Frank Dialect,"The voice of experience:our geriatric population"

I am often amazed to see the way our geriatric population is spoken down to, belittled, mistreated, and dismissed by the younger generation. I have had years of experience with the geriatric population in a myriad of clinical and healthcare settings. I am only one small voice on an issue about which I am passionate, certainly not a Mother Theresa, but I have made several attempts to discuss Healthcare issues with my local Representatives, Senators and even our “esteemed” governor in Illinois. Apparently without an MD behind your name, Sister or Mother in front of your name, or money to bump elbows with the elite, those of us who still believe that truth is the best way, the good will triumph over evil, and politicians are real people too, are merely dismissed much like our elder counterparts. I long to continue my own education and complete a Doctorate in Nursing Practices: Geriatrics. However, until that time comes, I am merely Julie, RN. I believe that I have very valid concerns regarding healthcare policy when politicians dictate how Drs and nurses are able to provide vital care. I have an affinity for this population, perhaps it is truly a God given gift. I feel strongly that we focus on productivity standards set up by non-clinical people who have never had to tell a family that a loved one has begun the final journey in their life. Because of CMS reimbursement, I am allotted a certain amount of time in which I am to complete a physical examination, check the pills bottles for any medication discrepancies, assess their pain status, cognitive status, spiritual state, family coping mechanisms, patient coping mechanisms and chart all of my findings. Heaven forbid I redirect an Alzheimer’s’ patient to a task instead of just telling them to be quiet because they are confused or take the time to hear the WWII stories, the love stories, the goals they never achieved or their risky ventures that did succeed and I provide emotional support an d an avid listener in a very difficult time for my patients. I am then considered non-productive, based on the per diem paid by CMS, I have cost the company money. I will not get a raise. I will be paid less than a machinist on a line for Caterpillar, GM or a construction worker. To whom shall they speak if we are not allowed to listen? I happen to remain extremely faithful to my beliefs and my patients as well as their families. I form a bond that few people even in healthcare would undertake. I am not uncaring or selfish with my time or my emotions. I feel that word of mouth is every bit as essential as good marketing; however, due to constraints placed on CMS by congress and imposed upon nurses like myself, I must enter, assess, document and schedule the next visit and see an average of 4.5 patients a day. Surely the 0.5 isn’t going to be bragging about his care. Would you want that nurse or would you want the nurse who visits on her day off, sits with you and holds your hand when your family is too upset to listen to the erratic breathing and death rattle and stays with you after her own children have gone to bed and calms you until you have completed your journey and rest in the hands of angels. Recently a televangelist was talking about doing God’s work and said, “ Just remember when you walk into your office or onto your production line, YOU are working for Jesus.” I remind myself every day that I work for Jesus. Unfortunately the legislators do not have to follow the benefits set forth by their regulations or can afford additional private duty care in addition to their traditional Medicare benefits. I am not so naïve that I expect an answer from you, and frankly if you don’t respond personally I would rather not hear back. However, if by the Grace of God, this makes it through the bureaucratic layers of yes men or women, I would sincerely love to bend your ear, offer you a few tidbits for thought, or simply babble as I am sure you can see that I am prone to do. My fellow nurses think that this is a pipedream and no one cares that we are in the midst of a crisis. Please allow me to prove them wrong. You are someone that I greatly admire for saying things like you see them. I have watched your expressions when our nation has suffered and believe that you would understand my plight. I would be very honored if you could spend a moment of time pondering some of the ideas I have presented. I should add that since writing this letter initially and never receiving a response from any of my current legislators, I am now unemployed due to my inability to trade my passion quality nursing care for the elderly for productivity and budget constrictions. Thank you for your time PS. I know you have speech writers, letter writers and no doubt official e-mail responders….I trust you will respond! That’s what makes you approachable. Please don’t refer me to Leslie Norwalk. I have met her at several CMS conferences and quite frankly, have never gotten an accurate or particularly polite response to very specific Medicare Advantage questions. I am not sure she has a heart or understands geriatrics, she is just another politician.