The Rodney Dangerfield's of Medicine

Geriatricians are the Rodney Dangerfield's of Medicine. We get no respect!  Throughout my career I've heard the refrain, 'what's special about taking care of old people?'  A lot, in fact.  I've always told my patients, "if you want a doctor who prescribes lots of medications, orders lots of tests, sends you to lots of specialists and puts you in the hospital at the drop of a hat, I'm not your guy!"

Here we are, in a pandemic that is particularly lethal to older adults who live in congregate living such as assisted living and nursing facilities.  Everyone is afraid to go out. People aren't going to the doctor or the emergency room.  Many hospitals are emptier than usual.  But the danger to nursing homes lurks in the background.  Nursing homes are the typical recipients of patients from the hospital.  It's a perfect storm.

The majority of people in the hospital are older COVID19 patients needing a place to go.  There aren't expensive procedures for the hospital to profit from.  The nursing homes are primarily housing frail older adults paid for by the Medicaid program.  The nursing home receives less per day than a stay at the local Marriott.

The reimbursement weaknesses in our health care system are on full display.  How do hospitals and nursing homes make money right now?  What's best for the patients?  There's a conflict.  Nursing homes are struggling to get enough PPE (personal protective equipment) and testing to fight this scourge.  Hospitals have been the supply priority.

Hospitals want to reopen for elective surgeries.  That's how they make money.  That means sending the COVID19 patients back to nursing homes.  The nursing home industry sees that as a way of increasing revenue.   Is it the right thing to do for patients?  As hospitals return to "normal," they'll need the PPE and testing that the nursing homes need so desperately to protect the frail older adults who live there.  As COVID19 patients are returned to nursing homes, the virus threatens to overwhelm facilities that are not fully prepared to care for them, thus putting the lives of the residents at greater risk.

Which brings us to what's happening in California.  The California Hospital Association, in conjunction with the California Association of Health Facilities (representing the nursing homes) and the California Department of Public Health, convened a group to "figure out" how to make this happen.  What's missing?  What could possibly go wrong?  There was no representation from geriatrics and long term care medicine.  We're talking about health care.  We're talking about the lives of frail older adults.  We should be talking about "doing the right thing." We should be focused on delivering quality care to older adults.

Instead, this group is focused on how to reopen hospitals and how to get higher paid patients into nursing homes, regardless of the fact that it might literally kick off another surge of COVID19 in the nursing homes, putting the lives of both residents and staff at greater risk.