If you are single and you need to have a simple outpatient procedure performed at a hospital, you may think that it is no big deal. You can just call a cab when you are ready to leave and sleep off any grogginess at home.
Untold numbers of single people have discovered that it is not so simple at all. As Professor Cathy Goodwin explained:
By federal law, patients who are cognitively impaired after anesthesia must be discharged to a “responsible” adult. In their zeal for liability protection, hospitals have escalated these requirements to include patients who are ambulatory and alert when they’re discharged. They’ve also tightened the requirements for what counts as a “responsible adult.”
At the Community of Single People (CoSP) we have discussed, in several extensive threads, the ways in which hospitals make it hard for single people to get the care they need. One thread began with a posting by a single woman who went to a hospital for an outpatient procedure, only to be told that she was not allowed to take public transportation home nor call a cab. Some hospitals require the person fetching you to sign a form saying that they will stay with you for a prolonged period of time.
If you can’t take a cab or any public transportation, and you may also need to have someone with you to agree in writing that they will stay with you for hours, that can be a problem for people who are single. Hospital policies sometimes seem insensitive to that problem.
I have often made the case, based on scientific research, that single people often have more friends than married people do, and are in many ways even more connected to neighbors, friends, siblings, and parents than people who get married. And now here I am saying that hospitals should not just assume that all patients can find a friend or relative to drive them home and maybe stay with them afterwards as well.
Let me explain. Some single people have recently moved and have not yet developed a local support system. Many of us do have friends or family nearby, but we are reluctant to ask them for help. The time when a ride will be needed can be unpredictable, and helpers may end up needing to take an entire day off from work, or they may have to put off other obligations and commitments.
Sometimes there are people in our lives who may be willing to help, but we are not very close to them and would prefer to keep private the details of our need for medical care. (And some of us, myself included, just don’t like asking for help at all.)
Even if single people generally have rich social networks, that does not mean that every single person does. And as Professor Goodwin points out, they should not have to:
“…why must I be a friendly, sociable person who attracts dozens of caring friends? Can’t I be a curmudgeonly hermit and still get medical care?“
Matters become even more daunting when hospital care requires overnight stays, and when patients cannot care for themselves after they are discharged. Consider, for example, this policy:
All patients receiving anesthesia other than a local anesthetic must have a ride home and, if staying overnight at the hospital, a responsible adult to stay overnight with them. This requirement is to ensure your safety. Your procedure may be cancelled if you do not meet it.
When I posted this at CoSP, several people immediately reacted with outrage. Then one posted again soon afterwards, wondering whether it was all just tongue-in-cheek and not a real policy. Unfortunately, it is very real.
As hospitals perform more and more surgeries on an outpatient basis, including some serious ones, growing numbers of patients are getting sent home while they are still in need of care. One single woman who was going to have mobility issues after her surgery asked her doctor how she would be able to manage on her own at home and whether she should go to rehab to recuperate there. After she left, the doctor had a staff member call to refer her to a different doctor.
In the U.S. today, a record number of people are single, and living alone has never been so popular. The issues I have been describing affect millions. And although my focus is on single people, they are not the only ones who may find it difficult to get the kind of help that hospitals require them to have. As someone in the Community commented, there are “people who are married but whose spouses are either physically, psychologically, or economically unable to provide this service.”
The hospital policies are well-intended. No one wants patients to be at risk on their way home from the hospital or when they recuperate at home. But the policies seem to be built on an outdated model of family that assumes that there is someone available (typically a stay-at-home wife) to ferry other family members wherever they need to go, whenever they need to go there, and also offer unpaid caregiving for as long as their care is needed. This model wasn’t even characteristic of all families during the 1950s.
Another issue, as Professor Goodwin again points out, is that the policies are a bit patronizing. They assume that patients are not sensible or responsible enough to make their own arrangements. She would like to “sign a release and make my own going-home arrangements.”
So what are single people doing to deal with these difficulties? Here are some of the answers offered by members of the Community of Single People and others who emailed me privately:
- Some simply are not having the medical procedures they need.
- One woman got a ride from her elderly, disabled mother, who drove cautiously in the slow lane.
- Several people waited to have their procedures until a relative could take time off and fly from another state to provide a ride or some help at home.
- One person hired a professional driver who had driven her places before, and asked the driver to say she was her friend.
- Others hired Uber drivers or people from Craigslist they did not know, and also asked those people to present themselves as friends.
- A single person who lives in a big city said she has access to companies that provide non-medical care, such as rides to appointments.
- As for having someone to stay with them for prolonged periods of time once they are home, some patients (or the people who supposedly will be there for them) simply lie about that to the hospital staff.
- Some remain in the hospital longer if they don’t have someone to stay with them after they return home.
Several single people did find helpful services. But some are costly, and not all single people can afford that. Some examples:
- Sometimes insurance covers home care for a limited amount of time.
- Some places have community volunteers who can help.
- There may be visiting nurse services in your area, such as Accredited Nursing.
- Care provides “child care, senior care and pet care and more.”
- People from 24-hour Home Care can be hired to provide a variety of services, including help with the transition from hospital to home. They have locations in California, Arizona, and Texas.
- The Village movement is a membership organization that provides a variety of services helpful to seniors who want to stay in their own homes for as long as possible. (I wrote about this in How We Live Now: Redefining Home and Family in the 21st Century.)
When there are appropriate services, they are sometimes available only to people who are elderly or disabled. More resources are needed for single people who fit neither or those categories.
Single people would like to see hospitals (or local services) provide reliable transportation for those who need it. Perhaps it could be fee-based for those who can afford it and free for those who cannot. Many single people also need affordable, reliable, and skilled help once they get home.
There are other issues as well, as members of CoSP noted. For example, Ellen Moore and Jane Dahlgren Zuroff pointed out that some patients may need an advocate while they are hospitalized to deal with doctors and hospital staff and stay on top of the care the patient is receiving and the decisions that are being made.
I did some online searching and found a hospital in Arlington Heights, Illinois (Northwest Community Hospital) that is particularly sensitive to the needs of their patients. They provide access to an affordable transport service, as well as a fee-based courtesy van. They also list other resources that patients may need after they are discharged, such as home health care, rehabilitation services, financial services, support groups, and community outreach programs.
Maybe Northwest Community Hospital should be put in charge of a nationwide initiative to persuade every hospital to be as respectful as they are to the needs of their patients.
[Note. Thanks to everyone who shared stories and suggestions. Maybe also of interest: “Singles have fewer benefits than married couples – but area slowly gaining more” and a new book, Single, No Children: Who Is Your Family?]