Lean on me: the challenges of day surgery for those living in poverty

 

By Kendall Worth!

Today I want to revisit an issue that I first wrote about over a decade ago:  the challenges faced by people on Income Assistance who are called into hospitals for day surgery. 

For most day surgeries, a hospital will recommend that the patient bring someone with them. This companion is for both general emotional support but also to safely accompany them home after the surgery, when the patient may be medicated or perhaps partially incapacitated. 

From my observation, it appears that up to 80% of IA recipients are unable to make such arrangements because of their limited social contacts and family networks. They may be estranged from friends and family who may actually live far away. As I first discussed in a 2014 article, as well as later here in the Nova Scotia Advocate, and more recently here in this BLOG, - what to do when at very short notice, such an individual has been told to find someone to accompany them to the Hospital? 

I recently revisited this issue in conversations with four First Voices from my community to see if anything has changed. All four told me that at different times they have had to defer surgeries because of lack of available personal support. While these individuals were reluctant to get into the details of their situations, with regards to both health issues and social relations, - they all agreed that there is a BIG need for some sort of program or service to ensure that this issue is addressed. They also emphasized that any such program / service will need to be FLEXIBLE, as the individual situation of people can vary greatly, and the needs can be quite different.

In my opinion, the Government needs to proactively address this issue, as the lack of available supports is clearly an obstacle to people’s access to necessary health care. Finding a solution would likely involve two different government department: the Dept of Health and Wellness, as well as the Dept of Opportunities and Social Development.  

With regards to the Dept of Health and Wellness:  the Dept’s policy with regards to the requirement for patient accompaniment to day surgeries is cited in the 2014 article linked above. The policy clearly states the requirement that any patient undergoing day surgery needs to be accompanied by someone with them, for the purpose of accompanying them home following surgery as well as monitoring and supporting them for the first 24 hours, post-surgery.  It is also made clear that “accompanying the patient home” is understood to mean that the companion is someone with a vehicle and driver’s license who is willing to accompany the patient home following surgery, and monitor their situation for a short period.

My contacts inform me that these criteria are a big problem for them. Firstly, they have a much smaller network of friends and family to draw upon. Secondly, the individuals in their social network are much less likely to have access to a vehicle.

For many IA recipients, their daily network of social contacts is limited to people they might meet at food banks, soup kitchens or shelter. The exception of course would be the professionals with whom they may engage: doctors, social workers, etc. But it is generally not appropriate to engage these people for ‘personal favours’.

In summary:

•  Many of the people I advocate for do not have that friends or family members who can do them favors like accompany them to and from the hospital for day surgery.

•  In the cases where friends or family are indeed willing to support, those people are less likely to have a drivers license or car; 

•  Furthermore, even the seemingly simple and straight forward issue of naming an emergency contact or next of kin can be problematic, as I have written about here;

•  Finally, even if accompaniment to the hospital for surgery can be arranged somehow, the need for post-op, at-home monitoring and support can also be a challenge, as I have written about in this article. 

Given all these many complications, it should not be surprising that many IA recipients chose to defer or even postpone or cancel scheduled day surgeries simply because they are unable to ensure the necessary support for themselves.

With regards to the Dept of Opportunities and Social Development: While the Dept of Health is the actual provider of heath services to Nova Scotians, O&SD is the department that directly engages with people receiving Income Assistance and other benefits. To that end, there is much that the Dept could do to strengthen the capacity of its constituents to engage with the health system in a timely manner.

For example, one can readily imagine the contribution of a newly created Social Prescription Program (as I have long been advocating) to enabling IA recipients to get the support needed for their day surgery appointments. It is also not difficult to imagine more flexible and generous allowances that would enable family and friends to accompany them to surgery as well as providing post-surgery support. 

Another helpful reform would be to eliminate clause (6.1.8) of the Employment Support and Income Assistance Policy manual such that co-habitation is permitted and IA recipients can help take care of one another, be that as romantic partners or simply roommates.

Conclusion:

The bottom-line of this issue is clear: the deferring and cancelling of day surgeries for people living in poverty will continue so long as there are such obstacles. This situation is obviously not good - for people’s physical health, or their mental well-being.

At root, this is an accessibility issue that needs to be addressed.  The Houston Government recently announced that it would no longer charge car-driving patients for the privilege of parking at hospitals. Now is the time to imagine a program or service that would enhance accessibility by those Nova Scotians more likely to be riding a bus to their day surgery appointment.

Kendall Worth is an award-winning anti-poverty activist who lives with disabilities and tries to make ends meet on income assistance.