Health Care vs. Wealth Care

[Outta Here]

Having recently been on the receiving end of health care (running the whole gamut from LifeLine to EMT to ER to surgery to hospital to chaplain to rehab hospital to skilled nursing to home health care), I am convinced there is not one caregiver in the St Louis region who really CARES about getting the caregiving right...nor about the needs of the individual being cared for. My experience was a constant stream of "I didn't know that", "Must be a typo", "She said she was in pain", "Not my job," "I don't have that in my record", "She broke her hip?", "Sorry, nothing we can do about that," "She was sleeping, she'll get a shower next week"....and on and on and on. I can count by name at least 53 different people who were involved in my grandmother's care for the past 2 months. None of them--no, not one--managed to give her perfect care. And each one made an error that made her stay longer and more complicated. If they're not in it because they care about the health, then surely it must be about the wealth.

Please tell me this is untrue in Adventist health care. We are not lucky enough to have a SDA hospital near us. 

[CoAspen]

I don't know if there is a difference, one can hope. You have just experienced the Health Care for profit system we have in this country. 

I make the statement after 38 years working in the health system. You can find exceptions to the above as you stated, but it is becoming more difficult for a variety of reasons.

[Outta Here]

It makes me sad to hear that it's getting even more difficult. I fear for my parents and in-laws and my extended family and friends. It took a great deal of effort by me to keep on top of the care my grandmother is getting--I can't imagine how bad it must be for people who have no one to keep tabs on the caregivers.

[Gregory Matthews]

You might attempt experiencing health care from the inside.  I do not know what your background is.  But, I know that hospitals have positions for volunteers who can help out.

 

[Liz]

I know what you mean, Aubrey. Recently when my husband had to be in the hospital, if I wasn't there taking care of him, no one was. Never could find a nurse--other than when I looked in the mirror. What was also eye opening, was not one nurse in a three day hospital stay ever did a full body assessment on him, most never even listened to his lungs. I was floored as this was NOT how I was trained. I asked where the linen cart was, and I changed his sheets, wrapped his IV and helped him into the shower.

Then a couple months ago my daughter had to be admitted into the pediatric ICU, where nursing is supposed to be 1:2 at the most, and it was, but still I provided the care, no full body assessment, never listened to her lungs--and she was admitted for breathing problems.

I often wonder if I were to ever go back to being a hospital nurse, what I would be doing all day? And before anyone says they were charting or in other people's rooms, if she wasn't in our room, and she wasn't in the other patients room, there was only two patients in the PICU when we were there, and she wasn't at the nurses station, where was she? There were hours when she was literally no where to be found. Why pay for care when you aren't receiving any?

[Outta Here]

I have spent 4 years volunteering at a hospital. Another 3 1/2 years volunteering as a caregiver to an elderly woman from church who suffered a stroke with paralysis. Then I spent 2 years caring for my father who had early-onset Alzheimer's. Then another 6 months of volunteering my time caregiving for another woman who suffered a stroke (without paralyis). Currently I am a full-time caregiver to my grandmother (92 years old with dementia, diabetes and a recent hip fracture). I am maintenance, housekeeping, valet, exercise coach, personal hygienist, cook, nutritionist, podiatrist, seamstress, masseuse, accountant, scheduler, lawn-care, liaison, pharmacology, activities coordinator all rolled into one. I don't get Saturdays off, and I never get paid. 

Ever hear of the sandwich generation? I'm like a flat piece of cheese right there in the middle! I've been caring for other people since the day my parents divorced when I was 11. 

It is highly likely that this "job" will last me another 8 years. It will probably be replaced with caring for my father-in-law, and then my mother-in-law, and then my own mother. I may find time for volunteering at a hospital again once I am in my late 60's. By then, I might convince myself to take a break from caregiving. 50 years of putting other peoples needs first is surely enough, isn't it? Hope my husband's health holds out! 

 

 

[Outta Here]

LIZ! Exactly! I feel your pain. Everything you described is similar to my experiences. Why pay for care we are clearly NOT receiving!

[Gregory Matthews]

Maybe this is more the result of the system and how hospitals are paid for their services  than it is that "not one person cares."

In my experience, the RNs have strong feelings about having enough for the patient load that they are required to serve.  I could say that same about many other clinical providers.

 

 

 

 

[Outta Here]

Yes, it is about how they are paid. Hence, "Wealth Care." The SNF that last "cared" for my grandmother kept her an extra week once they found out she could pay an extra $161 per day out of pocket. She was kept an 11 extra days AFTER the therapists gave her an "all clear" because social workers were not able to get all their ducks in a row at the same time. (But billing was sure on top of it! Got the bill for her last 7 days the first business day.)

Now...

