Cutting back on the number of nurses will injure the elderly ill most of all

March 10, 1996|By SUSAN REIMER

AS OUR NATION'S health-care system continues to convulse and recoil in the effort to slash costs, hospitals are reducing the number of registered nurses on staff and increasing the number and the responsibilities of less-trained and less-expensive nurses aides.

At least my sisters and I will be able to find work in this new world order.

Our frail and often disoriented mother was trapped inside this country's health-care delivery system for more than a month. And we, her daughters, were trapped there with her in the kind of 24-hour-a-day hospital life that we did not know existed when we delivered healthy babies and brought them joyfully home three days later.

The four of us spent 35 days, much of it around-the-clock, at our mother's bedside, giving her the kind of care we gave those babies in a role reversal heart-rending for all of us.

Though it is true that she did not always need this much attention -- Cleopatra comes to mind here -- and we kidded that she could not have located the nurse's call button on a bet, we also provided her with medical, insurance and legal expertise -- and phone-dialing, pavement-pounding staying power -- that her roommates did not have.

And still it was a nightmare of HMO and hospital bureaucracy from which we barely extricated her alive.

"What about the people who don't have people like us?" my sister, the nurse, kept asking aloud.

Among the many things I learned in the last month was something my sister, the nurse, already knew: Hospitals are not full of new mothers or children getting ear tubes. They are not even filled with heart bypasses and emergency gall-bladder surgeries. These kinds of patients pass through hospitals so quickly in the name of cost reduction that they hardly dirty a water glass.

Hospitals are filled with the elderly. People who suffer what professionals call "multisystem breakdowns." So much is wrong with them and so little is fixable that the elderly populate hospitals for such comparatively long stays that they should be allowed to redecorate their rooms.

And this point in the road -- where the elderly meet managed care -- looks like nothing so much as a bus crash. The population least able to navigate the system languish in it by virtue of the complexity and confounding nature of its illnesses. Doctors no sooner get one organ up and running than another breaks down, and, through it all, the cost-cutting review staff employed by Medicare and the insurance industry are handing these patients their coats and their hats. Their definition of "stable" cannot be found in any medical text. Our health-care delivery system has spasmodically and from a hundred different directions attempted to condense itself. Elderly patients and their elderly spouses -- or their far-flung children -- find themselves in the midst of this chaos.

This system is so overwhelming and so defeating for the elderly that a friend who works in a department of aging says she sees the need for individual caseworkers who can sort out the paperwork and the conflicting medical advice these patients and their families receive. The need for such guidance can only increase as more of us age.

It seems remarkable to me that hospital administrators would seek to cut costs by reducing the nursing staff and further isolating a hospital population already short on support.

A survey conducted by the American Nurses Association demonstrated the impact of these cutbacks on patient care. It is a foolish economy to cut nurses, because they represent only a fifth of a hospital's charges, and their care reduces recovery time.

This survey demonstrated the particular impact of fewer nurses on the elderly. But live those cutbacks with an ill parent and your eyes will open wide.

The young do not believe they will ever die. Those of us with children would make any bargain with heaven so that we might live to finish raising them. But the elderly have a thinner strand connecting them to life.

Often, their only grip on this world is the hand they find in the long, dark night. And it is the hand of a nurse. Not an insurer's hand, not an administrator's, not a doctor's. But a nurse's.

Healthy living, preventive medicine and sensible economies can do much to reduce this country's health-care costs. But nothing can prevent aging, and as more of us age, our hospitals will fill with people too sick to fix but not sick enough to die.

And it will be left to nurses to care for them. Nurses are often the only consolation for the elderly as they watch the dignity of a lifetime slip away. The tenderness I have seen exchanged at these moments has broken my heart.

Nurses can cure nothing, but very often they are the reason old people get well. Considering our current determination to reduce the expense of sickness, how can this country do with fewer of them?

Pub Date: 3/10/96

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