We need a better system...

On Thursday, I spent the better  part of four hours in the emergency room with my sister and her family. She has Stage 4 cancer and is undergoing chemotherapy. This is the latest in a long, long line of medical treatments she has had in the past several years. When she was diagnosed with her cancer, it was already at Stage 4 and inoperable. The best the doctors could do was to offer medical treatment to "prolong life" and estimated that they might give her another 5 to 7 years. Chemotherapy was the treatment of last resort because it is the most heinous, foul, poisonous thing a person can possibly have to do to their bodies. But, that is where she is at right now.

The cancer is wily and moves around in her body so when a tumor shrinks or leaves an area another one pops up somewhere else. Recently, two of the them took over her left knee making it impossible for her to walk with any sense of safety. It gave her what they call "drop foot". Over time, her right leg weakened as well and she is now not able to walk at all making her care at home almost impossible. Which is what led to her going to the ER on Friday. She was, for the first time, completely unable to stand, bear weight or move her legs. She could not even roll over in bed.

At the ER, we were told that she was just going to be sent home because her vitals were all normal and there was no medical reason to keep her at the hospital. Now mind you, no other tests had been done and her primary doctors hadn't been consulted but the social worker was telling us that my sister's insurance would not allow them to admit her as inpatient. She has Medicare.

We asked about nursing home care and we were told that Medicare would only pay for that if she was in a hospital for at least three days and then they would pay but, if not, Medicare would deny it so she would either have to go home or the family would have to pay for the nursing home out of pocket. That would have been a cost of between $7000 - $10,000 upfront.

We asked about Hospice Care, knowing that Medicare pays for Hospice and Hospice will pay for nursing home up to a 30 day stay. We were told that she would have to go home and wait to be assessed at home by a Hospice agency because they could not come into the hospital to assess her. So, even though she would be lying in her bed, immobile, with no way to move, use a toilet or change positions, she would have to wait until someone had time to come out to her. Then, the social worker, unbelievably, told us - and I am not kidding - that she was positive that if my sister went into a nursing home for 30 days she would DEFINITELY decline and they would allow her to lie in bed all day and she would get pneumonia and be right back in the ER when she was released!

Naturally, my sister was terrified. Her daughter was terrified. Her husband was at a loss to know what to do. Eventually, her doctors did get involved and took care of the situation and got her admitted for tests to finally find out what the heck was making her unable to walk. But, the time spent in the ER was eye opening to me.

The inadequacies of our health care system is appalling! My sister has Medicare - the insurance provided to her by our government because she has worked hard all her life and paid into it and deserves to have it and it pays for the barest, minimum of things and makes the health providers have to jump through such hoops in order to get people the care they really need. Then, the attitude of some of those providers about people with Medicare was clear and present in that ER. No time or thought was given to the stress, fear and worry that my sister was feeling. That social worker was rude and probably should seek other work. We can do better. We have to. People deserve and have a right to good health care that is helpful and accommodating. When people are sick and scared and need help, they have to rely on professionals and their insurance to be there for them. No one should have to go through what my sister did in the ER and she was lucky because she has a big, loud family there to advocate for her. What about those who don't? When we asked that question, what about someone who didn't have someone at home to take care of them - what would they do? The social worker said, and I quote, "You have to understand, we can only do what Medicare allows. We'd have to send them home." So, in other words, make sure you have a support system that you create for yourself because you cannot and should not rely on any medical professionals or the government to help you out when you really need it.