What I've Learned About the Health Care System

I've decided to write about a recent run-in my family had with the for-profit health care system in this country, not because I'm looking for sympathy, but because I think others can learn from our experiences. We found out that if you don't make the right decisions in one of the most stressful situations a family can face--a health crisis--your loved one could be shunted out of the hospital without getting needed care, and into "home health care," which turns out to be very little care at all.

While I was away from home on a business trip last week, my elderly mother fell in her home where she lives alone with her very obese dachshund. Paramedics rushed her to the emergency room of Shelby Baptist Medical Center in Pelham, Alabama. My sister, Betsey, who works at church day care center in nearby Chelsea, Alabama, quickly rushed to the hospital and tried to call me to let me know what had happened. After some confusion, my husband was able to reach me on my cell phone, and relay the message but it took me another agonizing hour or so before I was able to actually talk to my sister. Even so, she didn't have much to tell me. The doctors said that our mother may have broken her hip, but they wouldn't know for sure until after examining the X-rays. As most everyone knows, breaking a hip is one of the worst things that can happen to an elderly person. The injuries don't heal well and incapacitate an older person for weeks or months at a time. Many hip fracture victims never fully recover, and as a doctor told me later, mortality rates for the elderly in the year following a hip fracture are 25%.

I spent a long afternoon worrying and waiting for Betsey to call me back. When she finally did, she relayed the good news that our Mom had not broken her hip, but instead had fractured her pelvis. My sister told me the doctors said that was a much less serious injury, and that my mother was not qualified to be admitted to the hospital. Betsey told me that a social worker who called herself a "patient advocate" told her that my mother would be sent home with "home health care," and she would be just fine in 4 to 6 weeks. I found out later that she also told my sister that she couldn't be fired from her job if she took off work to take care of our mother, but that wasn't really an option for my sister, because my sister works for hourly wages and if she misses work she doesn't get paid! I didn't know what to think about all this. I considered flying directly to Birmingham, but found that changing the flight would cost hundreds of dollars. So I decided to fly back to Memphis as planned the next day and then drive to Birmingham on Friday. In the meantime, Betsey took two unpaid days to stay with our mother in her house.

When I finally got to Birmingham, I found my Mom in her reclining lift chair. She seemed fine, although she was in a lot of pain and was a little drugged up. Not long after I got there, my Mom demonstrated that she could stand up and with the help of a walker, make her slow and painful way to the bathroom.  My sister had also picked up a "potty chair," which looks just like the kind used for potty-training kids, but of course, it's adult-sized. The idea was that if our Mom couldn't make it all the way to the bathroom, she could at least make her way to the chair. I thought that probably made sense...but I kept asking when these "home health care" workers would come and help out. Wouldn't someone come and help our Mom get to the toilet and bathe? Betsey told me they had come on Thursday and filled out a bunch of paperwork to get her "in the system," but they didn't actually do anything to help out.

Friday afternoon, a physical therapist associated with the home health care agency also dropped in. She was nice and talked to us while typing into a kind of PDA or smart phone, but she also said that she was just there to fill out paperwork and get our Mom "in the system." I asked her when these home health care aides would be coming in, but she said she didn't know, but that she could set up twice-weekly physical therapy sessions. I was glad to hear that because I have always thought my Mom needed physical therapy. She is 82 years old, has severe arthritis, osteoporosis and a bad back, and was having a pretty hard time getting around even before this latest incident. But she was still living on her own, still able to cook and clean for herself, and she still drove her own car to run errands...she just doesn't do any of this very fast. I thought then and still hope now that when she recovers from this fracture, she will be able to go back return to doing all her usual activities. Meanwhile, I was still wondering when the real help would arrive...Eventually I let Betsey go on to her house and got my Mom bedded down. She decided to sleep in her chair because the bed was too soft and she couldn't get comfortable. I made sure she had everything she needed, then went to bed in the guest room.

Well, things went south in a hurry the next day. The first time I went in to check my Mom, she had slid down in the chair and couldn't lift herself out of it, and frankly I couldn't lift her out of it either. Fortunately my sister had arrived and together we were finally able get her up (after almost overturning the chair)! But that first trip to the potty chair was a complete disaster. Although we can get the carpet cleaned, I began to have serious doubts that all this would work out. Once the pain medicine wore off overnight, Mom was in too much pain to move at all, let alone get up and walk to a potty chair...but after taking the hydrocodone prescribed for her, she was too woozy and unsteady to get to her feet either.

