Custodial Care Isn’t Same as Health Care

The Dana Parsons column of Dec. 22 has raised the issue of the care of our elderly, but may have misclassified this as health care. The article identifies the issues as “catheter still in him,” “not strong enough,” “hardly talk,” [and] “walked a few steps but we had to guide him.” For these reasons someone would recommend “one more or a couple days in the hospital.” A hospital stay is a very expensive solution to issues that require neither doctors, nurses, physical therapists nor hospitals.

The issues identified are real needs, but they are classified as custodial needs. These are neither skilled nor health needs. They are basic requirements for activities of daily living that many of the elderly require. In this case the level of assistance lessened over several days, but in many it becomes a chronic problem. Many seniors require constant supervision for their safety and intensive help for their activities of daily living. In the present case the only medical concern would be the catheter, which does not require daily care other than emptying the bag of urine. The other needs are assistance to eat, assistance to walk and supervision for safety. An interesting analogy is that raising our children is not dissimilar to caring for the elderly. However, no one would put their child in a hospital or nursing home to be raised, nor could anyone afford the cost that would be incurred.

If Parsons can differentiate custodial care needs from skilled [nursing] and health-care needs, he may have revealed a significant portion of the health-care crisis that underlies the tip of the iceberg. Perhaps our system needs investigation, not the hospital.

DR. MARVIN J. GORDON

Laguna Beach