Unless you need critical care, opt for hospital-at-home
The Great Human Flood, I thought, as I leaned back in the chair of the emergency department waiting room. I probably looked like them — disheveled, dressed in sweats or thrown-together clothes, heaving great sighs, and scrolling cell phones.
A young man shuffled to a seat, his injured hand mostly covered by the pulled-down sleeve of his hooded sweatshirt. He plopped down. A little girl sopped a continuously bloody nose. She leaned against her mother who was looking at her watch.
People kept comin in, and no on seemed to leave.
I have pneumonia and was at the emergency room two days after an urgent care visit. I was wheezing with every breath. My ribs hurt when I cough.
I weighed the likelihood I would be admitted to the hospital or not.
Not, I decided, I was safer at home and would make that plea if asked.
The young doctor I finally saw agreed. She gave me two new medications, kind instructions, and explained she had weighed admitting me but hospitals have C-Diff and other hospital-based infections and are difficult places to sleep.
I suspected she was a traveling physician, skilled in emergency care, but only temporarily assigned to this location. That is common in healthcare, at least in this part of the country. The nurse with a European accent might be a traveler, too, a contract nurse.
I’ve hired contract nurses. They can make really good money by staying three-six months one place, moving on to the next contract.
I have managed some hospital units, and the halls are filled with patient calls, bed alarms, and various monitors’ beeping. A patient might have just fallen asleep when a doctor makes her rounds, or a roommate moans and snores.
Hospital care at home has become an alternative.
It was forced into faster adoption by Covid. Medicare and other insurance will reimburse operations that have set up hospital-at-home. Telecare has increased, and medical care is monitoring the machines, reading the lab reports, and the x-rays or other procedures, and hearing feedback from the patient. Very little hands-on care might be needed. Hospital care at home requires a safe home with electricity, AC and heat, and internet.
Registered nurses expressed frustration to me when I was a manager that they never had time for rewarding patient interactions–pausing for conversation, massaging feet.
Nurses are in short labor supply as are many healthcare professionals. If you, as a patient, can manage at home with the support of family and friends, and checking in with healthcare professionals, great. Even when I was managing healthcare ten years ago, doctors were asking for telephone pictures of swelling or rashes or incisions to quickly understand a patient’s explanations and needs.
Units that used to provide patient stays and support for orthopedic joint replacements were challenged. Orthopedic practices developed their owned suite-stays, to avoid hospitalizations. Orthopedic surgical advances mean that many procedures can now be done as outpatient surgery, with one overnight stay in a practice-owned suite.
A couple other reasons: some orthopedic practices with a sports orientation cater to executive or week-end warrior type patients, and orthopedics is a lucrative specialty.
I was surprised to learn that the highest healthcare consumers were the same people I saw in my human services work. Care for this population is often poorly reimbursed or not reimbursed.
Poverty creates a cycle of poor health outcomes.
I worked in a major metro area of 1.5 million people. I saw people like those who had been clients on food support or family case management or addiction treatment, but I also saw the same people. They recognized me, too, from my previous roles.
Medicare has identified the importance of social determinants of healthcare, and made that a priority.
I noticed there was a designated care area of the emergency room called continuing care. Some people seemed to be sleeping in chairs there, and one man clearly came in to arrange transportation. He was disabled physically with a significant speech impediment.
Keeping people safe and healthy enough to avoid hospitalization is a more humane — and cheaper — way to provide care, even if that is providing short-term housing or transportation vouchers or all the elements of social work.
We all want to stay out of hospitals, and technology makes that more possible. Some healthcare specialties are providing non-hospital recovery suites. We need flexible home spaces that can become work offices, living space, and healthcare.
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