As the day wore on, it became more obvious to me that our Mom would not be able to cope on her own. I called the home health care agency to find out when and how we could get some home health care workers to come help out. The on-call nurse let me know (rather rudely, I thought), that the home health care agency didn't actually provide any care. They were merely there to help teach the family members how to take care of the sick or injured person. That got my Irish up! I said, "Well, we can't be here all the time, and I guarantee she's going to fall again if she doesn't get 24-hour care!"  She told me I would have to talk to her doctor, but that it was almost impossible for someone to be placed into rehab or assisted living after they had been released from the hospital.

It was Saturday, but even so, I called the doctor's on-call number. A short while later, a Dr. Puckett called me back. He wasn't actually my Mom's doctor and had never even met her before, he was just on call for her primary care physician. I told him the situation, and I must have been pretty convincing because he agreed to make a few phone calls to try to help our mom out. About an hour and a half later, he called back and told me that the only way to get Mom in rehab was to re-admit her to the hospital through the emergency room....and the only reason she could be re-admitted was if she was suffering "intractable pain." But, he told me that we had to get her to the hospital before shift change at 5 p.m. I looked at the clock...and it was already almost 3. I quickly called Betsey and asked her to come over as soon as she could to help me get Mom into the car so we could get her back to the hospital. In the meantime, outside, the sky just opened up. A major storm front that had earlier slammed Memphis was now hitting our part of Alabama hard. While I was trying to figure out how to get her into the car without getting her soaked, a mind-numbing blaring noise started blasting throughout the house!

My mom's home alarm system had somehow been triggered by the storm. The problem was, although the house was wired for an alarm system, my mom never took out a contract on it, so there was nobody we could call to help us turn it off! And it was CRAZY loud!

When my sister arrived, we started screaming at each other. She wanted to know why I hadn't gotten Mom into the car yet! Meanwhile our mom was leaning over the walker and hobbling very slowly in our direction--painfully slowly. At that point, Betsey started yelling at her like she was a mule, "Giddyup! Hurry! Hurry!" Our mom almost started crying and said, "Betsey stop yelling at me!" Then Betsey said, "Okay, we'll just carry her!" I said, "NO!" Since it took 3 paramedics to pick her up after she fell the first time, I knew there was no way that was going to work. I think that because the alarm was BLARING so loud, none of us could think straight. But eventually Betsey got the bright idea to call the fire department to get them to turn off the alarm. Soon a big red fire truck showed up and 3 burly firefighters climbed down. They not only figured out a way to turn the alarm off, they also helped us lift Mom into the car. Thank God! We were finally on the way to the hospital.

She had been released from that very same hospital just 3 days earlier, but we had to tell our story three times to three different nurses. I instructed my mom to act like she was in "intractable pain," which by that time after all she had been through, was not hard for her to do. Two hours later, we got word that they were taking Mom to a room, but we were still in suspense, were they officially admitting her or not? Shortly after they had brought her to her room, an orderly came to take my mom to get an MRI, a test they hadn't bothered to do the first time she'd been at the hospital. While she was gone, a Dr. Julian Munoz came in to talk to me. He was 30-something, cute, and had a Cubano accent. He was very somber as he told me that the prognosis for these kinds of fractures in elderly people is not good. 25% die within a year. Even though hers was a simple fracture, he told me that it's not the broken bone that kills them, but complications like pneumonia that result from being bedridden and subsequent falls.

After giving me that sober warning, he told me that he was going to admit our mom for a few days so that they could treat her for pain with intravenous drugs and do some further testing, then he was going to recommend that she be released to a rehabilitation facility. I was SO relieved! Of course, it was all contingent on Medicare approval. I later told my sister she might still have to fight to make sure our mom got the care she needed. Betsey is just not as assertive as I am. I told her she would have to channel her inner me. "You mean my inner bitch!" she said. Well, yes, I agree. I am more of a bitch than she is.


So what have we learned here? 1.) If you're older or in poor health, you need a friend or relative who will advocate for you if you become sick or injured. Preferably one who lives in the same town as you do. Because in their zeal to cut costs, hospital administrators make decisions that are not in their patients' best interest. Does it really make sense that hospitals are for-profit operations? Should someone really be making money off my mother's pain and suffering? 2.) "Home health care" is a complete misnomer. How is it health care when no one is providing even a modicum of care? All they do is fill out the paperwork so they can bill Medicare for the care they are NOT providing. What a rip-off.

Update:  It turned out our mom's pelvis was fractured in 3 places. She is now out of the hospital and in a rehab facility where she's getting daily physical therapy. I don't know how long she will stay there, but I hope it's long enough for her to fully recover from her injuries and go back to living independently.