Why not give older patients routine treatment at home?

What would be the outcome in terms of good patient care, efficiency and the relationship between the

According to old family diaries, the revered Dr. Ford visited my grandmother every day when she was sick, and sometimes twice a day. I imagine he could only offer little pink pills, sage advice and a reassuring pat on the shoulder, but she and the whole family were heartened by his calls. She recovered time after time until her final illness. She died at home.

In recent months, patient care in Schenectady has suffered from mandated mergers, hastily arranged provision of services and unreasonably long waits in emergency rooms. Is there any way that elderly patients could be better served and health care providers more efficiently deployed?

Consider this scenario: A 70-, 80- or 90-year old patient nervously sets his alarm to be roused in time for an early medical appointment. Bathing and dressing requires an effort unimaginable to the young. He eats breakfast — or not, if it’s fasting blood work he needs or something else requiring abstinence. He makes his way to a car and heads for the testing site. Here he or his driver search for the closest parking place — often in a dark, slippery parking garage. It may be some way from his destination and he may require a cane, walker or wheelchair.

At the reception desk he answers questions, fills out papers, digs for health care cards and finally is dismissed to wait until called to the testing site. He may or may not have to change into a gown. Faulty eyes or ears, impaired mobility and reduced strength may all contribute to his confusion in an unfamiliar environment.

Another scenario

What would be the outcome in terms of good patient care, efficiency and the relationship between the patient and the health care professional if routine exams, simple procedures and (I hesitate to even say it) reassuring words and a pat on the shoulder were provided in the patient’s own home or living site?

I’ve often looked around a packed waiting room and wondered how many of these people could have been treated at home — vital signs taken, a wound cleaned and medicated, an antibiotic or a temporary painkiller given or advice on diet or activity level offered?

Think of the overhead saved — the cost of fully equipped rooms (well-lighted and heated), receptionists, secretaries, triage nurses, cleaning and maintenance people on hand. We are fortunate to have modern, sophisticated, medical technology available, but not everyone requires it.

In this time of “green” initiatives, it might be feasible to send a doctor, a physician’s assistant or a nurse practitioner to the home of the frail elderly. The patients could wait in the comfort of their own homes and the professional would have the luxury of a quiet space in which to examine, ask questions and render care. Private practice at its best.

All of the professionals mentioned above are trained to spot the more serious diseases and could refer the patient for more testing or to the care of a specialist if needed.

Current crisis

All agree we are in the midst of a health care crisis. If you’ve ever had a visiting nurse, a home health aide or a skilled nurse or physical therapist come to your home, you know about the voluminous paperwork required by government regulators, insurance companies, HMOs.

Much depends on qualifying as “homebound,” an important word in the lexicon of insurers with strict parameters permitting or denying care. In my experience, the time devoted to paperwork far exceeded the time spent actually examining and talking with the patient.

I think of my grandmother, who died in 1941, a mere 67 years ago. Her trusted doctor could be summoned on a moment’s notice — no paperwork, no “qualifying” for specific treatments, no middlemen, no huge medical bill — just a simple exchange based on trust between two people before big business got into the game.

To repair health care as it now stands will require tremendously innovative thinking as well as the ability to imagine the problems of every segment of society.

Everyone who has ever suffered from the abuses now rampant in our many-layered system should be ready to fight for single-payer accessible health care. One compelling issue should be providing more compassionate care for the frail elderly.

Ruth Peterson lives in Niskayuna. The Gazette encourages readers to submit material on local issues for the Sunday Opinion section.

Categories: Opinion

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