PT and the Poverty Line
I had a teacher in PT school who told us the best first job he ever had was working in an inner-city hospital treating patients with low incomes or limited financial resources. He liked the job because this lack of resources challenged him to think outside the box to ensure his patients had the equipment and assistance they needed prior to discharge. Now I work in a hospital as well, but it's in a fairly well-off suburb of Chicago. We have a fairly high Medicare population, but on occasion, we'll get a patient or two who don't have any insurance and have some serious medical conditions.
Over the past two weeks, I've treated two patients in particular who had no insurance and very limited personal financial resources. Our hospital system has a free clinic that can offer basic pro-bono medical care and both these patients were part of it, but specialty care and services is where things become dicey.
The first patient I treated this week was diagnosed with extensive myonecrosis resulting in bilateral foot drop. Due to the myonecrosis, this is not a problem that's going to resolve, so I recommended the patient follow up with an orthotist to obtain AFOs. The problem is, he has no insurance, and after contacting two social workers, two doctors and our discharge planner, no one seemed to know if AFOs would be covered or how the patient would obtain them. His gait was significantly impacted by the foot drop and AFOs would be of great benefit to him, but there seemed to be a lot of red tape and unknown standing in the way.
The second patient was admitted for what ended up being a pretty significant gout flare-up. When I treated him, we were able to get him standing upright with a walker, but it required maximal assistance of the therapist and an aide. He was unable to walk or move once standing because he lacked the strength to do so and was in too much pain. Enter the lack of insurance again. He no longer has any outstanding medical issues according to the lead physician, so he's ready for discharge. He wants to get home, but again, he needs two people for basic bed mobility and transfers. He doesn't have the financial resources to go to a rehab facility or pay for caregiver assistance at home.
So I'm the one recommending the AFOs and increased assistance at home for these patients. I seem to be the one throwing all the proverbial wrenches in everyone else's discharge plans. I have these patients who need things but can't afford them and no one seems to be stepping up to advocate for the patients' needs except me?
What do I do? Any suggestions? How do others deal with patients who don't have insurance coverage and need specialty services/care set up?
Some have asked how my reading of the Affordable Care Act is going. To be honest, much slower than expected. Real life has gotten in the way of a lot of my reading time. So it's coming along, I keep chugging through it. I've got a few out-of-town trips coming up with some serious airport layovers, so hopefully I can get up to speed!