The City of Palliative Care

https://jayriverlong.github.io/2021/11/28/palliative.html

by riverlong • 5 years ago

35 25 5 years ago

jayriverlong.github.io

With a spouse that works in palliative medicine, I really wish the author had chosen a different phrase. Please don’t get the idea that palliative care is only for the dying. Everything else about the article is spot on.

riverlong2• 5 years ago

Sorry, I wasn't aware of that. I was under the impression that palliative care is (at least generally) end-of-life comfort for the dying. I wish I had chosen a more appropriate term.

breckenedge3• 5 years ago

It’s ok, not the first time someone has gotten that impression about palliative care. It’s something that my spouse has to constantly reinforce with her patients and their families. Thanks for sharing the article. The point you’re making is important.

disabled• 5 years ago

It’s quite offensive, as somebody who nearly died from sepsis (a couple of months ago), like the drug user in the article, but for different reasons. In my case it was from an infected portacath, that was carelessly flushed during routine maintenance and care.

Also, I cost more, on a per year basis, than the individual in the article, as I require an orphan drug and will for the rest of my life.

I am American but fortunately live abroad so I don’t have to put up with people writing BS narratives and stories that “link” arbitrary statistics together, which people with economics backgrounds tend to do. All in all, this is clickbait.

The solution to the “problem” in the article is houses, regardless of drug usage status.

novok3• 5 years ago

Do you think the chronic drug addicted homeless could sustainably live in a house without utterly destroying it even if the 'rent' was $50/month?

jessriedel3• 5 years ago

To get to this number, I averaged the number of annual homeless in San Francisco since 2013, which is 6,864, and averaged the city’s homeless budgets from 2016 through 2023 (I could not find prior budgets), which is $486 million per year. That’s $632,000 per homeless person per year

No, that's $486M/6864 = $70,800 per homeless person per year. It's only after multiplying by the 9 years she lived in SF do you get $630k. It's a lot, and probably poorly spent, but probably only 10x what is reasonable.

riverlong2• 5 years ago

Sorry, that was a typo on my end. I'll push a fix momentarily. (Do note that the math for $630k over 9y was right.)

randometc• 5 years ago

A point in time count isn’t a good denominator to understand cost per person given an annual budget.

This article sheds some light: https://missionlocal.org/2019/07/in-san-francisco-we-obsess-...

the Department of Homelessness itself applies a multiplier of 2.89 to the PIT count to estimate how many individuals are homeless not just on one day but throughout the entire year.

glenda• 5 years ago

70k per year is less than we spend keeping someone in prison, which is where many people believe we should put drug addicts. The truth is it’s not about the money, people just don’t want to see other people suffering where they live.

As a society, even spending all this money, we are failing to help some of our most vulnerable citizens. It’s quite telling that conversations about social safety nets always become about money rather than reducing harm effectively.

nick__m3• 5 years ago

I think that opiate addict should be freely provided with a stable quality supply as long they want, something like that https://mysafe.org/ .

jessriedel3• 5 years ago

No where in the article does the author bring up taxes or the cost per tax payer. The entire focus of the article is on the effect on the homeless person.

watersb2• 5 years ago

“The city is way too easy for people with nothing to get by,” she said. “That’s why I’m still here nine years later. You get by with doing drugs and suffer no consequences. I like it here.”

No doubt, chronic homelessness is a problem in San Francisco. And there's truth in this quote, from a fentanyl-addicted homeless person.

But I hesitate to base my entire view on the situation from a hot take of conversation with someone deep into drug abuse. They will feed the addiction first, and only then go on to address their other needs.

The article leaves me wanting to hear from people in recovery. Perhaps they are harder to find. Or perhaps (even more likely) I misread the article.

Nevertheless, I hang on to the real money quote:

The bitter joke of the story is that in San Francisco, the mother works full-time, drains her savings, but still can’t make ends meet and is forced to move away.

bsder• 5 years ago

Agreed.

For example, a recent report on the SF homeless population flags 15% of them as having a traumatic brain injury.

You can spend as much as you want on other things, but those people need permanent, long-term medical care and nothing less is going to help.

olliej2• 5 years ago

And all of CAs public long term care facilities were closed in the 80s in order to save money, even though in reality it has ended up costing vastly vastly more.

mindslight2• 5 years ago

I wish this post had continued with the analogy rather than pulling the ripcord with "the government has inadvertently created a thing of immense cruelty: this is a system that takes in people and slowly, but surely, kills them.".

Hard drug addiction can be seen as a terminal disease. The main cost to the city is truck rolls for EMT response. $100k/yr is much more than it costs to feed and house an individual in basic accommodations. The main cause of overdoses is purity/potency. Taken together, it seems like treating the situation as a public health problem with a palliative approach would save the city a lot of money as well as making life better for those trapped in it. Especially if SF could then turn around to the state and claim healthcare reimbursement for doing so.

The City of Palliative Care

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