In life, we often refer to our “bucket lists.” But we rarely think about our “healthcare buckets” — especially as they relate to enjoying what has meaning to us and our loved ones.
Since joining the team at Healthassist, Dianne and I meet every Tuesday morning at 7:00 AM to discuss each client for whom we provide project management services. When we first started to meet and I would bring up issues, she would invariably say, “let’s separate the issues into buckets.” Eventually, we came up with three:
Crisis. This one is the most difficult to manage and the most likely way we start our relationship with a client. This is when everything feels out of control.
Episodic. Here things are relatively stable but during which an issue might arise that requires quick action to prevent a crisis from occurring.
Chronic. At this point, we are effectively managing multiple issues, but all is mostly under control.
Ideally, when managing multiple and complex healthcare issues, you want to be in the chronic bucket, acting to prevent an episode of illness that can lead to a crisis.
As you think about your healthcare and that of loved ones, what bucket are you or they in? This is especially relevant today, with millions of Americans living longer with at least one chronic disease (e.g., hypertension, obesity, dementia). Further, because of these chronic issues, many people find themselves in one or more buckets at the same time.
Let’s look at each bucket in a bit more detail…
The Crisis Bucket
Ninety percent of our clients contact us at this point — when the rug has been pulled out from under them, sometimes by something as “simple” as a fall or a minor infection that results in hospitalization.
One client, Jim, called us in a panic: “Mom’s being discharged from the hospital in two days to a facility for further rehabilitation for her broken hip. We really want her to come home, but don’t know if my dad (who has his own health issues) can take care of her. And is this even the right move? My siblings and I are not on the same page and dad keeps telling us not to worry, he’ll be fine.”
Jim felt both guilty — neither he nor his father had anticipated this — and a little bit angry. He knew that his dad might be unable to care for his mother and that this responsibility might fall to him.
The Episodic Bucket
Jim’s mom went to inpatient short-term rehabilitation in a skilled nursing facility and eventually came home with a great deal of support from family, skilled homecare services including nursing, physical, and occupational therapies, and private homecare services for assistance with activities of daily living (e.g., showering and dressing).
After six months, Jim’s mom is walking again, but dad has taken on more of the household functions such as grocery shopping, cooking, cleaning, and laundry.
Throughout this phase, there were a few trips to the emergency department of the local hospital — one for an acute change in mental status that turned out to be an undetected urinary tract infection and two others for falls that fortunately did not result in any acute injury.
Jim and his dad were wrestling with mom’s need to be in the “revolving door” of hospital admissions. This was draining them both physically and emotionally as they watched her fragile health gradually decline.
They kept asking themselves, “How much should we put her through? She sees herself as invincible, but I think, in her heart, she knows otherwise. Yet she’s unwilling to discuss what she wants or would like me to do.”
The Chronic Bucket
Over a long period of time, we were able to get Jim’s mom to this phase. It was necessary to add back in some daily private homecare services from individuals who would pay attention to all the little details of keeping her healthy.
They made sure she was eating nutritious foods, that she was getting enough fluids on a daily basis, that her bladder and bowel function were regulated, that her skin was well taken care of, and that she was “exercising” daily with at least a 10-minute walk and ascending and descending six steps in the house.
Although this might all seem like common sense, these are the proactive things that can prevent an unexpected turn of events from becoming a crisis. Jim’s favorite phrase about his mom and dad has become, “Every day without a crisis is a good day!”
Recommendations Regarding Your Healthcare Buckets
Here are some things to keep in mind…
- Anticipate what might occur. Think about what could potentially happen to precipitate a crisis, such as a fall or an infection, and identify if you are doing all you can to prevent it.
- Optimize care of your chronic conditions. Your primary care physician is the “hub of your referral wheel;” your partnership with this individual is central to keeping potential crises at bay. At each appointment, be sure your agenda includes a discussion of the plan you have in place to manage each condition. This can minimize potentially adverse impacts.
- Be prepared for a crisis. One of the tools Dianne and I share with our clients is the “Grab-N-Go” Kit. We have mentioned this many times before and it serves as a wonderful reminder of the value of planning ahead. Along the same lines, it is important to get your insurance and financial affairs in order, so that you will have the information and flexibility needed as you move among healthcare buckets.
- If a crisis occurs, immediately begin planning for a transition. We think less clearly and make poorer decisions in the midst of a crisis. By speaking early with family and all health care professionals involved, we can both improve the coordination of care and be confident that wishes will be honored.
- Empowerment comes from being proactive. As you take more control of your overall healthcare, you will feel more engaged and, hopefully, less stressed. I find this transition quite rewarding, as I watch my clients add the necessary tools to their toolbelts such that my services are revised or no longer needed. (I also admit that I’m a little sad because I do miss them!)
One constant in life is the ongoing change in our health and the healthcare system including personnel, services, and resources used. An understanding of how these relate to each other and change over time is critical for optimal management of your healthcare.
Illness is a family affair and relationships can be turned upside down abruptly during a crisis. Paying close attention to the little signs of an impending crisis, such as unsteadiness on one’s feet or a change in cognition, might allow conversations ahead of time with loved ones as to their wishes and can go a long way in providing a supportive and reassuring anchor during fluid health issues.
Keeping your healthcare buckets in mind may even provide more opportunity to check off some of those treasured plans on your life bucket list!