My best friend of 28 years is an RN. She just finished her NP coursework and will be sitting for that exam in August. I do believe she has a heart for the work and the parients. But even she sees the lack of concern for patients among her coworkers. Her mother in law is someone I cared for after the stroke. When her MIL went through all the various aspects of health care it became obvious to my friend that very, very few of the healthcare workers actually cared for/about their patients. She decided to go back to school so she might be better equipped to DO something to improve the system.

Do I think that EVERYONE in healthcare is only concerned about their paycheck?  No. But I think it is fair to say that nearly everyone my grandmother and I came into contact with was primarily concerned about the $$$. Patient care was hastily performed and full of errors at every turn.

I'm sorry if I am offending anyone in the healthcare field. I am sharing my perspective. It is valuable to those who want to know what it's like on the "other side."

[CoAspen]

You are not offending me. Many of the conditions you are describing are due to lack of staff. Why lack of staff, the bottom  line. The bottom  line is equally important in a nonprofit system as well. Paperwork, yes there is still paper, documentation  requirements, privacy laws, insurance issues, etc , etc are having a big impact on our current healthcare system. When a system becomes larger and larger it can become less efficient and more costly. Healthcare is huge part of our economy. It includes many parts such as pharmaceuticals, equipment, etc. All of those areas are about profits, increasing profits on a yearly basis. I could go on and on but just wanted to give some idea of how complicated it all is. Patient care can and does at time get lost in all of it.

[CoAspen]

On the other side of the coin.....pt care and profits can be maximized in some situations. The company I worked for, cancer treatment and care, is a for profit organization. We focused on pt care  first as a way to increased profits. We delivered a service that was less expensive and more patient oriented. Example, our patients were always pre authorized for insurance. Pt new up front whats was paid for and what their expenses would be. Go to a hospital, doesn't happen that way. They simply take the insurance info and then just bill the patient for what is not covered, surprise, surprise! Our cost of services were less expensive than a hospital also. Example, patients getting an exam, CT or PET/CT, as an outpatient at the hospital were charged more, common complaint from pts. We had to focus on patient care to keep  those pts returning to us. We made them first. We focused on being efficient. 

The down side to all of this and one that I hated, numbers, numbers, numbers. Pt care and satisfaction=more income. More pts/exams/treatments=more income.

Its the American Way.

[Outta Here]

The American Way.  One day I hope the American Way will be known as "Love your brother even as He loves you!"  What profiteth a man, eh?!

[Aliensanctuary]

Soon enough, people without a lot of money will just have to die when they get really sick. Prevention of illness would be a good plan if one could get that to work all of the time. I heard recently that healthcare is in third place for cause of death in the USA, so going to doctors and hospitals can be quite hazardous to your health due to medical errors.

[Outta Here]

Someone told me that stat recently. I believe it! I think I'll do as much prevention as possible.

[Gregory Matthews]

I do not want to either deny or to belittle the experience that Aubrey shares with us.  But, with 20 years of experience of working in a hospital I would like to share some reflections.  This will include my friendship with several hospital CEOs who came from other types of hospitals from the one in which I worked.

Clinical care in the United States is very complex.  The monies that hospitals receive from care is generally determined by Federal rates.  Some care actually costs the hospital more than they receive.  They cover their costs by the fact that for other care they receive more than it costs them.

Prescription medication is a very interesting subject of discussion.  In reviewing these costs to my family medical coverage I  typically found that the actual payment made was typically 1/3 of what ha[d been billed.  This means that the typical family purchasing medications without insurance may be paying much more than the insurance company.  Some medications cost hundreds to thousands of dollars  per dose.  I was talking once to a woman who had good coverage and was on a very expensive cancer medication  (Cancer medication are very expensive.).  She was telling me that she could nto afford her co-pay.  At that time I had access to what the hospital where I worked paid for medications.  We paying less than her co-pa for the same medication!

Clinical providers today are often being asked to do more with less.  This is true for others than nursing personnel.  All to often, regardless of pay, people who work 10 - 12 hours a day pay a price.   They may lose their edge.  This is also true for people who have to work rotating shifts. 

In the hospital where I worked, for nine (9) years I filled a role in which employees could come to me with their problems and I could negotiate on their behalf with management.  In this role, I worked closely with others.  E.G.  Nursing personnel generally went to people who were RNs.  I generally worked with others.  Our RNs commonly had problems with decreased staffing below generally accepted standards. 

I am reminded of one woman whom I represented.  She was a single parent who worked for a senior physician.  She typically worked a ten (10) hour day.  But she was only paid for an (8) hour day.  Her ten hour days had not only been approved by management, but it was expected that she do so.   As management had approved and expected that she do such, there were official records of the hours that she had worked.  Those records showed that she had worked hundreds of hours of unpaid work.  Well, due to problems with an ex-husband, she missed some work.  As a result her new boss wanted to fire her.  It was at that point where I became involved.   I pointed out that she had accrued those hundreds of hours of unpaid work.  She retained her job and  immediately went back to working ten (10) hour days but only being paid for eight (8) hours. 

