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.