By Kate Snow, Janet Klein and Dustin Stephens
Rock Center
For Barbara Latasiewicz, home was a hospital room. The Poland native, who had cleaned homes in the Chicago area for 20 years, suffered a stroke while on the job in September 2009. An ambulance took her to Adventist La Grange Memorial Hospital in Illinois.
"I was thinking that after a few days, that I'm just gonna get better," Latasiewicz told NBC’s Kate Snow through a translator in an interview airing April 25 at 9pm/8 c on Rock Center with Brian Williams.
Latasiewicz suffered paralysis on one side of her body, but eventually became well enough to leave the hospital. However, more than two years later, the 62-year-old was still in the hospital.
“She hasn’t needed to be in this acute facility for a long time,” said Richard Carroll, the hospital’s chief medical officer.
When asked about Latasiewicz’s more than two year stay at the hospital he oversees, Carroll said, “That’s really a function of how our health care system is working right now, which is it’s not working very well at all, particularly in cases like this.”
Carroll said that Latasiewicz belonged in a skilled nursing facility where she would receive a more appropriate rehabilitation, but she had no way to pay. Latasiewicz had no insurance and was an undocumented resident with no access to government safety-net programs like Medicaid. Without payment, no facility would take her.
NBC News
Barbara Latasiewicz
The end result? Latasiewicz stayed at La Grange. Her care cost the hospital $1.4 million. A skilled nursing facility would have been a fraction of the cost.
An NBC News investigation discovered that cases like Latasiewicz’s are not unusual, but the result of current health care policies and guidelines. They are known as “permanent patients” and are hidden in plain sight in hospital rooms across the country. That’s because under federal law, hospitals must treat any patient who needs emergency medical attention even if they have no way to pay. Nursing and rehab facilities are not required by law to do so. At the same time, hospitals cannot discharge a patient without a plan in place for his or her ongoing care. The result is patients stuck in the hospital in need of long-term care but with nowhere to go, large medical bills, and no way to pay – a cost that is usually covered at the hospital’s expense.
“It would be cheaper to take these patients and send them to the Ritz Carlton,” said Harvard University School of Public Health Professor Ashish Jha. “They could get room service all day, and that would be cheaper.”
Jha estimates there are tens of thousands of these patients stuck in the hospital with no clear place to go. Some stay an extra week, some months, and some like Latasiewicz even years. NBC News spoke with officials at dozens of hospitals across the country who confirmed housing patients who didn’t need to be there for extended periods.
Many patients are stuck because they have no money or insurance to pay for long-term care. Other patients may have insurance, but their medical needs are too complex for most skilled nursing facilities to accept. Then there are those in limbo at the hospital waiting sometimes for months to qualify for Medicaid. Once they’re approved, Medicaid will cover the nursing or rehab facility they need.
A spokesperson for the American Health Care Association which represents skilled nursing facilities says that the industry works with hospitals to find facilities for such hard-to-place patients.
According to data from the National Inpatient Sample database at the Agency for Healthcare Research and Quality, the problem of permanent patients appears to be on the rise. From 2005 to 2009, the last years for which data was available, uninsured hospital patients with no access to Medicare or Medicaid in need of long term care increased 20 percent.
NBC News
Garrick Amato
“Most of them are Americans,” Jha said. “And if they get hit by a bus, they get sick, they’re in this situation.”
Garrick Amato, 59, arrived at Banner Heart Hospital in Mesa, Ariz., after suffering a heart attack. A few days later, he was ready to leave the hospital for a rehab facility. However, Amato, who said he worked part-time at a local discount store, had no health insurance and no way to pay for his rehab.
“I guess no nursing home will take me cause I don’t have insurance,” Amato said.
Furthermore, as a single adult without dependent children, he did not qualify for Medicaid in Arizona. Amato spent most of March and much of April at the hospital. Banner Hospital eventually found charity care for him that placed him in a skilled nursing facility where he belonged.
