Caregiving and Health Care: The Situationship

The term situationship meant to convey a lack of clear labels, commitment and definition existing in a gray area of romantic or sexual connection, seems to fit the odd association between caregiving and health care. Admittedly, neither conjures up any fantasies worth fantasizing over, which I think is part of the problem with our management of these two very critical aspects of our collective lives..

The fallout from our mismanagement of our health and care “institutions” is creating havoc in our lives. People complain about the cost of health and continuing care but we have yet to see any sizeable outcry against the current “situationship.”

To be clear, these two “industries” overlap, but they are not the same and yet part of the same problem. We have experienced some outrage over insurance denials, and increases and individual cost contributions, unfair reimbursement practices, and, most recently, inability to access vital resources. Now that even people with financial means are having trouble finding and retaining home care support, the outcry is growing, as would be expected.

So, we come up with fixes that are not working effectively. For example, value -based care has become the new mantra for meeting the needs of the people. Problem is whose values, and how are they being instrumentalized? Caregiving is relying more -and -more on the support of the family or extended family caregiver to fill the increasing gap in access and affordability of formal care. Then there are the fragmentation issues that you might have experienced where you have 2 separate visits from 2 different agencies, e.g. licensed home care agency (that provides aides) and certified home health agency, in one day to repeat the same patient assessment and hopefully agree on the issues.

WHAT IS THE BASIC PROBLEM AND WHAT CAN WE DO ABOUT IT?

Here is my list:

1. IDENTIFY THE PROBLEM

That sounds simple; but you know the adage about the “Blind Men and the Elephant?’ Of course you do. Everyone’s perspective is rooted in their social and economic position in society.  Get the stakeholders in the same room for the purpose of identifying the common ground wherever possible. Of course, some of these stakeholders have no vested interest in thinking mutually. Therefore, you get as many stakeholders as possible in the room to identify the problem(s).

2. IDENTIFY THE VALUES THAT NEED TO BE ADDRESSED

We have heard enough of the rhetoric. There is one value that serves as the foundation for any planning and advocacy: health equity! When you begin with health equity as the foundational building block, you can then begin to build consensus regarding standards for institutional reform. This formula does not preclude the inclusion of private enterprise or private insurance; but it does place limits on corporate contributions to the production, distribution, reimbursement, and regulation of caregiving/health services that are designed to provide health, and care, equity.

3. CARING BECOMES THE UMBRELLA FOR INSTITUTIONAL REFORM

Health care is transforming many of its functions to home and community delivery systems. These efforts need to be coordinated under a CARING umbrella. We have it reversed in the US and probably elsewhere. We relegate caregiving to an ancillary role in health delivery, when in fact, it is caring in the context of increased longevity and chronicity, that is becoming most critical in managing people’s health needs. We started to get away from a treatment focus, but certainly, recent anti-public health propaganda has taken the wind out of prevention. Well, that cannot continue if we ever are to solve our health issues through integrated and affordable mechanisms.

4. SO, NOT POSSIBLE?

Make the impossible, possible! It is unlikely that Medicaid would have been passed without Medicare. They were strategically linked to ensure their combined passage. This is where we need a strong community outreach and advocacy movement. Legislation changes in this country according to the influence of different stakeholders.  The corporate rationalizers took over primary control from the medical establishment. Now, it is time for the medical establishment to join forces with other health professions in promoting care (and health) over proprietary interests. We know that! It is not currently happening.

5. HAVE A PLAN IF YOU ARE THE ORGANIZER

I have been very interested in the advantages of the Bismarck Model of Health Care and think that many of the features would fit in with our capitalistic system as it can preserve a significant place for free enterprise, and the insurance industry. However, within the model that I am proposing, financing and development of health services is incorporated within a culture of caring, not vice versa. If we do not start on the level of what people need and want in the way of community and social services, then we will miss the boat in terms of providing for those needs within a wholistic, cost-effective, integrated system of care.

This is not a pipe dream. We have been through many permutations in our history. We are in a sea change right now. The smart legislator will hopefully rise to the challenges that we face, not least of which is getting a handle on the caregiving crisis that is only going to deepen.

The smart community organizer will jump on this bandwagon. The smart entrepreneur will be thinking in terms of social enterprise, mission over profit. The smart employer will be creating a culture of care in the workplace, not only to support their conflicted caregiver-employees; but, also to avert work disruptions, terminations, and reduced productivity. And, most of all, we need grass roots support from the public…and I am sure it would be available. I just got back from seeing the devastated lives of our fellow citizens in an area that was left behind by economic forces. Do not tell me those people are not interested in coalescing around programs and services that are life-restoring.

AND IT ALL BEGINS WITH RAISING THE SCEPTER OF CARING IN THE INTEREST OF GIVING LIFE AND HOPE TO ALL!

This is not socialism. It is humanism. And a healthy society is a boon to all economic and social structures.