WHEN THEY CLOSE YOUR HOSPITAL, POLITICS DON’T MATTER – Marilyn Armstrong

We don’t seem to be having much luck talking national politics. We have rigidified our views in these areas, so there is no conversation possible. Nonetheless, there is stuff to talk about and a lot of is hits much too close to home.

Entry

Each state has its own unique ballot questions. While these issues are statewide, the subjects involved affect many places not only in this country but worldwide. While no two places have precisely the same issues, many problems are similar enough. The states watch each others’ ballot issues — both on how they are fought and to see how the solutions do or don’t work.

This year, Massachusetts is trying to vote on government-mandated Nurse Staffing Ratios for hospitals. The Nurse’s Union put the issue on the ballot because nurses in many hospitals are greatly overworked. Not only are the nurses exhausted and underpaid, but tired, harried nurses make mistakes. Some of them are fatal.


According to a recent study by Johns Hopkins, more than 250,000 people in the United States die every year because of medical mistakes, making it the third leading cause of death after heart disease and cancer. — Feb 22, 2018

No one could reasonably argue that nurses are not overworked. Except for Intensive Care Units where nursing ratios are tightly controlled, Massachusetts does not have mandatory nurse-to-patient ratios. In the U.S., the only state that has state-mandated ratios is California.

From inside looking out at UMass Memorial Hospital

The problem is, that Massachusetts doesn’t have enough nurses. Forget, for a moment, whether or not the hospitals could afford to hire enough nurses. We don’t have them to hire.

Almost anyone who wants to go into nursing can get a full scholarship. The shortage of nurses has been an issue for many decades. Nursing was a popular choice for women when I was a kid, but by the time I was an adult, women were beginning to think that if they were going to do the work, they might as well become doctors.

In an attempt to get a better grip on the subject, we had a conversation with our doctor. Garry figured he probably had a pretty good sense about it.

He thought for a while, then he said “It would probably mean closing at least 200 hospitals around the state … most of them in areas like this one where we don’t many hospitals.” Rural areas have very different issues than big or even medium-sized cities.

There’s the fundamental problem.

Milford Hospital from the Dana-Farber

Nurses — when we have recent graduates — want to begin careers in places where salaries are better (who doesn’t?), facilities are more advanced, and there are reasonable opportunities for professional growth. They don’t choose little hospitals in the middle of Worcester or Hampden counties.

“The hospital closures would,” our doctor commented, “make it very hard to find places to put patients.” Like me, I thought.

It’s not that he doesn’t think nurses are overworked. We all think they are overworked. I don’t think that’s even an issue. The problem is (1) where are we going to get all those nurses, and (2) how are we going to pay them?

What’s the answer? We are missing approximately 13,000 nurses. If we vote for government mandated nursing ratios, will the government also provide the nurses and money to pay them? A lot of hospitals are operating on a shoestring already. It wouldn’t take much to push them over the edge.

We have the same problem with teachers, police, firefighters, and medics. They work hard and they don’t get paid well. We are short of libraries and librarians and a lot of other things, too, like functional railroads and bridges that won’t collapse. Roads that urgently need paving.

It’s not like we don’t know about the problems. It’s just that we can’t always fix them by passing laws. There are secondary and tertiary problems that result from “just pass the law and work it out afterward.”

In rural areas — like ours  — if you close one hospital, there’s a very good chance there will be no place to go if we get sick or have an emergency. Boston is more than 70 miles away through very heavy traffic. Some of our “local” hospitals are not places you’d want to be if you had a serious problem.

As I am coming to realize in our personal lives, you can’t always fix the problems. Even when you know what the problems are and what needs to be done, that doesn’t mean you can make it happen. Unlike the federal government, states can’t just raise the deficit.

Putting aside all of our national problems, we still need to bang our heads together and figure out sensible solutions to problems that face us personally.

When you live in the country, these problems are at least twice as difficult to manage as they are in Boston. Hospitals are big business in Boston — and yet even there, they are merging many of the biggest and best facilities to stay solvent. Or nearly solvent.

Out here, we don’t have many hospitals. They have already closed most of the smallest ones. Unlike Boston where they make their budgets by giving parking tickets to any car that pauses too long at a stop sign, we have to live on property taxes that are already very high … too high for many of us. We don’t have enough police and if there’s a big fire, all the towns have to get together to fight it because no town has enough professionals

We have a Fire Chief, but firefighters are 90% volunteers. And some of the smaller valley towns don’t have a fire department at all. Uxbridge has a pretty good fleet of fire trucks and a new firehouse in town … but we don’t have a professional staff. For this, we — and our nearby neighboring towns — depend on volunteers.

