More than two-thirds of Americans use social media, and 90 percent of adults in the U.S. have a cell phone. With these tools surrounding us, we must be more connected with one another than ever before. Right?
It doesn’t feel like we are. At least, the people who engage with the health care system don’t feel connected to the rest of us. They feel lonely. It feels like we send them off into situations in which we know they’re not equipped to succeed that at the intersection of the health care system and the rest of society altogether, we’re doing just what we talk so much about within clinical practice — siloing off from each other.
The health care system has no pill or procedure for this problem. We should not mask its symptoms. Nursing facilities are the furthest things from the answer. Home care visits, while important, serve other purposes.
Our society, at least on any meaningful scale, has not reorganized to meet the needs of its isolated elderly. So many could be helped more than anything by simple contact, yet we engage with them only during sickness episodes. We haven’t reorganized to address a group who we’ve done well enough caring for to keep alive but not nearly well enough for to keep safe, active or engaged once they can no longer live alone.
We wonder at the patient who returns to the hospital time and again. We tell each other “he’ll be back,” when we discharge the man with the wound on the sole of his foot, the history of substance abuse, who cannot afford his medicines, has no family or support, who has not worked in years — as though the hole he finds himself in is one that could be escaped from through hard work or determination. We erect boundaries around what constitutes hospital care and where personal responsibility begins, then we ignore the massive unclaimed territory between them — the vast expanse that exists between what we’re designed to offer and what patients really need.
Evidence-based health care surpassed the biomedical model long ago. It’s well-established that health and disease are influenced to a great degree by psychosocial factors. We know that social stress — an emotional experience – can stimulate a range of harmful physical changes. The mechanisms are complex: chronic stress (of any cause, loneliness, poverty or otherwise) leads to a sustained increase of sympathetic nervous activity, which drives expression of genes and production of cells that promote inflammatory changes and generates high blood pressure and hardening of the arteries.
And causal or not, a relationship exists between social isolation and behaviors like physical inactivity and poor diet — choices that also elevate risk for nearly every kind of disease. We don’t need any more literature to understand this. We observe over and over the positive-feedback loop of sickness and social withdrawal.
This has become an inherent deficiency of the system of health care delivery in the U.S. The people we are tasked to care for come to us problems we understand. Their solutions are not always straightforward, but the barriers to their implementation we ourselves have created.
Because there is no money to be made in solving these problems under the current structure of reimbursement for services, we go instead through the motions of administering treatments that we know will not be effective until the more fundamental problems underlying the disease are addressed.
Our patients return, worse off than they were, and we tell ourselves that burnout is a product of work volume rather than our own powerlessness to help the people in front of us.
We have the resources to solve these problems, and in fact, they might present their own solution. We need only to make the first move, without expectation of reward.
There are many retirees armed with the willingness to help, and there will only be more. There are many extant models we could emulate: consider how we assign jury duty and how we perpetuate social security. We need to care enough to coordinate what we have with what patients need. If we do well, we can leverage the financial benefit to the system to influence change.
This is a situation where everyone involved can win. The only lasting solution to this problem will be the one which benefits every group aiming to keep patients healthy rather than treat them after they’re sick.
The people who spend so much time as patients, because our system has no good solution otherwise, would experience enormous benefits of reduced mortality and morbidity: they would add years to their lives and life to their years. They could escape the cycle of being hospitalized, warehoused in facilities and teetering on the edge of safety at home for brief periods between sickness episodes. They could, themselves, find renewed purpose in checking on elderly neighbors and supporting peers.
Our system, starved for common-sense solutions that cost a little and accomplish a lot, could save enormous sums for doing something better than what it’s doing right now. And providers could do work that might deliver the impact it’s supposed to. We all benefit from the power of cumulative purposefulness.
Social wellness visits will not ever produce billing revenue. That’s not a problem of the idea, but of our strange collective viewpoint about the purpose of health care services. To advocate for good programs, sooner-or-later demands a willingness to reduce their value to cost-modeling. If we view hospitalization for chronic illness as a failure on the part not just of outpatient services but of the community itself, it’s easy to see why proactive wellness visits could be cost-effective. Keeping patients out of the hospital is a cost-saver for the system. It’s a benefit to taxpayers. It preserves access for the very sick.
There is only one focus which will lead to sustainable change in our system. We need to do the things that keep people healthy, that are good for them before they become patients.
Deficits of social connection may not fit into DRG buckets or under the ownership of one group. This should not limit us from addressing them. We can help people in meaningful ways by choosing to put their needs and the long-term health of our system before the rules that we have in place now.
John Corsino is a physical therapist who blogs at his self-titled site, Health Philosophy.
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