Hospitals have evolved as a business. They are bigger, have flashy newspaper and TV ads, and tout medical prowess. Arising now from their sterile halls are horror stories of compromised care and self-serving profiteering administrators.
The general population, especially seniors, are most vulnerable. Knowledge is power, and knowing hospitals have manipulated the system to their advantage allows one to strategically fight back improving the chance of getting home.
Your first step is to prepare legal paperwork prior to hospitalization.
Documents should be completed designating a decision-maker if you are mentally incapacitated (for instance if you have had a stroke, infection, or metabolic imbalance). Most States allow “next of kin” as a “surrogate”, but not in California. (See * below)
Paperwork should include: Advanced Directive; Medical Power of Attorney; your code status (e.g.. POLST), and an updated list of medications and allergies. You might want to have an attorney check your final documents.
Many patients keep copies in an envelope taped to the refrigerator or back of the front door for paramedics to grab on the way out.
Secondly, it is important to select an advocate. This person must know you well, be at bedside, and speak and ask questions for you. They don’t have to have power of attorney nor be a relative, but someone you trust to maintain communication as your second set of ears and eyes for family members and healthcare professionals.
Thirdly, seniors must be adept utilizing present technology. Using a cell phone, tablet, or laptop requires learning and practice. Having one of these devices helps during hospitalization, so start this education now.
In the past, your primary care office doctor would be the “admitting physician.” Not anymore. Most of the time it is a “hospitalist” who you have never met. You don’t know them, and they don’t know you.
If you have a sink drain or car engine problem, you can google a plumber or mechanic. But instead you have an unknown doctor you must trust with your healthcare. That should rev up your heartbeat!
Laws in California and other states do not allow doctors to be employed by hospitals as this influence might be construed as “practicing medicine without a license.” To game the system, hospitals have contracts with medical groups and HMOs who they financially dangle swaying medical decision-making by hospitalists. Therefore, hospital administrators can manipulate hospitalists from afar.
What medical decisions critical to your care are they interested in manipulating?: How long you remain in the hospital; where you are discharged after hospitalization; and whether specialists (like neurologist, pulmonologist, cardiologists, endocrinologists, etc.) consult on your case.
Added to this, your admitting physician could be given a monetary bonus to discharge you as fast as possible, which is not in your best interest.
All of us eventually arrive at end-of-life, also called hospice or comfort care. As we age, our road of life narrows, but modern medicine has allowed care to get us back on our feet with over 95% of my hospitalized older adults returning home.
Some medical groups and HMOs practice “medical ageism” and coerce you into hospice care after seeing how old you are or how much gray hair you have. Why?
Should you or your loved one agree on hospice care, you are removed from the hospital and HMO insurance list and placed in a separate category relieving them of financial and medical responsibility. Worse, they provide only minimal “comfort care” and send you home (or more likely a nursing home) for further care. There are financial incentives for the hospital, HMO, or the medical group to minimize medical care. Yep, you are a red line on their balance sheet.
Now that you know how to be prepared and have an understanding of the financial background of hospitalization, you are ready for admission if you become ill.
Make sure you have writing tools to compile a diary. Why? Accountability. Knowing someone’s name, and the fact they know you know their name, is a powerful weapon. Every doctor you come in contact should be asked to provide their name and business card. And every time you come in contact with them, you must address them by name.
You, your advocate, or Power of Attorney must take notes on every interaction, and you should know your diagnosis, testing to be done, results of those tests, treatment plan, and when you might go home.
Heed any paperwork the hospital might give you. Sometimes, it says your time is up, and you have to leave. Medicare does not allow this without proper notification and ability to appeal. Usually, a phone number on this document allows you or family member to discuss this potential discharge with an outside agency (QIO – Quality Improvement Organization). It will buy extra time for recovery and further decision-making.
By far the worst news coming after being told you’re not going home, is you have to go to a nursing home. The term “nursing home” is not used these days, and instead “SNF” – Skilled Nursing Facility, or Rehab Center is preferred. Remember “lipstick on a pig”?
Commonly, family members are given only a few hours to choose which facility, and seeing them online provides no appreciation for actual smells or sounds. This decision ultimately elicits the most guilt from family members.
Finally, if you are lucky enough to be going home, make sure the “durable medical equipment” you might need (e.g.. hospital bed, wheelchair, walker, oxygen, etc.) is at your home before you are discharged.
Kudos to my hard working hospital colleagues during this pandemic. As we settle toward normalcy, these suggestions are only the tip of the iceberg. Yet hospital administrators will find new ways to profit off your illness, re-direct doctor care, and add to their salaries, bonuses, and retirement.
For them it is a business, but for you it is your right to have appropriate medical care.
When you are ill, you don’t want to be challenged by compromised healthcare or a manipulated system. Knowledge is power, and utilizing this information can get you back home with loved ones to move on with life.
Gene Uzawa Dorio, M.D.
(*) Default Surrogate Consent Statutes, Sept. 2019, American Bar Association:
Thank you so much for your up dates. I have all paperwork done, need to make copies!
My son recently was I the hospital. He has issues so a little different to deal with. He had 2 very judgmental nurses that behaved unprofessional. One gave him a paper to sign, leaving against medical advice. Son didn’t know what he was signing. So he was out. Needing meds I called and asked how I was supposed to get those. Was told to wait til Tuesday and call doctor. He ended up back in ER to get meds. He spoke to house supervisor about treatment and nothing happened. Very disappointed in whole situation.
My wife, Carol, and I enjoy and look forward to your emails. In fact, we have not received any the past few weeks
How does our country compare with others such as Canada, England, France, etc.?
How does our country compare with others with regard to the medical care
parameters you have cited?
Within our U.S.A., how do our differently-funded hospitals compare—DoD
Hospitals vs. private nonprofit hospitals, etc.?
Henry E. Butler III M.D., F.A.C.S.
Commander, Fleet Reserve, U.S.N.R.
Email: HButler@post.Harvard.edu
Spot on in being pro-active now and not wait until your dependency becomes critical.
Plan for the UN-expectant.