There’s a particular bit of conversation I hope never to hear when my doctors are discussing surgery or testing. Not the details of the procedure. Not the possible outcome. Not the pain (and let’s be real, we all know “some discomfort” is actually “pain”). It’s the post-op directions that pose a conundrum: “You’ll need someone to drive you home.”
Nothing sparks dread and uncertainty for me like that statement. It’s a problem for a lot of patients that has been heavily discussed on social media, and it’s one hospitals have been slow to address.
I think all of us recognize that hospitals cannot legally or ethically just let a sedated post-op patient wander off alone. They want to ensure everyone gets home in one piece, doesn’t cause a traffic accident and has someone to watch over them. What isn’t recognized is how difficult it can be to arrange. There’s an assumption that those who have trouble finding someone to accompany them must be friendless and estranged from family, with no one in their lives — and their situation must be an anomaly. It’s not quite that simple, and it’s not rare.
As per the 2020 Census, 28 percent of U.S. households consist of one person, meaning that there’s nobody at home to offer assistance. Several years ago, the Washington Post reported that 22 percent of older Americans are “solo agers” or “elder orphans” with no trusted support systems. Even when there are other people in the household, they may not be reliable caregivers or have access to a car to drive someone home from the hospital.
Wait, ask a neighbor! Or not.
Sorry, the odds are not high that Aunt Bee is going to drop in with a bowl of chicken soup. Even when people truly want to help, finances and logistics often become insurmountable obstacles. Taking time off from work is not always possible, especially if it’s unpaid. Child care can be expensive and difficult to find. Friends and family may already serve as caregivers for someone else in their lives or have health concerns of their own that make it hard to help. Additionally, we might not trust casual friends, neighbors or co-workers quite enough: even if we say hi in the laundry room or go out for pizza sometimes, we may not feel comfortable entrusting our personal safety to them while impaired and vulnerable.
Proximity is also a consideration; many of our loved ones are loved from a distance. According to Pew Research, 45 percent of U.S. residents surveyed live more than an hour’s drive from any extended family.
If a person has a nearby friend or relative who can step in, they’re still not out of the woods: some hospitals insist that patients leave in “personal vehicles.” Not everyone can drive; not everyone who drives has access to a vehicle. When patients are not allowed to leave with their caregiver in a taxi or rideshare, some of them aren’t getting home at all.
Even as someone with a support system, if I needed sedation or anesthesia, I’d be in a real bind. My family and circle of friends are spread across several states and countries. My local friends mean well, but none are in a position where it would be easy for them to step in. One cares for a parent with Alzheimer’s; another has small kids at home; a third works 12-hour days at her own business and has no one to fill in for her; and so on.
Given the pandemic, it’s not safe for my older relatives to fly in to assist. If they did fly to help, they could still be disqualified because we’d need to use rideshares, not a “personal vehicle.”
And I’m not alone. Bella DePaulo, writing about this issue for Psychology Today, points out that some patients become so desperate to have their surgery they end up risking their safety — hiring complete strangers on the internet to pose as family to appease the hospital. They might end up going through procedures without sedation or anesthesia that could make the ordeal far less stressful and agonizing. Or they are forced to skip it altogether, leaving conditions untreated or unscreened.
Medical websites generally advise staff to postpone procedures until patients find someone to look after them. This really isn’t a solution, and in practice, it means that some patients will never be able to get the care they need. The answer might be allowing patients to remain in recovery areas longer, or admitting them for, say, 23 hours until they are lucid and able to get home on their own.
It might be arranging home health aides and non-emergency medical transportation to take a patient home and check in with them for the first few days. Admittedly, insurance companies won’t like these ideas, but it’s worth fighting for if the alternative is not getting the care at all. It’s a project for local nonprofits to work on, too: cultivating a network of vetted individuals who are willing to be post-op escorts and collaborating with hospital social workers to connect them with patients.
The status quo is neither working nor protecting patients as intended. Hospitals and surgical centers need to be realistic about the availability of loved ones to care for a patient or escort them home. There needs to be a more viable strategy than “don’t come back until you’ve made a friend with a car,” and ignoring the situation won’t make it go away.
Denise Reich is a patient advocate.
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