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Two elderly aunts, two health systems

WOKING, ENGLAND — A few years ago, I drove my 96-year-old aunt from her assisted-living apartment to the emergency room of a Twin Cities hospital. She was experiencing congestive heart failure, and sat doubled-over in her wheelchair, in great discomfort, trying her hardest to breathe.

Despite my repeated pleadings at the nurses’ station and calls to her physician, she did not see a doctor for six agonizing hours (and only then, I believe, because I threatened to call in the media). It took another two hours for her to be admitted into the hospital and given something to relieve her obvious pain.

I was then told she could stay in the hospital only a night — or two at the most — and that I would need to find nursing home care for her. As it turned out, however, I never had to make those arrangements. She died that night in the hospital.

For the record: She had very good private health insurance.

This week I’ve been in England caring for another elderly aunt, my mother’s 92-year-old sister, a dear, sweet former nurse and midwife who experienced a terrible fall in her home last week. (She spent 17 heartbreaking hours on the floor of her bedroom before a family friend became worried and went to check on her.The emergency call necklace, which she had been given by some governmental agency, lay draped across the back of a chair, just out of her reach.)

I wasn’t with my aunt when she was taken to her local National Health Service (NHS) hospital, but I (along with my sister) have visited her there every day since. No one has set a time limit on how long she can stay in the hospital. In fact, the staff has informed us that she won’t be released until she’s off the antibiotics she’s being given (she was discovered to have a low-level infection). Even then, she’ll remain hospitalized — but at another nearby NHS facility that specializes in rehabilitative care. And she can stay there, we were told, until a room opens at the residential home (a cross between an American assisted-living facility and a nursing home) where my aunt has told us she’d liked to live next.

All this costs money, of course, and my aunt, like all British citizens, pays a hefty tax to support the NHS. Nor am I sure Americans would go for the rather unadorned (by American private hospital standards) hospital services. My aunt, for example, is in a large ward with five other elderly women — a lack of privacy few Americans would tolerate, I suspect.

Still, the care my English aunt is receiving is attentive and — how shall I put it? — totally focused on her wellbeing rather than on how well-off she is in terms of insurance. No paperwork to determine who pays what. No calling of an insurance agent to see if she’s covered for this or that. No pressure to get her out of the hospital before her family can arrange for her to be somewhere safe.  

And — despite the rumors running rampant in the U.S. about Britain’s "death panels" — no talk of pulling the plug on my aunt or any of the other "grannies" on her ward.

NHS care is not perfect. My sister and I have our list of complaints. Nor am I suggesting that my experiences getting health care for my elderly aunts is typical for either the U.S. or the U.K.  But based on those and other encounters with the medical systems in both countries, I know which end-of-life approach seems (to me, at least) more patient-centered. More civilized. More caring.

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Comments (3)

What kind of sick writer would compare two health systems? Just kidding thanks for the article. I for one am a bit dismayed by seeing all the cute billboard ads that Regions hospital is now running. My mother spent time in the Aberdeen SD hospital and in some rehab care. I wonder how a more social (i.e. larger room) setting would have worked out. Do they have any other concerns regarding hygiene?

About 10 years ago, I took an elderly (96, 97) to Regions because she had chest pains. She was taken immediately to the cardiac unit and remained there for days, receiving care from a highly skilled staff. This part was fine.

What Regions did NOT provide, however, because of layoffs due to money shortages, was sufficient nursing and nurses' aide care. On her fourth day in the hospital, she not only had not been bathed but was wearing (in bed) the blouse and underclothes she had on when she was admitted. I hope the hospital has been able to improve this part of its patient care.

I am very sorry to hear that the hospital to which you took your 96-year-old aunt was so terribly remiss. Did they give any reason for not helping her right away?

Dan: British hospitals have the same problem with deadly MRSA infections as do American hospitals. And they, too, have launched a massive campaign to reduce the MRSA incidence rate. My aunt's hospital has huge signs everywhere telling visitors and staff to use the antibacterial disinfectant dispensers that appear everywhere--including at the foot of my aunt's hospital bed. A voice also reminds us to use the dispensers as we enter and leave the ward. I've watched the staff carefully. They seem to have gotten the message. Not so sure about visitors, however.

Bernice: I have often reprimanded myself for not thinking to tell the hospital staff that my aunt was having chest pains (even though she wasn't). I believe she would have then been immediately admitted as a heart attack patient. As it was, I never got a satisfactory answer for why her care took so long. My English aunt is bathed daily, by the way, but NHS nurses appear to be just as overworked as American ones. Doctors here, however, spend much, much more time with each patient.