* * Anonymous Doc: Limbo

Thursday, December 27, 2012


The latest chapter of "there's something awfully wrong with our health care system."  I have a patient who's been ready for discharge for a couple of weeks... but is still in the hospital because there's nowhere for him to go.  He can't be discharged home -- he needs a nursing home.  His wife refuses to have him sent to a nursing home, because she doesn't want to pay for it.  They have too much money for Medicaid, but not enough to afford nursing home care.  The nursing homes don't want to take him without guarantee of payment, since he's not on Medicaid.  So we're stuck holding onto him -- we can't discharge without a safe place to discharge him to.

The usual reaction in cases like this (and this isn't the only time it's come up) is to say that the wife is the problem and she's preventing someone who actually needs the hospital bed from getting care... and that's completely true, except I also understand where she's coming from.  Her husband isn't really her husband anymore.  He has no quality of life, he's non-verbal, may or may not know who he is, or where he is, or what's going on.  But he may linger for months or years, and it'll bankrupt her, and destroy whatever they might have been saving with the hope of a decent retirement.  And then if she ends up with medical costs down the line... perhaps in a situation where she could have some quality of life remaining... the money isn't there.

Of course there are all sorts of problems and inefficiencies with government-run health care.  But there are all sorts of problems and inefficiencies with a hospital ending up in a standoff with an elderly woman, losing her husband, who doesn't also want to lose her financial footing in the process, for no good ends-- her husband will never regain function, he will never be himself again.


  1. It's cases like this that make me wish for humane, human euthanasia. We're so much kinder to our pets.

  2. Can't believe people would blame the wife in cases like this. If she hasn't the money, what can she do? I'm sure if she could afford to pay for it, she would, but she can't spend money she doesn't have.

  3. I totally agree with you. But having dealt with Medicare a lot lately, they do some really egregious things too. A patient said to me today, "I thought everything would be better for me once I was on Medicare, but it's just as bad."

  4. One of my grandmothers, a widow, spent everything she had on her own nursing home care. She had almost nothing when she died. I think she left each of the grandchildren $1000.

    The other grandmother, also a widow, had a decent estate. She developed Alzheimer's. It cost many tens of thousands for home health aides, then hundreds of thousands for nursing home care, until she was finally eligible for Medicaid. She left a modest estate to her one surviving child, my mother. I hope it's enough to care for my parents when they require nursing care. There won't be enough to take care of any of us children, though.

    I don't judge the wife of your patient at all. She has to take care of herself.

  5. I may be wildly unpopular with this statement, but the fact of the matter is that saving up money for retirement does not mean you have the right to avoid using it for medical needs and only for "fun" stuff. There are a lot of ways to avoid this kind of financial scenario, and failure to prepare for the future is not the system's fault. Financial legacies are not inalienable rights.

    Yes, the "system" is unbelievably expensive and, at times, horribly inefficient. But it's not an unknown. Long-term care insurance, better financial planning, etc. are available to anyone willing to make the effort.

    And no, I'm not a conservative or a republican.

  6. Insurance companies are NOT the solution to this problem. Back in the day, I used to work in the marketing department of a company that used to sell long term care insurance, so I'm more than a little familiar with the product.

    Now that people (i.e., Boomers) who purchased long term care insurance are actually utilizing their policies, many insurance companies (including Prudential and MetLife) are no longer selling it because they're finding it is not a profitable product. IOW, the insurance companies wildly underestimated the cost of providing care, so continuing to offer LTC insurance products would necessitate charging much higher premiums. Check out the prices for LTC insurance. It has never been cheap, or even affordable to people of average means. Wealthy people don't bother with LTC insurance because they can afford to self-insure. So... the market for LTC insurance is: people who can afford the premiums, but cannot afford to self-insure. That's a small market. No wonder companies aren't writing any new policies.

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