Hospitals are a lot more dangerous than people think, especially for the elderly. Three times as many people die from errors in hospitals than from car accidents every year. Experts in the medical field tend to agree that if someone does not absolutely have to have access to hospital grade care, they are safer recovering at home. It’s not just the exposure to infections and disease, but also a whole host of other problems that largely come from putting the budget above patient-centered care. Reducing our national health care expenditure has led to a reduction in quality of care, and while people are living longer healthier lives now more than ever before, how much better could we be doing with the appropriate attention given to each patient’s needs?
Hospital stays increase risks for ill effects in patients, especially the elderly. Just a few days of bed rest is damaging to an aging body, making it harder to get up and get moving after a stay, independent of the medical recovery needed. Patients are prone to infections, pressure ulcers, and other illnesses that add to recovery time and overall poor health. Testing and treatments can lead to unintended side effects, complicating health issues even further. The stress of the illness and the strange environment increases falls, confusion, and even delirium, which often goes unnoticed and untreated. Incontinence develops in more than 40% of elderly patients within a day of admission. It’s very difficult to get a good night’s sleep in a hospital; there is always noise, uncomfortable devices monitoring health, and often patients are woken for a test or check in – this is not good for recovery. Nobody finds hospital food appealing; add in difficulty managing a food tray while in bed and a lack of assistance to eat, and undernutrition becomes a problem for many. Prescriptions are often added or changed, and this can lead to unintended interactions with medicines the patient is taking at home. The pitfalls are many, and even with all the staff available to treat illnesses, there isn’t enough time to take care of patients.
One story from the Washington Post illustrates this point beautifully. It tells of a 91 year old woman who fell in her garage while home alone. She pressed her medical alert button and had EMTs helping her within five minutes; fifteen minutes after that she was at the hospital. From there her care devolved. She spent eight hours having tests run and waiting for a bed, with next to no attention paid to her personal needs or her pain. A chest X-ray was taken, but no one checked it for 12 hours despite her worsening cough, fever, and low blood oxygen levels. Her son, a geriatrician, asked for the results and only then was the X-ray checked, pneumonia discovered, and her condition treated. Trays of unappealing food mush were delivered to her room and left out of her reach. Equipment alarms went off regularly, but no one ever came to check on her or turn off the obnoxious, sleep-depriving noise. She was not bathed in more than a week, never repositioned, and no one came to ask if she was in pain or needed anything. The discharge planner, however, came by from the first day. The patient’s advanced directive stated that she did not want a feeding tube, but the doctors tried to order one anyway; the geriatrician son insisted that her wishes be honored and reminded them that the feeding tube would not resolve the medical issues at hand.
This woman was lucky in that her sons stayed with her and provided her care. They helped when she needed something, pestered doctors and nurses for test results, and made sure the staff knew when her condition changed. They were advocates for their mother’s care. The sons asked why their mother was not being tended to in the way they expected; more than one nurse responded, “We used to do all those things, but there is no longer any time.”
The patient’s overall health is no longer the focus at hospitals. They have shifted their attention to the bottom line in order to stay in business. Cut backs from Medicare and the skyrocketing cost of healthcare have forced cuts in hospitals that are not good for people. While there are certainly still untold numbers of dedicated doctors and nurses who go the extra mile for their patients, tighter budgets mean everyone has a heavier workload – more patients per caregiver, a wider range of responsibilities, and less time for the kind of personal attention people need. This has contributed to 100,000 deaths every year due solely to medical errors in hospitals. Unless a hospital stay is absolutely necessary, consider other options before heading to the emergency room for treatment.