Davis: No longer hospitable
American hospitals are long overdue for a major change in the way they deliver care. I was reminded of this need after reading an Aug. 10 article by Anna Gorman from Kaiser Health News titled "Elderly Hospital Patients Arrive Sick, Often Leave Disabled."
Gorman talks about the harm done to elders who are hospitalized because of lack of attention to the details of their lives that really make a difference such as getting out of bed, good nutrition and restful sleep.
According to Gorman, "Many elderly patients ... deteriorate mentally or physically in the hospital, even if they recover from the original illness or injury that brought them there. About one-third of patients over 70 years old and more than half of patients over 85 leave the hospital more disabled than when they arrived, research shows."
Hospitals do an excellent job of fixing things, of focusing on a patient's diagnosis and doing what has to be done to help a bone mend or a belly heal but they do not do a good job of recognizing the person behind the disease and tending to the needs of the soul.
Research indicates that elders suffer the most from this lack of dealing with the person who has the disease. Western allopathic medicine has historically done a poor job of recognizing the needs of the soul or of paying attention to the person who has the disease, instead focusing on the disease that just happens to be in the body.
Sure, it is not fair to paint such a broad stroke because there are so many excellent doctors and nurses who do make an effort to deal with just more than a disease entity. But the system is biased toward cure and not care and, in the end, the work of cure almost always trumps care.
So what's should be done? One approach taken by about 200 U.S. hospitals has been to set up Acute Care for Elders units within hospitals. Gorman notes, "San Francisco General is one of them. Its Acute Care for Elders ward, which opened in 2007, has special accommodations and a team of providers to address the unique needs of older patients. They focus less on the original diagnosis and more on how to get patients back home, living as independently as possible."
She goes on to say that, "Early on, the staff tests patients' memories and assesses how well they can walk and care for themselves at home. Then they give patients practice doing things for themselves as much as possible throughout their stay. They remove catheters and IVs, and encourage patients to get out of bed and eat in a communal dining area.
"Bed rest is really, really bad," said the medical director of the ACE unit, Edgar Pierluissi. "It sets off an explosive chain of events that are very detrimental to people's health."
Poor care of elders also translates into a lot of Medicare dollars being spent on preventable problems. According to Gorman, "a 2010 report by the Department of Health and Human Services' Office of Inspector General found that more than a quarter of hospitalized Medicare beneficiaries had suffered an "adverse event," or harm as a result of medical care. Those events, such as bed sores or oxygen deficiency, cost Medicare about $4.4 billion annually, according to the report. Physicians who reviewed the incidents determined that 44 percent could have been prevented."
While the ACE units might be a good start, I think the best way to transform hospitals and protect elders is to use hospitals only as a very last resort. This country needs to recognize that people do better at home and we need to readjust our health care spending priorities to reflect that. Until we do, we will be throwing money down a black hole that is also littered with the bodies of those who could have been saved.
Richard Davis is a registered nurse. He writes from Guilford and welcomes comments at firstname.lastname@example.org. The opinions expressed by columnists do not necessarily reflect the views of the Brattleboro Reformer.
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