Hospitals have come a long way. They are responding to the need for service beyond on-site medical care by stretching to ensure comfortable recovery after hospitalization, particularly to the "shades of gray" generation.
Those efforts occur as hospital staffs have less time to devote to small personal services and as pressure increases to control medical costs by limiting the length of time a patient spends in the hospital.
But North County hospitals are working to bridge the gaps left by short hospital stays and limited staff sizes.
A month ago, my husband underwent surgery. During the three days of his hospital stay, I realized how much hospitals have changed since my own first experience as a patient 20 years ago.
There are no longer aides such as those who stood by my bed the night before surgery, listened compassionately, brought juice, suggested a back rub, rearranged sheets, tightened and plumped pillows. Now those things are left to hospital volunteers, who come by only occasionally, or to members of the patient's family.
There is neither time nor staffing for hospitals to routinely offer the small comforts of yesterday. But, in instances where family or friends are free to attend a patient, they are strengthening and lengthening the reach of the nurses, freeing them to focus on other patients who are alone.
Many patients do not have family nearby, and often the children of the elderly are in two-career families; after caring for their own children, they may not have time to also care for their parents.
During my husband's hospital stay, I was able to be there to fill in as provider of missing comforts. I enjoyed the role, but was surprised to be expected to perform it. The nurse told me where to find an extra pillow for him. A patient in a hospital without a family member in attendance learns either to be quietly patient or to become a noisy complainer.
The differences in hospital care start before the patient becomes a patient. My husband had to pre-register two days before admittance. He signed medical papers and was taken by an "orientation" nurse to her office, where she explained procedures in detail and answered his many questions. Admittance took place not the night before surgery, but in the morning just two hours before his trip to the operating room.
This system was established because insurance will pay only for limited days in the hospital; each illness and procedure has its Medicare-insurable, allotted hospital time. The hospital correctly reserves those days for medical care, not paper work.
"No question asked by a patient at pre-registration is foolish," said Diane McGrogan, supervisor of Patient and Family Services at Scripps Memorial Hospital in Encinitas. "We want people to bring a list of questions, take notes or even tape the session and, by all means, bring along a friend or family member."
Fears associated with a trip to the hospital can expand out of proportion for elderly people. The mere thought of illness is threatening. It is not the physical pain as much as the fear of being alone.
Medical social workers are involved in offering support for patients in the hospital and planning for their return home. Their intention is to eliminate anxiety, loneliness and isolation. They help set up services ranging from convalescent care in a special facility to weekly visiting-nurse care to transportation to doctor appointments.
According to Sally Rice, discharge coordinator for Scripps Memorial, some patients are unrealistic as they prepare to leave the hospital. They underestimate their needs and overestimate their families' ability to offer consistent help. The discharge nurse and a social worker try to present the patient with realistic options.
Scripps, Tri-City and Palomar-Pomerado offer home health care services that follow the physician's orders for skilled care after a patient returns home. Each North County hospital offers electronic devices that allow patients who have returned home to summon emergency help at the press of a button.
Hospitals are also trying to reach out to the elderly before they become ill.
Last February, Tri-City Medical Center launched "Issues on Aging" seminars. The series was so popular that there is a waiting list for the fall offering. Seven sessions cover the gamut: healthy eating, understanding Medicare/Medi-Cal, coping with aging parents, managing medications and so on. For more information, call 940-3131.
Years ago, families stood together shoulder-to-shoulder, as only some do today, supporting the patient when in the hospital, then caring for the convalescent.
But many more of us are alone today, removed from our family circle. It is a critical problem.
One gentleman, when asked who was waiting for him at home, answered, "My dog." Good company, welcome therapy, but not much else.
Fortunately, hospital administrators have come to understand the need for professional involvement in patients' lives before, during and after treatment.