But sick people? We have a plenty of them.


For more information, see Nurse staffing ratios: What is the 2018 Massachusetts ballot question all about?

Author: Marilyn Armstrong

Writer, photography, blogger. Previously, technical writer. Retired! Yay!

33 thoughts on “WHEN THEY CLOSE YOUR HOSPITAL, POLITICS DON’T MATTER – Marilyn Armstrong”

  1. That’s an issue just about everywhere I think. Only yesterday I read posts from local people asking what the council candidates thought about trying to get a local hospital and the discussion went along the lines of “it would be great but as the hospital in Hobart is underfunded and understaffed (ramping is a big problem) it’s just not feasible”. What are the alternatives, a 24-hour clinic? Local doctors being rostered so there is always one available after hours? There is no easy solution. Basically, if you get sick after hours you go to Hobart to the emergency room at the hospital and sit for up to six hours waiting to be seen. It ought not to be like this but unless you are rich that’s what you get.

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    1. Even if you ARE rich you may not do much better. We are lucky I suppose that we have the state medical facility relatively nearby and if that doesn’t cut it, you can make the long slow drive to Boston. People drive down to Boston from hundreds of miles away because if you live in other parts of New England, there’s nothing. The local doctor is in no position to handle the complexities of healthcare now. And this isn’t local. It is everywhere. It gets different names, but it is the same story.

      Liked by 2 people

      1. It’s a thorny issue. I’m glad we’ve asked questions to get both sides of our “Question #1” so we can vote with some insight, not just a flip of the coin vote. It impacts many of us.

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  2. Does Massachusetts have urgent care centers? They operate like an emergency room but no trauma. They also are like doctors and only take certain insurances. I went to one three years ago when visiting Houston. They were equipped to take blood and X-rays.

    Liked by 1 person

      1. I get it… I’m now part of the older clan. My dad lives in Northborough and in hospital next town over. I’m glad he did not have to go to Boston. But my brother who lives in Lawrence had to for cancer treatments.

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        1. I had my cancer surgery in Boston. Also my heart surgery. I get follow-ups at the Dana-Farber (Milford), which is the ONLY cancer hospital in Worcester country. When you have something serious and dangerous, you go to Boston because I don’t trust any of the local hospitals … and we don’t have a lot of experienced surgeons. UMass is the best we’ve got and while dealing with them makes me want to scream, they do have good doctors, many of whom work in Boston but come out here to help because it’s really bad in the boonies of Worcester.

          It just gets increasingly difficult. We are very lucky we at least HAVE UMass relatively nearby. Otherwise, we’d be stuck driving into Boston for just about everything. Then, there’s Milford about which I’d rather not even speak. This is a BIG county and we don’t have much going for us.

          Liked by 1 person

          1. My grandson was treated and had reconstructive urinary track surgery at Boston’s children. NOT at Texas Childrens in Houston which was right down the street. Bigger isn’t always better. Argh.

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    1. Funny about that, isn’t it? Someone is still getting rich and it isn’t the nursing staff or even the doctors at this point. I keep wondering: What is the point of amassing amounts of money vastly in excess of anything anyone can actually use for any purpose? WHY?

      I don’t have answers. But our basic structures are crumbling while they proudly announce a billion dollar surplus in the treasury. When you don’t pave the roads or repair the bridges or pay the medical teams, it gets a lot easier to store up money. And you just KNOW the money isn’t going to be used to fix anything that needs fixing. Big bureaucrats will get bigger salaries and pensions and we will wonder how we can afford our medications.

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      1. That’s the problem. While we have the planners outsorcing services, and private companies now making money from the health Service, the service itself is struggling to provide basic services. And don’t get me started onthe state of our roads…

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        1. There are potholes the size of tank traps and winter is coming. Also, we’ve had SO much rain, a lot of roads have had the underpinnings washed away. I hope we have a mild winter. I shutter to think of what will happen if it’s really bad.

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          1. Same here. Even my excuse for a lawn looks like crazed pottery at the monent, with fissures big enough for me to break a leg, let alone Ani. Enough rain would probably cause flooding anywhere there is water too.

