While the debate continues about whether patients are discharged from hospitals sicker as a result of medicare and private-insurance reimbursement policies, no one can deny that they are released quicker. A study by RAND Corporation, the Santa Monica, Calif., think tank, revealed that hospital lengths of stay for Medicare beneficiaries dropped from 9.8 days in 1981 to 7.8 days in 1985, while the percentage of discharged patients requiring home health care rose from 8.5 percent to 13.3 percent.
Because of the high cost of health care, patients of all ages are being discharged earlier. Recently, my husband had hernia surgery. This procedure used to require a four- to five-day hospital stay, but not any more. My husband was discharged the same day. "The operation went well," the doctor assured us, "although Jon might be uncomfortable for a few days."During the first 48 hours of his post-surgery, Jon was dizzy, alternately hot and cold, could not sleep and was in pain despite taking pain medication at regular intervals.
At 3 in the morning that first night, we both agreed he should have remained in the hospital, an option which was not offered to him. We survived the ordeal, but both wondered how others in similar straits but living alone would have coped.
The burden of care for people released from a hospital falls more heavily than before on the family. Instead of visiting my husband in the hospital, I was responsible for everything from preparing his meals to getting him showered and dressed. No one had prepared me to be my husband's nurse.- Elyse Salend
QUESTION: I'm 72 years old and unhappy with my current doctor. I have tried to find another doctor through the phone book, but that's so impersonal. Is there a better way?
ANSWER: Friends and family can be good referral sources. So can local hospitals or your county medical society. In some medium-size and large cities, university medical centers may provide physician-referral services. For example, the University of California at Los Angeles offers an outpatient-referral service. Using a computerized database of 1,200 physician names, nurses provide individualized referrals based on the patient's needs. A similar program is provided at Georgetown University in Washington, D.C. If you have a particular medical problem, seek referrals from special health agencies, such as the local chapter of the American Heart Association or the Arthritis Foundation.
When calling for referrals, provide as much basic information about your medical problems as possible. Under most circumstances, it's best that you call, rather than having a family member do so. In this way, the referrals you receive are most likely to meet your needs.
When selecting a doctor, it is essential that you are comfortable and have an easy time communicating with him or her. Not only do you want your physician to be a good listener, but you want reasonable appointment and waiting times and assured availability in emergencies.
You can evaluate basic medical competency by asking whether the physician is a broad-certified internist, family physician or subspecialist. Older people with major problems often prefer to see a trained geriatrician, a physician committed to the care of frail elders. There is now a board examination in geriatrics.
Office location and accessibility (handicapped accommodations) and hospital privileges may also be important. Finally, make sure you can afford the physician's services.
QUESTION: I'm a 78-year-old woman with arthritis. My husband teases me because I often pray about the aches in my joints. I am under a doctor's care, but feel praying helps me cope with the pain. Besides, I tell my husband, praying is a common response to health-care problems. Am I right?
ANSWER: Yes, say a pair of researchers who found that many older people use prayer in response to physical symptoms. At the same time, the investigators wrote in a recent issue of the Gerontologist, the elderly often hold mixed views about God's role in health and illness.
Lucille B. Bearon and Harold G. Koenig, both of the Veterans Administration in Durham, N.C., asked 40 adults aged 65-74 whether they prayed about pain, dizziness or other recent symptoms. More than half do.
Persons with less education were more likely to pray about health conditions. Baptists, the most conservative denomination represented in the study, were the most likely to report praying.
Most respondents expressed a belief in a benevolent God, one who wouldn't used illness as a punishment or to test a person's faith. Few counted on good health as a reward for moral behavior. Instead, most agreed that "health is a gift from God."
Send questions about growing older to On Aging, P.O. Box 84256, Los Angeles, Calif. 90073.