Dr. El

Nine years ago, when I started writing “The World According to Dr. El,” McKnight’s Editor Jim Berklan reassured me that I’d always find something to say. I was surprised to discover that not only was this true, in fact the opposite was often the case — many weeks I’ve had difficulty choosing between an abundance of intriguing topics.

Over the years, I’ve used the column to explain what psychologists do in long-term care and what they could do if given the chance. I’ve highlighted issues that I thought deserved more attention, and I’ve tried to amplify the efforts of do-gooders in the field. I shared my COVID-19 experiences back when New York City was an anomaly, and I’ve advocated for the growing number of severely mentally ill residents in our midst. 

And while I haven’t run out of material, I’m tapping out my last column because I don’t want to run out of time. If there’s one thing I’ve learned from sitting by the bedsides of elders in the nursing home, it’s that life goes faster than we think it will, and I have other mountains to climb.

I plan to spend more time with the octogenarians in my own family, focus on my New York licensed virtual private practice, and continue with my speaking engagements and other eldercare-related projects. 

My greatest hope, aside from enjoying time without a biweekly deadline, is to publish the novel I started many years ago about a psychologist working in a nursing home. (A stretch, I know.) It’s the undertaking I’d most regret leaving undone if I were talking to my psychologist in my nursing home room at age 85. 

But enough about me. 

The pricey problem I haven’t mentioned before

There’s one thing I haven’t told you in the last nine years, and it’s costing you a fortune. I’m not exactly sure whose fortune it is, given our convoluted system. But “the system” is paying for it, and it’s negatively affecting the physical and emotional well-being of residents.

Not surprisingly, it’s a transition of care, but a more subtle and more frequent transition of care than is usually studied: Off-campus medical appointments are not going well.

Over the last 25 years, I’ve heard the following reasons for an incomplete medical appointment: The resident wasn’t out of bed in time, the staff couldn’t find any clothes and the resident refused to go out in a gown, the ambulette was late, the driver got lost, the ambulette got into a traffic accident, the office address was incorrect, the date of the appointment was wrong, the referral form was missing, the doctor had an emergency, the wheelchair couldn’t fit into the elevator, the doctor needs the old X-ray/Doppler/scan, the wait for the doctor was too long and the aide needed to get back to her family so they left, etc., etc. 

I tell my distraught residents that if anyone actually gets to an appointment on time and returns without a problem, I write it down on my calendar because it’s so rare.

According to this Forbes article, missed medical appointments “cost the U.S. healthcare system more than $150 billion a year,” and the third most common reason that older adults miss appointments is transportation problems. 

Given that nursing facilities are arranging transportation, this should not be a problem. But it is.  

I will leave you with that information in the hope that it will lead to research and self-reflection within the continuum of care and result in savings that benefit everyone in the system, including and especially residents and direct care staff. 

Thank you

I’d like to thank Jim Berklan, John O’Connor, Wayne, and the other folks at McKnight’s Long-Term Care News for the opportunity to write this column and to be a part of their outstanding team. 

Thanks to my colleagues in Psychologists in Long-Term Care, particularly Margie Norris, for their support and encouragement of my efforts to represent psychology in LTC. 

To all the health researchers, organizations and policymakers striving for healthcare justice, the workers doing right by their residents, the families advocating for their loved ones, and the residents keeping the faith — you are inspiring! 

Keep going — it’s making a difference. The system urgently needs change and conditions are riper for it than I’ve ever seen before.

Eleanor Feldman Barbera, Ph.D., author of The Savvy Resident’s Guide, is an Award of Excellence winner in the Blog Content category of the APEX Awards for Publication Excellence program. She also is a Bronze Medalist for Best Blog in the American Society of Business Publication Editors national competition andGold Medalist in the Blog-How To/Tips/Service category in their Midwest Regional competition. To contact her, visit her at EleanorFeldmanBarbera.com.  

The opinions expressed in McKnight’s Long-Term Care News guest submissions are the author’s and are not necessarily those of McKnight’s Long-Term Care News or its editors.