‘How many of you expect to die?’ Joanne Lynn on the importance of honesty and agency in care for elders

January 6, 2016

By Kim DiGioia, MSPH

I first met Joanne Lynn, MD, Director of Altarum’s Center for Elder Care and Advanced Illness at a conference a few years ago. Already aware of her impressive body of work and recently floored by her impassioned participation in a panel at the conference, I approached her to ask the secret to rallying audiences around a cause. Her response? “I usually ask them ‘How many of you expect to die?’”

Americans are living longer, and this means that most adults will experience the end of life with multiple chronic conditions and progressive disabilities. In a blog post on her website, Lynn warns, “The arrangements we have now for health care and supportive services [for the frail elderly] are frustrating, wasteful, and a serious misfit for providing the comfort, meaningfulness, personalization, and reliability that are so greatly desired at that point in our lives.”

At the 2013 Lown Conference, Lynn gave another rousing address. Making the case for major changes, she said, “We don’t talk about the period of frailty. We don’t set aside a different kind of care system and we really must. The last phase of life is very different.”

Lynn also emphasized the need to address social determinants at the end of life. “How is it we allow anybody to build an apartment building that isn’t already a universal design? We’re going to have 20 percent of the population needing disability adaptation. Why do we ever allow a shower to be built without a handrail? This is just inconceivable,” she insisted.

Presently, Lynn is working toward innovative solutions to radically transform the unfortunate status quo.

One such solution is MediCaring, “the exciting idea that Americans can learn to build reliable, effective, and efficient arrangements for services to support one another when we face the serious chronic conditions associated with very old age or the last years of life.” Lynn and collaborators are pioneering this initiative in communities across the country.

She is also currently striving to eliminate waste in low-value care in Medicare so that savings might be reinvested in community-based services that otherwise are often in short supply. This project will additionally help to manage services on behalf of the community, so it becomes apparent what services are oversupplied, undersupplied, or have quality problems, and action can be taken to make improvements.

At the 2016 Lown Conference, Lynn will be speaking about the many problems in elder care and how they are indicative of deeper systems-level issues. On medical overuse, she says: “Putting people in charge of their own treatment and giving them honesty about their options is likely to yield more prudent care.” She looks forward to attendees renewing their commitment to providing better care and reducing waste in medicine.

We look forward to hearing her keynote!