As the percentage of trauma survivors continue to grow, so too does the number of people who will live to realize this final phase of life. In this third phase, it becomes increasingly apparent that life extended by medical intervention continues to suffer from the progressive ravage of chronic ailments: arthritis, emphysema, diabetes, and a host of other insults whose end stages are debility in function, gradually giving rise to the argument, in the eyes of those concerned over our “well being,” of incompetence to live alone and independently. Eventually, under duress by family, doctor, and social services, we will capitulate and do what is “right”. We will consent to supervised custodial care. The question quickly becomes where will the supervised care take place?

It is the contention of the P.E.A.C.E. advocacy that the “grin and bear it”solution is ludicrous. Just when refuge and privacy are most indicated, we are asked to surrender our homes and seek institutional care. At home we could have had one-to-one care. In the institutional care system, we are confronted with, at best, a six to one ratio. In deference to the many hardworking health care providers, in whose number the author of this advocacy is proud to be counted, it must be stressed, with all due respect, that even Mother Teresa on skates could not attend to six patients at one time!

Eighty percent of institutional health care is business for profit, business that is increasingly accommodating the growing numbers of survivors — i.e, people who in their last years are progressively vulnerable to neglect in a competitive (institutionalized) environment. “Nursing homes care for many people who are too frail, too sick, too poor, and too powerless to choose or even protest their care. We believe that it is unwise to entrust such vulnerable patients to profit-seeking firms.” American Journal of Public Health, Vol. 91, No.9, p. 1455 (September 2001).

The P.E.A.C.E advocacy is a Spartan plan for all to consider. It is intended for a very specific point in time. Like a trump card, it must be held until all other possible avenues of assistance have been tried and exhausted, as will occur anyway, with or without Long Term Care Insurance coverage. Church, community, friends and family see us through the IADL phase. The difference comes when ADL custodial care is declared a “medical necessity” by your doctor, your assertion to stay in your home will be creditable – having the weight of foresight. In truth, for young and old alike, there is no place like home – it is where the memories of the heart recede.

Stand Your Ground!