In medical school, the importance of monitoring vital signs, labs, and disease markers was drilled into our brains. When these numbers were sub-par, we were told to advise folks to “eat less processed food,” “get more exercise,” “take your meds as prescribed,” etc. It becomes easy to fall into the trap of treating the humans sitting across from us in the exam room as the total of their labs and vitals. But for many patients, other factors are just as important. Some cannot easily eat well or bathe themselves, so they ask their PCP to find home health care to assist them with food shopping, meal preparation, laundry, and basic housework.
The PCP’s office must find an agency, the PCP must document in what ways the patient needs assistance, and then insurance determines how many hours of home care will be paid. Often the covered number of hours differs significantly from the time the patient requires. Rhetorical question: How does this gap get covered?
I don’t understand why the PCP is part of this certification. Insurance doesn’t cover me visiting a patient’s home and verifying they need help as claimed. Requesting assistance; inviting a stranger into one’s home; admitting the indignity of needing someone to assist with bathing, toileting, etc. is difficult. My patients are not scamming the system.
Imagine having no family or friends you can ask to help you with matters like these. Or not wanting to ask for fear of burdening them. So, at your next doctor’s visit, you summon your courage, and just as the visit is ending, you manage to explain that although you raised several children and worked productively, now, for a myriad of reasons, you need help.
Labs and vital signs leave so much of a patient’s story untold. We need a new set of medical questions, starting with: “How do you spend your day?” Many patients spend their entire day in bed, mindlessly watching television, alone.
We also need to ask about activities of daily living: “How do you get food?” “How do your clothes get washed?” “How do your meals get prepared?”
My patients heartbreakingly have shared some of the answers: “A neighbor goes to the store for me once a month.” “I only get takeout fast food.” “I keep a bottle in my bedroom because I can’t get to the bathroom in time.”
Imagine an affordable, accessible, stimulating co-living space for those needing such assistance. I would sign my loved ones and myself up for that!
Pam Adelstein
Newton, Massachusetts