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            1. We are saturated. I have never seen the rivers this full except in the spring of 2001 when the entire valley flooded, including us. Our yard is a mass of mud. Summer came late and hot, so everything went from winter dead to insane wild growth. Good that our climate is stable.

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              1. Our reservoirs are all pretty low after the summer we had…we’re not used to prolonged dry weather…and they were low enough tobegin with. Even some of the drowned villages are showing…

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    2. Sue, there’s always enough “Kitty Money” for the “suits” who seem immune to the financial and medical blowback. Not fair –but it’s reality. Another reason to be informed before you vote.

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        1. Yeah. I hear very varying reports of who is likely to vote — literally exactly opposite polls. I think I’ve done pretty much what I can. Now, the ball is in the other court and we need someone with a great arm to whack that ball out of the park.

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  3. Having been raised in Wakefield, MA, and being the recipient of the wonders of Mass General for many of my birth defect repairs, I want to reframe the question around realistic finances.

    While we don’t have enough money for everyone – teachers, police, firefighters, etc., – we certainly seem to have allowed Corporations to take over everything, inserting a need for “shareholder profits” into the conversation at every turn.

    While I left Massachusetts for California many years ago (33 years at this point), my childhood surgeries were covered by insurance. Insurance provided by my Father’s job as a carpenter, and my Mother’s job as a bank teller. When there were periods of uninsurance, my parent’s bartered their services in exchange for the necessary surgeries to make sure that I and my sister had the best options possible for survival.

    While I agree with Suze Ormand’s thinking, “pay yourself, first” when it comes to being able to afford one’s life, the reality is that we no longer respect each other. We no longer respect the value of everyone’s work. That very “pay yourself, first” means that we don’t value the work done by others, and certainly not at the wages that would allow them to take care of themselves, too.

    We rank waitresses as less valuable than the administrative assistant, and often rank the grocery clerk as more important than the waitress, but less important than the car mechanic or the plumber. And everyone is ranked behind the local politician, who makes 2-3 times the “average” income of their constituents, don’t seem to have any idea of what it means to live within a budget, and walk away from their roles in politics as millionaires.

    Somewhere along the way, we’ve turned the fundraising that each town did to raise the necessary hospital in our small home towns into something owned by a City, and a disposable commodity as some bureaucrat strips the asset value from the hospital, consolidates it with larger hospitals nearby, and allows their town assets to be closed down, leaving their citizens with no local hospital to rely upon.

    I don’t have the answer for how this happened other than the 80’s and the whole “Greed is good” thinking thanks to Hollywood and Gordon Gecko. Everyone wanted to be an instant millionaire in the 80’s, and many folks brought their dreams to fruition.

    But, for every Steve Jobs or Dean Kamen, there were hundreds if not thousands of friends and families trying to survive as life in their neighborhood evolved to separate us from our tethers to our communities and realistic expectations.

    We booted people with mental health challenges out into the cold, and when there was no outcry over the saving of money at the cost of the value of individual lives that needed guidance and shelter and assistance, the communities upped the ante by reducing the wages and benefits for every worker, as Corporate profits and managerial salaries soared.

    I do remember, though, the day I told my mother that I was done allowing any reparative surgeries (1974) as our family was broken up by trying to pay for the repairs I and my sister required, and our father decided that he didn’t want to be a responsible parent any more. Money was more important than self-respect and caring for each other, and he decided that he wanted stuff vs. being shackled to the every increasing cost of paying for my healthcare. Healthcare which had no demonstrable monetary value to him.

    Rather than be a further burden to my family, as our income was cut by 2/3rds, I stopped allowing discussion of repairs and improvements, and focused on how to be able to build a life where I could afford to live and not be a financial burden. This was all before medical records were automated and I lost any hope of insurance coverage due to my pre-existing conditions as of 1992.

    Now, 44 years later, I am 58 years old and trying to survive despite my diagnosis of COPD, diabetes, liver disease, etc., etc., etc. Without amazing medical care, I’ve managed to live a good life by relocating to California and by finding a way to afford to pay for my bare bones medically necessary care without insurance for much of my adult life.

    One of my best friends took six (6) years to get through Nursing School in the late 2000’s, after being laid off – yet again. Gen Xers are nothing if not versatile, as we entered the job market at the time of the first real estate crisis that took down Wang and liquidated most of the East Coast during the first banking scandal.

