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© St. Petersburg Times, published October 23, 2001
TAMPA -- Madge Boyster fell through a hole in the country's health care system when her late husband was diagnosed with Alzheimer's. He became violent and needed to live in a nursing home. Five kicked him out for his behavior. She didn't know what she would do.
The system is focused on acute, or emergency, care, and it's failing people with long-term, chronic illnesses, critics say. They are the fastest-growing group of patients and, as Boyster discovered, the most underserved.
She recently joined eight others on a panel of doctors, insurance providers, patients, nurses and caregivers to discuss how to fix what's broken. The forum at WEDU's Tampa studios was held in conjunction with Thursday's premiere of Who Cares: Chronic Illness in America.
The one-hour program will be used to spark discussions in communities across the country about the issue. It frames the challenge in dramatic vignettes: A girl with asthma must repeatedly return to the emergency room, pulling her parent away from work; a stroke victim is discharged from the hospital to a family unprepared for his intensive medical needs.
"We have a health care system that is broken in many ways. It's by far the most expensive in the world, but we are not delivering care in a manner that gives us a healthy population," said Tampa panelist Dr. Barry Schwartz, vice president of quality management at Blue Cross and Blue Shield of Florida.
"Acute care is simply easier. It's also sexier. Everybody watches ER. The problems of chronic care are much more difficult."
Chronic illness is defined as a medical problem that requires ongoing care for a year or more. About 125-million Americans have chronic illnesses, and they account for three of every four dollars spent on health care in the United States.
"Medicare will not pay for custodial care, so we end up doing intermittent care in the home," said Mickie Poston, a registered nurse with House Call Home Health Care. She spends most of her time teaching family members to take over.
The transformation from spouse or child to caregiver can be emotionally devastating.
But almost everyone will be a caregiver, or a patient, someday.
"We're still practicing the same medicine" as a century ago, when life expectancy was 50 years, said Dr. Ira Mandel, a physician who founded Tampa Bay Alliance to address the disorganization. "I see a lot of unmet needs, a lack of coordination across agencies."
The Hillsborough County Health Care Advisory Board also supports programs to get people to doctors before they need emergency rooms, said chairwoman Mary Ellen Gillette, director of student services for Hillsborough County public schools.
"The problem," said Gillette, "is knowing how to connect those dots."
Who Cares: Chronic Illness in America, a seminar and discussion hosted by journalist John Hockenberry. 9 p.m. Thursday on WEDU-Ch. 3. More on the Web: www.wedu.org or www.pbs.org/fredfriendly/whocares.