Healthcare, it’s a very popular topic these days especially with the “graying of America,” one of the deepest recessions we’ve experienced in 25 years, and people losing their jobs and the health coverage that often comes with employment. President Obama used his intention to reform the healthcare system and get coverage for more people as one of the key issues to catapult him to victory this past November. Medicare, Medicaid, prescription drugs, physical therapy, I could go on and on,but there’s not doubt it’s a topic that’s on many people’s minds, and also one that’s very misunderstood because of the many various twists and turns the topic entails. While the purpose of this article is not to sort out the topic in it’s entirety (I don’t think ANY one article could do that), the sub-topic I wish to address is a very basic one.
One thing that I’ve noticed in my practice is that people don’t understand the basic type of impairments that one might experience and the care these impairments require that would cause them to go to the healthcare system for help. Without understanding the basic impairments, how they are defined, and what they entail helps explain why there is even greater confusion, and even frustration whenever there is a problem at one of the more advanced levels in the system. If what follows helps to clear up healthcare at it’s most basic level for its readers, it will have done its job.
ACUTE CONDITION – Can be defined as a health impairment that, if not taken care of immediately, can lead to death or long term disability. In most cases, an acute impairment can strike and be completely cured such as when one gets the flu. But it could strike, and even with care, leave one permanently physically impaired like a stroke (more about this later.) When one first gets the stroke it is imperative that the person gets to the hospital immediately because the quicker it’s caught, and the proper steps taken by qualified professionals the less the long term effects. This is what makes it an acute condition in the beginning. When you hear the topic of healthcare being discussed in social circles and on the news, more than likely it is financial assistance with acute care that is being discussed. When we have an acute impairment we go to the doctor, or a health clinic or hospital depending on the severity of the impairment. The treatment is paid for by health insurance that we have either through our employer or on our own, by Medicare if we’re disabled or age 65 and older, or by Medicaid if qualified by income.
CHRONIC CONDITION – The next type of healthcare we’re going to discuss is regarding people who have conditions that can be managed but not cured. People with chronic conditions can live somewhat normal lives, meaning they can live in their own home, cook their meals, shop, bathe, drive to the store, walk etc. without any assistance. They also might be physically or mentally impaired. Which we’ll further discuss below.
PHYSICAL IMPAIRMENT – A physical impairment leaves one incapable of performing one or more of the Activities of Daily Living (ADLs) which are
1. Eating
2. Dressing
3. Toileting
4 Transferring
5. Bathing
6. Continence
A physical impairment can be an acute condition such as breaking both legs in an automobile accident, but once the bones are set and a cast or splint put on the legs, the condition is no longer in need of immediate medical care since the malady received the proper medical attention. Until the leg heals though, the person will probably need CUSTODIAL CARE, which is help in performing everyday tasks, or one of the ADLs listed above, tasks that most of us do ourselves and probably take for granted. After everything heals the person more than likely will be back to fully functioning.
A physical impairment can also be chronic such as a stroke and/or Parkinson’s Disease. These conditions might require the person to have custodial care as mentioned above, which is typically performed either at home and known as INFORMAL CARE or performed at a nursing or rehab facility where the care is provided by nurses aides and is called FORMAL CARE since it is being performed by professional caregivers. The chronic physical impairment might also require SKILLED CARE which is care performed by doctors, nurses, as well as physical, occupational, and speech therapists.
This is where payment for care gets to be difficult. Typically health insurance will cover the costs of the acute condition(at least most of them). For example, the guy in the first example with the broken legs from a car accident, will be covered by health insurance that will pay for his transport to the hospital, the skilled care received there, and at least up to six weeks of physical therapy. If he’s over 65 and on Medicare his hospital and post-hospital care will be covered for up to 100 days.
When the condition is chronic is where the coverage stops and the panic, fear, and frustration set in because unless one has Long Term Care Insurance, or a good Disability Insurance policy, the coverage for the chronic condition must be provided personally by the patient or family and this is where financial devastation sets in. Though some may disagree with me, I think even if some type of universal health coverage is passed, chronic condition care is still going to fall on the affected person and his/her family, because most nursing facility stays currently run $200 per day and up. For the government to cover everyone for acute conditions AND chronic conditions too would take a heck of a lot of money (meaning a HUGE increase in taxes.)
MENTAL IMPAIRMENT – Mental impairment is the final topic of discussion today. Like a physical impairment it can be caused by an acute condition, such as a stroke. It can also be a strictly chronic condition that never had an immediate care need, such as Alzheimers disease. If fate allows it there can be a double dose of destruction, both physical and mental impairment, such as Parkinson’s Disease with dementia.
A mentally impaired person might need custodial care, but a different type of custodial care than a physically impaired person. A physically impaired person might have trouble performing one of the aforementioned ADLs, which is not necessarily so with the mentally impaired person. A mentally impaired person, in many cases, can go to the toilet by himself, that’s something he’s been doing for years. It’s just his short term memory that’s shot so while he can eat by himself, two hours later he will have forgotten what he ate or will not even remember eating at all. The custodial care required by a mentally impaired person might be to watch him, much like a child, so he doesn’t indirectly harm himself by turning on the gas to cook and forgetting about it, or walking out the door into the middle of a heavily travelled roadway.
As you can see the topic of healthcare is more involved than providing coverage for people to get a physical, and their blood pressure prescription filled. It’s even more in depth than I’ve covered here. Some might want to disclude out of hand those that have chronic conditions because they don’t consider that to be “healthcare,” but for the people and the families that are suffering from those conditions, they are health conditions that are very real. Since we can’t ask us taxpayers to cover everything, where we draw the line, and who can objectively draw that line?