Other patients linger in hospitals despite their best efforts to find charity care. Fatima Khydarova, a professor from Uzbekistan, has been at Maimonides Medical Center in Brooklyn, N.Y., for more than two years. Khydarova arrived there after suffering an incapacitating stroke while visiting her grandchildren in New York. While Khydarova will never walk or talk again, doctors say she does not need to be in a hospital.
NBC News
Fatima Khydarova
“In a perfect world she should be either at home with her family caring for her or in a nursing home,” Maimonides CEO and President Pamela Brier said.
Khydarova’s grandchildren said that they cannot take care of their grandmother at their mother’s small apartment and at the same time make a living to support all of them.
“I’m working, I’m working.” said granddaughter Nigina Abdullaeva who works at a doctor’s office.
Dr. Jha of Harvard University says that the costs for treating permanent patients are passed on to other consumers through higher medical bills and insurance premiums.
“The bottom line is we’re all paying for it,” Jha said.
To mitigate the cost of these patients, some hospitals have paid out of their own funds to move them to skilled nursing facilities. Once there, the hospital could pay for their care for the rest of their lives.
“Hospitals don't want to widely advertise that they will pay for your care elsewhere,” Jha said. “But in select situations, they look, and they realize, instead of spending tens of thousands of dollars to keep the patient in the hospital, it's probably cheaper for them to send them somewhere else.”
Back in Illinois, case workers at La Grange Hospital also struggled for years to find a more appropriate medical facility for Latasiewicz. They eventually found one, but it was in her native Poland.
Wiping tears away from her eyes, Latasiewicz told Kate Snow through a translator that she did not want to leave. Latasiewicz lived in the United States for 20 years and has a son and grandchildren living nearby. However, her son, Peter Latasiewicz, said he could not take his mother into the small apartment he shares with his children and another family.
“I wouldn’t be able to provide as much help and support and care for her,” Peter Latasiewicz said, “she’s got a lot of medical conditions where she requires 24/7 care.”
The hospital eventually went to court for permission to send Barbara to the medical facility in Poland.
The hospital won and on March 1, Latasiewicz boarded a flight back to her native Poland.
In Brooklyn, Khydarova, the professor from Uzbekistan, remains at Maimonides and the hospital is still working hard to find a solution for her family
“She’s going to stay in the hospital unless we can find a spot for her,” CEO Brier said, “She could stay here potentially for the rest of her life.”
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Early in my career I met an older guy & drew labs on him every day for over 3 months. I wondered why he was in te hospital soo long. He looked well enough to be at home. I asked a nurse (I had a right to know) & they said he didnt have a job & was a registered sex offender so no nursing home wanted the guy & he had nowere to go. Nice guy though. He was still in the hospital long after I had found another job in another state. Sad but this happens quite a bit.
If I remember right from what I heard it might be in the law that the nursing homes can't take people in that may endanger other patients.
That is accurate.
Screw the whole damn health care system in the United States!
It's an obviously anachronistic model. It's no surprise the rest of the world has moved on.
For those against Obamacare as it is called...have you read all of it? Parts of it are good....EX: ins co's cannot exclude pre-existing conditions, no life-time caps on $$ for care. The fact is, that people who get regular healthcare are generally cheaper to treat/care for long term as they get preventative care. Whereas people who do not have insurance generally do not get preventative care and manage health issues as well...thereofre having a higher cost of care, so if everyone had health ins coverage, that should bring the overall cost of healthcare down....theoretically anyway...
But....Universal healthcare or anything else will not address the issues in this article, 2 out of the 3 people discussed (as I recall) were not citizens, 1 was here illegally and therefore wouldn't qualify for anything, and 1 was here visiting family with every intention of returning home.....
Another example of the Federal gov't intruding where it has no business... with the typical unintended negative consequences...
Many Rightwingers/Teabaggers would throw these people out on the street to die in a gutter no doubt. They don't contribute to society,these lazy good for nothing leeches! They're probably Liberals anyway! I can't have my taxes increase because of these worthless people! I bet they don't work!! Now where is my Bible? My pastor told me I'm a great Christian!
i am not saying they are worthless, just need to be sent to their homeland.
