A Changing Service - Hospitals

Viewed a century ago as a death-house, the hospital has a new image. With an entirely revised role built on its ability to provide comforts and even amenities, the hospital has added a “hotel” function to its fundamental “healing” function. But the hotel role does not affect the hospital's main medical purpose: to provide, within budgetary and other limits, sophisticated, technologically up-to-date care. The hospital has become the place to go for diagnostic and therapeutic care that a physician's office cannot provide.

A basic method of classifying hospitals is by length of the patient's stay. Viewed this way, hospitals fall into two groups, long-term or extended-care institutions and short-term hospitals. The former will be discussed later; the second group includes community, teaching, and public hospitals.

Community Hospitals

Most Americans receive medical care in community hospitals. Usually quite small, with 50 to 500 beds, this kind of hospital generally provides good to excellent secondary-level care. Traditionally, community hospitals were nonprofit corporations that depended heavily on community support. Today, the community hospital is increasingly likely to be proprietary. That means it is run for profit by investor-owned groups or corporations.

The costs of medical care at a proprietary community hospital may not be significantly different from those charged by a voluntary or nonprofit hospital.

Teaching Hospitals

Ranging in size from a few hundred to a few thousand beds, teaching hospitals universally offer training for undergraduate medical students, postgraduate students, or fellows. Also, nearly all have ties to major medical schools. A state government may own a teaching hospital that is used by state medical schools; others are owned by the associated university or by a nonprofit corporation. Teaching hospitals provide care at all three levels.

Public Hospitals

Public hospitals include not only county hospitals but others supported by public funds, among them public health service hospitals, Veterans Administration (VA) hospitals, and municipal short-term-stay hospitals. Many such institutions that are owned by federal, state, or city governments are teaching hospitals, and many also have associated rehabilitation units and nursing homes. The Elderly: Home Care

Surprisingly, most elderly persons live at home and receive care from relatives and others who may visit the home to help out. Younger family members may need home care because of illness or injury, but typically the disabled or ill older person is the one receiving such care. A number of community resources are available to make home care—or self-care for those living alone—easier. These resources include home health workers, such services as Meals-on-Wheels, and various day-care programs.

Invaluable aids for those responsible for home care for an aging relative are unskilled companions and temporary help. With this kind of assistance, the elderly person may be able to enjoy continuity of care and independence while maintaining ties with family, home, and community.

Home Health Services

Some 2,500 home health agencies operate under the general direction of physicians to provide two kinds of services: skilled and supportive. Of the many types of home health service providers, the best known are private, either profit-making or nonprofit; public health agencies such as neighborhood health centers; hospital-based services; and local or county health department or community and church programs. The nationwide Visiting Nurses Association is perhaps the most familiar.

Different communities and areas enjoy different levels and types of home health services. But most such agencies provide care to anyone who requests it. Fees vary, and may be paid by the individual or the family accepting the care. In other cases the government or individual insurance plans may reimburse the family, partially or totally, for the fees charged. Hospital social workers or discharge-planners, the Area Agency on Aging, the local office of the Social Security Administration, day-care centers, and churches and synagogues normally provide information on home health services.

Voluntary Health Agencies

Many voluntary health agencies provide aid and support to the disabled or sick elderly person (see Chapter 36). Such groups and organizations as the American Cancer Society and the Easter Seal Society may even offer “friendly visitor” services in specific communities. Most of the groups see education of the public as functional to their roles. Thus they may provide films, lecturers, books and pamphlets, and other materials of interest to groups and organizations of many kinds. Many such agencies have specialized equipment for those who need it as well as listings of community resources.

Drugstores and Medical Supply Houses

Two other basic sources of specialized equipment and sickroom supplies, the medically oriented drugstore and the medical supply house, play important roles. In many cases the family discharging home care responsibilities can obtain wheelchairs, walkers, portable oxygen equipment, and hospital beds from one source or the other. Often, the supplier will rent or sell the specialized equipment; the choice may be the family's to make.