The choice is not ours to make anymore.

By Steve Moran

A few days ago I published an article titled “What Do You Want To Be When You Grow Up?” that was inspired by a keynote given by Atul Gawande at LeadingAge. Perhaps the most important point he made was that when we start really listening to residents, they do much much better.


It turns out when you talk to individuals who are in hospice, individuals who are dying, and give them choices — rather than just telling them what they need to do or rather what is going to be done to them — they do better and not just emotionally. Gawande made the point that there are 4 striking results that come from shutting up and listening to patients/residents:

  1. Individuals who were dying, who were listened to and given choices, reported significantly lower levels of suffering.

  2. Even though there was no particular effort to encourage these individuals to make lower cost choices, giving them choices resulted in lowering the per patient costs for similar diagnosis.

  3. They mostly chose to stop treatments earlier than the professionals would have (likely the primary reason for lower costs).

  4. Craziest of all — even though they chose to stop treatments earlier — they actually experience a 25% increase in longevity.  

This is crazy and counterintuitive, because, after al,l it only makes sense that the professionals know better what should be done . . . except they don’t. They don’t — and can’t know each individual’s history and how they react to specific kinds of treatments.   

A personal example: Many years ago, I was prescribed a “Z-pack” for a sinus infection. I tried it and it just plain didn’t work. Several months later I tried it again and had the same results. The literature, the studies, and the professionals, all said this was the right drug for certain infections. For unknown reasons, it just didn’t work for me . . . while other antibiotics did.   

What’s Our Role?

You might argue that as a senior living provider it is neither your right nor obligation to insert yourself or your company/community in this conversation. Legally that is almost certainly true . . . but dealing with death and dying is something that most residents and family members are not comfortable with. They need all the help they can get.

More importantly, we want . . . or should want . . . a bigger piece of the eldercare, aging, healthcare, dying pie. Beyond the obvious financial benefits, we as an industry know more about these things than any other part of the crazy jumbled maze our elders must travel in the last years of their lives. We are intimately acquainted with their needs, their desires their quirks. If allowed, we could be the very best case managers for our residents in the whole wide world.

We need to help our residents and their families force the medical professionals to stop and really listen to what they need.