    In my friend’s case, it took so long to get her second college degree because the colleges have become for-profit nightmares, where they don’t have to offer the classes consistently to enable one to retain the degree for which they’d started college, and where colleges can reject the classes taken at other schools as “insufficient” – even though every college is fully accredited to bestow the nursing degree if they offer that kind of training – because they, too, are chasing the almighty dollar for profits vs. concentrating on providing an education in exchange for the massive student loans the constituents mortgaged their futures to obtain.

    As a society, we see some people living the high life, and everyone else struggling to cobble together a career that can last them a lifetime. College students have degrees that are useless in the real world before they even graduate, as jobs and technology change and evolve faster than curriculums can keep pace (I survived by bypassing a degree and constantly keeping my eyes peeled for the next “big thing” so that I could write contract language where the concepts didn’t yet exist for the cutting edge products being developed – think Apple, Napster, Facebook).

    With the firing of the Air Controllers by Regan, and no public outcry from the masses trying to survive, our society has become marooned in massive debt by our political leaders, and we seem to have lost the grassroots initiative that once allowed us to stop wholesale looting of our civic institutions.

    I forget where I was going with all of this when I highjacked your posting to add my 2 cents, but I know I had a point when I started.

    At the end of the day, we cannot provide enough nurses for demand because:

    a) We don’t want to pay a fair wage for EVERYONE working, so that EVERYONE can afford to pay for their medical care, and,

    b) We have jury-rigged the college education system to game the students such that it takes way too long to get a degree as we suck them dry for limited seating in the desired courses, all the while outsourcing their jobs to whoever will work for the cheapest wages by importing talent from overseas and eliminating any kind of structured work week, eliminating benefits and regular hours.

    We have lost our mind as a nation on so many fronts, but medical care for our aging population seems to be in the forefront of excuses for why we are not prepared to maintain and repair what we have, while charging more for less services. Crazy. Capitalism run amok.

    Liked by 1 person

    1. Good rant. I agree.

      They keep pointing out that we have a billion dollar surplus in the treasury while the bridges and roads crumble. The lack of nurses is a combination of everything you’ve said. Why become a nurse when your working conditions will be so dreadful you’ll be too exhausted to survive in 10 years? It’s not ONE thing. It’s many things.

      MassHealth has done a lot to fix the healthcare system in the state, but now? Who knows what’s going to happen? I wonder if I’m going to make it safely to my coffin before they cut off Medicare and Social Security. We live in south central Mass, down by the RI border. There are very few medical facilities here. Everything goes to Boston and we don’t live there. So when our doctor wonders where he can put patients, I figure we are likely to be “those people.”

      I don’t know what to do either. I’m just pointing out that we have local and very personal issues to deal with that are not linked to any party but to this country’s passion for making money as the goal of every industry. Nothing is sacred, nothing is worth saving. Roll those bulldozers and bury the wetlands. It’s not about making money. It’s about making MORE AND MORE AND MORE money. Will it end? Not in MY lifetime and I’m beginning to feel that’s a good thing.

      Liked by 1 person

  4. Some how these politicians need a wakeup call. We are running into some issues here about a planned development. The developers come and give a presentation and it is merely tokenism. We know they are going to go ahead with what they want to do regardless of whether it fits in with the official plan or not.
    Leslie

    Liked by 1 person

    1. They did that here, but then the economy crashed so now, they don’t. But if things perk up, welcome to the New World where we will keep digging and building regardless of climate, wildlife, water availability or anything except money. It’s how we’ve gotten where we are and why we aren’t going to fix it.

      Liked by 1 person

      1. It seems that all we can do is try to alter our own ways as much as we can. If the government won’t take the prerogative then we must.

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      1. We are having municipal elections on the 22nd of October. I got a phone call from someone from the incumbent mayor asking who I planned to vote for. I told her “the last time I looked it was a secret ballet.” Now I think I’m not going to vote for any of the incumbents.

        Liked by 1 person

  5. The problem for far suburbs, exurbs, and rural areas is that we don’t have the polling power to pull the money into what WE need. All the money goes into Boston so what little gets done, doesn’t get done out here. New York has had this problem forever, which is why “New York” votes liberal. But get yourself out of New York city and into the rest of the state — and it is a BIG state — and you’ll hear a lot of bitter anger among all the farmers trying to keep alive.

    Liked by 1 person

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