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Navigating Heath and Aging: Changing health care means paying attention

I love being a nurse. Thirty years later, and I remain grateful to be a part of my patients' lives, even if only for a short time.

I have traveled the lifespan - beginning as a labor and delivery nurse, working as a home care infusion therapy and chemotherapy nurse, triaging phone calls for pediatrics, research nursing and now advocating for and navigating patients (young and old) through the health-care maze. Nursing has been good to me.

Here comes the "but" ... as a nurse of 30 years, the downside, or occupational hazard as it seems, is remembering the "good old days."

The "good old days" for most of us are the remembrance of the way things used to be. Usually and admittedly we tend to remember the best memories and often forget that those "good old days" had their own challenges. This is like having a baby and experiencing the pain of childbirth, yet we look back and remember the best of the experience. The good old nursing days are those in which our patients were admitted to the hospital, if need be, and then treated until they were all better. It seems we fixed them, if there were any hope of that happening.

Here comes the rant - the complete and total frustration of caring for people in the age of bean counters controlling health care. I had a discussion with another nurse recently, in which we agreed that we became nurses to care for people, as opposed to financial planners trying to figure a way around the health-care dollar squeeze - those who care become rogue renegades looking for a way to get Medicare to pay.

For example, a simple urine test appears necessary because an aging person is acting confused and unusual, but Medicare follows the textbook symptoms that may not apply in an aging person to decide whether it is necessary.

I want the days back when doctors decided what test was needed, and which antibiotics to use.

I want the days back where doctors decided whether a patient should be admitted to the hospital, not CMS (Centers for Medicare and Medicaid Services).

These days, CMS tells the hospital: Give us a good enough reason why this patient needs to be admitted and we'll pay you. If not, sorry, you lose. To some, this attitude sounds like fiscal responsibility or cost containment. To others, the word "bully" comes to mind. In the attempt to walk the fine line in order to get paid, hospitals are only admitting the sickest, while the others get sent home or are placed on "observation status."

You can now get a hospital bed and not really be admitted for days. This prevents big brother CMS from denying payment. What does that mean to someone who is aging and sick and becoming deconditioned by illness? It means you don't get your three-day stay that allows you to move on to rehabilitation, which is paid for by Medicare, if you need such treatment. It means you go back out into the world and visit your doctor with the hopes you will get well ... unless you don't.

In that case, it means you might not get well and need to go back to the hospital. However, CMS has a way around that too. If you come back within 30 days, CMS won't pay for that either. Hospitals are getting a bad rap for the other guys making the rules. Hospitals are challenged to become creative regarding how to treat people.

It's important that we all start paying better attention before hospitals start folding. Consider how many hospitals have the same name you remember. Many of them have a conglomerate name attached, because they have to join forces to remain in business.

What can we, as consumers, do?

Contact your representatives and tell them your experiences. Tell them you want health care to be controlled by health-care professionals. Tell them you know about the little "observation status" secret. Tell them you want them to start paying attention in order that we will have a place to go when we get sick, and the doctor decides whether we are sick enough. Tell them to support the bill "Improving Access to Medicare Coverage," H.R. 1179.

I try to be an optimist and remain hopeful that something good will come out of all of this change. Maybe healthcare will become available to all. Maybe your doctor - who is mandated by law to spend more time touching the keys of a computer and looking at the screen, than actually touching and looking at you - will be a better practitioner for it all. Maybe we can all figure it out. But really ... I just want the "good old days" back again.

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