Challenges in Urban Health Care: A Case Study of the Banes Family

In her book "Mama Might Be Better off Dead: the Failure of Health Care in Urban America," Laurie Kaye Abraham illustrates the challenges faced by the Banes family, who have resided in a disadvantaged Chicago community for three years. Abraham highlights how the American health care system has let down the Banes family members. The main character, Jackie, is tasked with looking after her ailing grandmother and three kids while her husband Robert is also unwell. Despite the existence of government assistance programs, the health care system falls short in providing sufficient support to families like the Banes.

Cora Jackson, an African American woman in her late sixties at the start of the story, grapples with various chronic illnesses like high blood pressure and diabetes. Her diabetes caused issues that led to the amputation of one of her legs, a typical consequence for diabetics with poor circulation. Alongside being restricted to a bed or wheelchair, Mrs. Jackson copes with bed sores, incontinence, and deep sadness after losing her limb.

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Despite her health challenges, she remains the matriarch of her family.

Mrs. Jackson raised Jackie when she was young, and they had a close relationship with her great-granddaughter Latrice. But as Mrs. Jackson's illness worsens, Latrice starts to distance herself, which is not uncommon for children dealing with a terminally ill loved one. Jackie, on the other hand, continues to show warmth and care towards her grandmother. She vents her frustrations, mainly towards doctors and government agencies responsible for her grandmother's treatment and care.

Obtaining health care services is a challenging task for Cora Jackson. Jackie, her primary caregiver, faces daily struggles due to issues such as Medicare's view on adult diapers as a convenience rather than a medical necessity. Despite covering a large portion of health visits and treatments, Medicare fails to address transportation needs for disadvantaged patients like Mrs. Jackson. Consequently, she misses scheduled appointments and important treatments recommended by her doctors. This leads to the unfortunate decision of having her remaining leg amputated due to an infection that could have been caught earlier. Jackie is forced to call an ambulance to transport Mrs. Jackson to the hospital, resulting in complications as the closest hospital does not have all her medical records.

Many rules and policies confuse me. I don't understand why adult diapers are not considered medically necessary when they are essential for infants. Why wouldn't they be necessary for adults with incontinence issues, especially since they can help prevent bed sores in elderly patients? This prevention can avoid future hospitalizations and procedures due to infections. The spend down policy of Medicaid is also a concern for me. Mrs. Jackson has to spend a certain amount on medical needs every month to qualify for Medicaid, only to start the process over again each time she meets the requirement. Additionally, the Banes are unaware of some entitlements they have. For instance, Medicare covers home health aides for those in need of home nurse visits, but Jackie declines this service mistakenly thinking it will cost her $110 monthly when it is actually free and no one informs her of this.

There are various changes in the health care delivery system that could have enhanced the experiences of Mrs. Jackson. It is unreasonable to track a monthly spend down for an elderly, disabled patient such as her. In her situation, Medicaid was necessary to cover her transportation needs, making it difficult to schedule appointments and procedures without a reliable way to get there. Many other patients rely on Medicaid for different reasons, including regular medication expenses and doctor visits. A more effective approach for Medicaid eligibility could involve averaging expenses over a few months rather than determining eligibility on a monthly basis.

Knowing they are covered by Medicaid for an extended period of time brings immense relief to patients. They can attend appointments without worrying about transportation costs and take medication as prescribed without fear of running out before the next month. Another issue that needs to be addressed is the determination of what qualifies as medically necessary items. Who decides if adult diapers are a necessity or simply a convenience? For an elderly person who struggles to reach the washroom, adult diapers may be considered convenient. However, for someone without the use of their legs and insufficient assistance to move from bed, adult diapers are clearly a medical necessity.

As a social worker in health care, my goal is to assist Mrs. Jackson by encouraging her to utilize available services and ensuring she comprehends her entitlements. Many individuals, particularly those with limited financial resources, may find it challenging to understand government policies like Medicare and Medicaid. I believe there should be more resources accessible to explain these policies and provide assistance in understanding them. Regular visits from a home health aide could have greatly benefited both Jackie and Mrs. Jackson. It's essential to address the overwhelming stress Jackie faces as the primary caregiver for three children, a sick husband, and an elderly, disabled grandmother. By prioritizing Jackie's needs, she may be better equipped to make decisions for her grandmother.

When discussing the situation with Jackie, it is important to consider the possibility of moving her grandmother to a nursing home. Despite Jackie's initial worries about her grandmother feeling unloved and ignored, it is crucial to weigh the advantages and disadvantages of this choice. By emphasizing how continuous care can help avoid missed appointments or medications and organize medical records more efficiently, there is a chance to improve Mrs. Jackson's quality of life. Instead of jumping straight to extreme measures like assuming her grandmother would be better off dead, why not first look into the option of a nursing home?

The book "Mama Might Be Better off Dead: the Failure of Health Care in Urban America" portrays the stark human suffering caused by the unequal healthcare system in America, contradicting the country's ideals of freedom and equality. While media debates about healthcare reform continue, this book provides a firsthand look at the system's shortcomings. It is crucial for individuals to recognize the urgent call for change and actively participate in reform efforts.