This is the story of a 90-year-old woman, her ill treatment at the hands of Australia’s broken aged-care system and how I came to dispense possibly the worst advice of my career. One day, I call an old friend who sounds frazzled. Her mother has been discharged from a private hospital in deconditioned form.
A healing wound demands an intact dressing, which in turn means help with personal hygiene. She is cognitively intact but fatigue-induced risk of medication misadventure calls for oversight. My friend explains that travelling to her mother every morning is becoming logistically difficult and affecting her job.
“She needs home help until you can get there.” I frown, somehow forgetting that her three professional daughters would know this. When my friend claims she can’t find such help, I declare it unbelievable and tell her I will fix it. Little do I know how hollow my promise is.
The hospital says that the patient could have accessed interim help if initiated at the time of discharge. In other words, it’s the family’s fault for not asking.
An apologetic woman at the council explains that it first became unsustainable to deliver meals and, now, home help.
She refers me to My Aged Care, a government portal I regularly use to register my most vulnerable elderly patients.
The registration part is quick – and I emphasise rather than downplay their vulnerabilities to hasten the assessment. If eligible, patients are assigned funding based on needs: from occasional home help to nursing home level care. Then comes the toughest hurdle: finding a provider. The portal hints at this but the current wait of 12 months or more tests even the most forgiving description of “a short while”.
Like many people, my friend’s mother did not plan ahead. This might be said to be her only “fault” but when you are still clambering up football stands in your 80s, you could be forgiven for thinking that aged care is for the truly elderly.
After a long wait for an assessment, a package is approved. Then, my friend comes unstuck finding a provider. It defies belief that in a sophisticated, “most livable” city like Melbourne, there is no public provider to help a frail nonagenarian shower and dress. But ironically, if in the process of helping herself, she trips, hospitals will fall over themselves to repair her fractured hip at far greater cost.
I call a geriatrician, who offers sympathy without solution. Disbelievingly, I call a second geriatrician, who says that the only way out is for the family to fund private help as a bridge to government support.
Curious, I call the private company and the boss answers. She is knowledgable (“you’ll be waiting a long time for services”), efficient (“we can send someone tomorrow”) and empathetic (“this must be a hard time for you”). The service sounds too good to be true, so if I wonder if it is untrue or just expensive. The latter: a minimum three-hour package costs more than $200, not covered by private insurance.
If it were one of my patients, I might as well tell them to move to the moon. But while the sum is initially affordable for my friend, the open-ended duration sounds a warning bell, especially if her mother’s needs increase.
Stumped, I offer possibly the worst advice of my career.
“You can take your mother to a public hospital and leave her there, saying you can’t manage.”
These words fill me with shame. Doctors are supposed to safeguard public hospitals but I am encouraging their misuse. The terrible part is that I know exactly what happens to such patients because I meet them on my medicine rounds.
A tired resident repeats a tired story of another old person admitted for “social reasons”. The family is labelled “acopic”. A battery of tests seeks nothing and finds nothing. Doctors call the social worker, who can’t perform magic. With dozens of such patients admitted on every shift, there is no time for human communion. Patients feel unwanted; relatives feel guilty; and the “helping profession” feels astonishingly helpless.
In an event that could not be scripted, my friend’s mother returns to the emergency department of the same private hospital where a medication causes a serious reaction. Hours later, a doctor proclaims her “fit for discharge”, following which she immediately collapses. Without witnessing it, I would have dismissed the story as ridiculous.
My friend complains and the hospital deigns to ask what “outcome” she desires. Instead of saying, “I hope this doesn’t happen to anyone else”, (it will), she should have demanded an apology to her poor mother and interim care – minor recompense in my view for her lost sleep, lost income and lost faith. But she quietly takes her mother home.
This is just one example of how the healthcare system is desperately failing our elders and needs an injection of reform and humanity. The problem is not only funding but also directing funding to the right places.
Still, I console myself that the all too frequent morally distressing experiences in medicine may be turned into lessons for the future.
Here are three I will be teaching my residents.
One, the aged-care system is so fraught to navigate that when elders end up in emergency for “social reasons”, we must treat them with utmost care and respect while demanding higher standards.
Two, no 90-year-old who collapses while under medical care should be sent home that night. No amount of “bed pressure” justifies doing the wrong thing. Administrators don’t discharge patients, doctors do.
Finally, the sorry-not-sorry brand of apology has no place in healthcare. Bureaucrats who “protect” doctors in this way do us a disservice and help erode the doctor-patient relationship.
Months later, my friend is still waiting for help. Her mother’s demoralisation is complete.
If this could happen to an English-speaking, articulate, professional family of means, we should all be worried when it’s our turn.
• Ranjana Srivastava is an Australian oncologist, award-winning author and Fulbright scholar. Her latest book is called A Better Death
