available here during the "Final Stages of Life". Or actually the care NOT available here, as the quoted study indicates. And what might be even more alarming is the ultimate finding of that particular study that "The DR was ranked the WORST country for palliative care in the 2015 Quality of Death Index." The worst.
"End of Life Care", whether administered within the home or an institutional setting can be a fairly complex endeavor depending on the patient''s specific concerns. The complexities can involve quick access to qualified doctors, not just geriatric specialists but specialists from a broad spectrum of medical fields, as well as a diversity of medications and medical equipment way too numerous to mention. Without getting specific, I have to wonder if those absolute necessities are available on a general basis here in the Dominican Republic, or for some more specialized concerns, even at all in this country. Based on what I have seen, and objective observations such as "Cobraboy's" posts above, I doubt it.
It is comforting to have seen Dominican families generally caring for their elder members towards the end of their liives in a home setting. The "patient" obviously "feels" better, surrounded by family and friends to comfort them during their later years. I have seen it myself numerous times over the years and depending on a patient's needs was quite often adequate. But I have all too often seen the suffering of the elderly, not due to any lack of comfort or care delivered by their immediate friends or family living with them, but by lack of availability to the basic needs of the geriatric patient. It can be heartbreaking.
Many like to point out how the "culture" here is to take care of their elder family members at home. As posted here:
"They prefer to not send their relative to the hospital for care unless absolutely necessary." Well, perhaps it is not as simple as they "prefer" not to. Perhaps the overwhelming majority simply have no choice.
