Why Patients and Healthcare Providers Need Another Option
When Dr. Dave Moen, President of Prospero Health Partners, was a young physician working in an emergency department, he met a patient whose story would guide the trajectory of his career for years to come. It was a Saturday evening in the wintertime, and Moen had just started an overnight shift. Rose was the first patient he saw.
“She was bundled up in a blanket and smiling,” Moen recalled. “But she winced any time she was moved because she had pain in her hip.”
Rose was in her mid-80s and lived alone. She had fallen in her apartment, and it had taken her several hours to crawl over to the phone to dial 911. At first, Rose’s case seemed straightforward; all signs pointed to a broken hip. When Moen looked at her X-ray, though, he didn’t see a fracture. Nothing showed up on the CAT scan, either. With a waiting room full of other patients, he deliberated on what to do next.
“An elderly lady on a Saturday night, now 10 o’clock. Medicare doesn’t pay for a ride home. Medicare doesn’t pay for admissions without a diagnosis that makes sense. So, I go ‘diagnosis finding,’ meaning I need to find something to put Rose in the hospital.”
After more tests, it seemed plausible that Rose had a urinary tract infection, which was a good enough reason to admit her. That night, Rose became disoriented, potentially because of mild dementia, and fell once again, this time in her hospital room. She suffered a head injury and spent the next two weeks in the ICU. She was eventually discharged to a rehab facility, and then to a nursing home. She passed away within six months of her initial visit to the ER.
“The hospitalization was a trauma to Rose and likely the cause of her demise. And I put her in the hospital because I had no place else for her to go, even though, reflecting on it, that really wasn’t the best answer for her. That’s a powerful story because it’s not uncommon.”
Carrying the memory of Rose and others like her, Moen has become a champion for Prospero’s physician-led home-based care model; one centered on the needs of patients and families while prioritizing at-home treatment. Within the Prospero framework, Moen is part of an interdisciplinary team of providers who lean on each other’s strengths to help people write the final chapters of their lives.
In Moen’s experience, some patients and families know exactly what their care goals are, while others need help facilitating difficult but necessary conversations. For example, when two sisters couldn’t see eye to eye on whether their mom should undergo another round of chemotherapy, a Prospero social worker sat down with the family to discuss their options and unpack the emotional issues at play. After several conversations in the mother’s home, the family moved forward with a hospice plan. According to Moen, “they were all happy with that outcome.” This particular case illustrates the value of giving patients all the information they need to choose the path that’s right for them.
“If we’ve done all we can to inform, to engage, and to help patients feel safe, we also have to stand by them if they make decisions that don’t make sense to us. What’s interesting is that doesn’t happen all that often. The vast majority of people make decisions that feel consistent with the best possible outcome.”Dr. Dave Moen