This is part of an ongoing series in which Bronx writers share their personal stories on the state of healthcare in America.
by Silvia Blumenfeld
February 11, 2019
I thought I knew how to navigate the healthcare system until I found myself lost in the maze
The main focus of this series has been on the double indemnity of health crises and financial troubles. Stories have focused on how the expense of healthcare has led to trauma beyond the illness itself. Even people with costly insurance have found themselves one illness away from bankruptcy. Today’s story by someone whose career involved advocating for patients found herself caught not so much by her personal financial expense but by the impact of the current system on the delivery of care: a broken system has added costs (physical, psychological and fiscal) that impact everyone.
A few years ago, I officially retired from the healthcare field where I worked for over forty years in various venues ranging from long term care to acute psychiatric settings. Often in the facilities where I practiced, I functioned as a case manager. When I retired, I served as a volunteer Long a Long Term Care Ombudsman—part of a state run program, (LTCOP)
Using my professional experience, I served as an advocate and resource for persons who live in nursing homes, adult homes and other licensed residential care facilities. Ombudsmen help residents and their families understand and exercise their rights to quality of care and quality of life. The program promotes and protects residents’ health, safety, welfare and legal positions by receiving, investigating and resolving complaints made by, or on behalf of, residents. By supporting resident and family councils, and by informing governmental agencies, providers and the general public about issues and concerns impacting residents of long-term care facilities, Ombudsman services work to effect real change. These services are free of charge.
LTCOP advocates for more than 160,000 residents in 1,547 long-term care facilities across New York. These include 115,708 nursing home residents and 44,639 residents of adult care facilities, assisted living and family-type homes. In 2013, there were 920 certified volunteer ombudsmen providing a regular presence in facilities and helping protect the care, safety and rights of residents.
I thought I knew the system in most of its permutations. But this past summer, I found myself greatly in need of services that I had formerly rendered for others. I needed an advocate. It was a learning curve and I saw facets of our current system that I had not faced professionally. That awakening came through a series of trips to the emergency room for my husband. There were surgeries and a myriad of complications that followed. I came to learn that the E.R. at Montefiore, our local hospital, is among the busiest in the country.
There were six trips to the E.R., in about as many months. On each occasion, the staff determined that my husband needed to be hospitalized. But there were no beds in the E.R. This necessitated a wait in the E.R. for an average of 22 hours even after my husband was seen and it was determined that he would be hospitalized. But, for his particular case, there were no beds in the main hospital. We had to wait for someone to die or to be discharged. It was crowded in the E.R. with other patients in the same situation. . The staff was mostly great, and tried to contain the chaos, but it wasn’t really working.
Accompanying family members (who remained beyond the initial admission and who wished to keep the patient as comfortable as possible) were required to stand next to a gurney: no chairs to be found. Imagine how it must feel after determining that emergency services were needed, rushing to the hospital, seeing my husband strapped into a gurney and waiting with him, trying to calm him and trying to deal with my own anxiety for that long a time. What does this initial wait mean for people who care for their families and friends? They are exhausted before the patient is admitted (usually for a very brief hospital stay). Patients often return home still weakened and debilitated and the caregiver is also exhausted by the accumulated tension.
During one such hospitalization, I was rushing from the intensive care unit where my husband was after surgery to get things needed for his recovery. I fell and broke my arm, requiring surgery so both my husband and I were in need of care. These multiple experiences led me to understand the extent to which our system needs fixing.
One can’t help but think, there’s got to be a better way! Actually, there is one. It would help if people in our community could count on good community based, accessible health care when and where it’s needed. Part of the reason for crowding in emergency rooms is that people without insurance or people whose insurance does not cover consistent visits to a primary care (or a specialty) physician almost always wait too long, not taking proper meds because they can’t afford to take them regularly, not having somewhere to go when they find themselves with a “small”—easily treatable—situation, feeling frightened that something that seems dangerous might lead to disaster—and so they wind up in the emergency room.
If we had affordable, consistent, available healthcare for all New York residents, the E.R. could go back to caring for really sick folks who get caught in situations where neither they (nor their long-standing physicians) expected them to be, where an emergency would truly be an emergency. A good and comprehensive Single Payer program of holistic and preventative care would go a long way in improving the lives of New Yorkers. See The Campaign for NY Health.
With a BA from Barnard and an MS in therapeutic recreation, Silvia Blumenfeld has developed and implemented therapeutic arts programs in a variety of settings throughout the Bronx.
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