In my years of working in health care I have found many people who were working well beyond what they were paid for doing.  That has often taken a toll on them.  And does anyone realize what often happens in relating to their patients.  I am reminded of the following which I personally know as happening:

1)  Patients who cam to an Emergence Department and were armed with weapons to assure that they got the care that they desired.

2)  A conscious patient, who during a surgical procedure on his heart physically assaulted the physician who was doing the procedure.   It took five (5) police to restrain the patient and I was one who responded to the call for help and entered, along with the police and others, the operating suite.

3)  A family member who wanted to thank clinical staff for the care that had been given to a relative.  So, she gave a physician a list of people and asked that physician to make the  contact thanking the people on that list for the care received.  I was present when she asked the doctor to do that.

4)  People who have set fires in the hospital.

5)  People who had warrents out for their arrest and attempted to spend the night in our hospital.

Again, I do not want to belittle or challenge what others have posted here.  That has been their experience.  I can only say that this issue is a complex one.

 

 

 

   

[CoAspen]

Quote

I can only say that this issue is a complex one.

True, very true with no easy solutions.

[Outta Here]

Agreed. Very complex. Something MUST be done.

[rudywoofs (Pam)]

 the hospital doesn't tell the patients or their families a lot of what happens to the patients...  I recall a patient with a hip fx went to surgery for a hip pinning.  The procedure was done successfully, and the patient was being moved back onto a stretcher, when someone let the stretcher slip away from the surgery table.  The patient fell onto the floor, we did another xray, and found that the patient's other hip had been fractured.  So the ortho doc had to do another hip pinning.  All that the family was told was that we had found that the other hip was also fractured.

And always, ALWAYS, when you have a chest xray in the hospital where you need to stand up against the chest board, ask the technologist to disinfect the board, including the top where people breathe on it..  It's supposed to be done, but seldom is.  It just takes less than a minute to do, and you'll be saved from being in contact with germs left by hacking, coughing patients.

I saw lots of behind-the-scenes disasters, but not so much "go-the-extra-mile" behavior, though what there was, usually came from the same individuals.

Sometimes technologists, nurses, and physicians can get "burned out" — they listen to the same comments, questions, concerns, and/or complaints day after day after day.  They can become jaded, perhaps, but in a self-protective way.  You can't let your caring become too emotional, otherwise you'll be no good to anyone.  That's not to say they shouldn't be kind to their patients.

 

[Gregory Matthews]

Some hospitals are fully informing the patients and families of what happened.   Those who do so are finding that there is less litigation.

My ex-wife once took our oldest son the  ER.  She was  surprised at how  long he spent.  When the MD came out he informed my ex-wife that an error a medication had been administered to my son that was 10X the amount prescribed by the MD.  That had thrown my son into a crisis, but the staff had brought him through and he was now ready to be released and go home with her.  He did not need to be admitted.

The hospital where I worked believed in full communication, wit[h consideration for the extent to which the person wanted to be informed and in addition a basic outline of the issues and what had happened.  From that point on, it was up to the person to ask for further clarification, as desired.

 

[Outta Here]

Part of the problem is that patients often don't know about what to ask for clarification. Medical speak is confusing to a layperson. I had to laugh at the times when staff asked ME what such-and-such meant. Thankfully...I knew because I'd been paying very close attention.

[CoAspen]

Another Factor

The above article points to a really big issue is this country with the explosion of stand alone and Hospital ER's. These type of stories are a common everyday problem. It has hit my family as well. Is it any wonder that people are losing faith in our Health Care systems?

[CoAspen]

If  informed Heath Care was a primary goal for the patient, then transparency would be the norm.

I believe that most Hospital Corporations are all about the monies. They were once formed to become more efficient and to contain costs, but they soon learned it was a method to higher profits. Example, out patient cancer treatment is reimbursed by MCR at a lower rate than a hospital based environment. The outpatient centers provide the same level of care at a lower cost. Hospitals buy up those centers but are still are able to collect more monies from MCR. It is an ongoing battle to stop the practice.

Cost savings are never passed on to the patient...just like any other business. You can buy stock in Health Care as well.

(...need to get off my soapbox and lower my BP...)

[pierrepaul]

Some states and provinces have enacted "apology" legislation, essentially providing that an apology made by a professional (or tradesman) to a client does not constitute an admission of liability, is not admissible in court and does not void insurance coverage.

I was once in the unfortunate situation of having committed an error and could only disclose fully to the client at the risk of voiding my insurance. Luckily the damage was within my means so I decided to disclose to the client and pay the damage out of pocket. In healthcare, where most people recognize that it's not an exact science and not every mistake is negligent, and where damage is not quantifiable monetarily, often what patients would really like is for the physician to meet with them and say "sorry".