Gary Tetz

We hear a lot about Medicare for All. How about if we start with Privacy for All, and see how that goes first? 

Maybe the problem is that privacy is inconvenient. That might be one of the major understatements of long-term care life, falling somewhere between “margins are tricky,” and “staffing is tough.”

I was reminded of this eternal truth in talking with a still-seething friend who has a close relative in a facility. While visiting her loved one, whom we’ll call Betty, it became time for a care conference, and the busy social worker was trying to decide the best location.

“Who’s Betty’s roommate?” she asked my friend. “Irene? Oh, she’s pretty confused, so we can just meet in there.” Soon five staff and two family members were clustered around Betty’s bed, with lucky, confused, unimportant Irene just across the curtain, captive to the whole discussion.

 In fairness, Betty is pretty much bed-bound, and getting her into a wheelchair and out of the room would take considerable staff time and energy. But though she’s of sound mind, at no time was she herself even asked, “How do you feel about your roommate overhearing all your personal health information?” 

And as for Irene, my friend has had many enjoyable conversations with her while visiting Betty. “I’ve probably talked to her more than that social worker has, and I can tell you she’s not as delusional as they might think,” she told me. 

But even so, no one offered to take her to the courtyard to watch the birds, or even just out into the hall until the conference was over. She wasn’t even given the courtesy of an option or explanation. She was just “confused” Irene, who didn’t deserve even a modicum of accommodation to move out of the path of this torrent of personal health information.

To me, it all seems like part of the dehumanization process that can happen in any institutional healthcare setting. In the world outside, real people are deemed to deserve real choices. But within the walls of a hospital or nursing home, patients, particularly the elderly, are too often made secondary to the system, with all its flaws. 

For overworked staff, having the meeting in Betty’s room and ignoring Irene was certainly easier, and who can blame them?  It’s a busy facility, and you have to break rules sometimes just to make things happen, right? Furthermore, what’s the real harm? It’s not like Irene is going to take that PHI and alert the media, or post a care conference transcript to Facebook. 

True privacy is inconvenient, even impossible sometimes. I get it. The very existence of shared rooms, for instance, is a 24/7 HIPAA violation waiting to happen. But by putting respect and compassion for our residents over every other consideration, we help preserve the one thing they’re most likely to lose in their time with us — their dignity. 

Things I Think is written by Gary Tetz, a national Silver Medalist and regional Gold and Silver Medal winner in the Association of Business Publication Editors (ASBPE) awards program. He’s been amusing, inspiring, informing and sometimes befuddling long-term care readers worldwide since the end of a previous century. He is a multimedia consultant for Consonus Healthcare Services in Portland, OR.