You sir are a Pinhead.
send her back to where she came. if not a citizen, she should not be eligible for any type of health care in our hospitals. This is a good case of our gov't not overseeing these people coming into USA and then we have to take care of them.
And it took them 2 years and $1.4M later to send her back to Poland. I'm sorry but the United States government can't take care of the whole world. She's not a citizen, she has no insurance and she still wants the government to care for her, in a private room no less.
And they wonder what's wrong with the economy, go figure.
Does anyone else not find this particular quote a little bit disturbing?
I recognize the ironic nature of the quote, as he was trying to emphasize the costly nature against the medical community.
However, that doesn't excuse the fact that medical costs have risen exponentially to a point where it is no longer feasible for me to continue seeing a doctor for an ailment that they cannot properly diagnose or treat.
I'm speaking from personal experience, having symptoms of Eustachian Tube Dysfunction for two full years now.
I've seen two ENTs, three GPs, one chiropractor, had an expensive surgery (to insurance costing over $30,000) and spent at least $6,000 out of pocket total of my own money.
All this, and no results.
... and this professor makes a joke out of the matter by saying if we holed up at the Ritz Carlton and got room service all day, it would be cheaper.
What's the BIG issue here? Sounds like the medical field's out of control expenditures are the real issue, not the foreign or uninsured public, or "Hippocratic oath" excuse.
It shouldn't be this costly to see a doctor. Plain and simple.
Professor Jha should be ashamed.
KMoser,
53% pay no Federal taxes because they don't make enough money, however, they pay property taxes, sales taxes, state income taxes, etc etc etc,,,Turn off Fox and do some research,,,stop being a minon of the evil ones and please don't say you're not heartless,,,the proof is in the pudding!!!!!!!!!!
Give me a count on how many ILLEGALS we have using the emergency rooms as primary care.
allot happens when you allow illegals into this country AND you have the health-care system we do.
Want to see how many million use the system? Annually?
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1303412/pdf/westjmed00354-0020.pdf
every one with out insurance uses the emergency room for primary care duhhh , or i guess u could just sit home and wait to die .
You cannot count the illegals anyway as the ER does not ask for immigration status.
also ,, my great grandfather was a docktor , and from what i've heard did home visits and whatnot and literally got paid in chickens and meals . back in the 20's so how did it get to be such a lucorative trade . most of the time they just give you a script. unless its a broken bone , or cancer .
The government became more involved, insurance companies, attorneys and so on wanted more. Years ago the Republicans wanted to limit how much attorneys could gain from lawsuits as a lot of them can easily get 50-60% of an award dealing with malpractice. Clinton and his wife through a big fit as they are both attorneys and the whole bill got pushed aside. Both parties are so corrupt when you look at it. Years ago I worked for a company and asked a sales rep why our glass products were so expensive and he said that they sold stuff to doctors so they have to protect themselves also from malpractice lawsuits so they have to hire attorneys to be on staff full time along with paying higher insurance premiums. They end up passing the costs down to the customers.
My husband did not have health insurance due to a pre-existing condition. As much as we tried as soon as the insurance companies heart high cholesterol he was denied. On October 6, 2010 he suffered a massive stroke. My son and I got him to the hospital. I saw a major difference in how he was treated compared to other patients with insurance. Those with insurance got long physical therapy sessions daily, he got 10 mins. No facility for rehab would accept him without insurance so he was sent home after 3 weeks with an infection that landed him back into the hospital for Thanksgiving weekend. If it were not for our Church we would have not had any help. Two PT's volunteered their time to teach him and myself his therapy exercises, still he is not the same man. We should be ashamed as a country to have this going on anywhere to anyone.
If it costs a fraction of the cost of a hospital to place them in a care facility, why doesn't the hospital foot the bill and place them in one? I suppose there is a regulation against that little bit of common sense.
If you really want to find out about and excellent system, just check out PNHP.org, Physicians for National Healthcare!
Yeah, who needs to overhaul the health care system, this is much better as you can see.
/sarcasm
I think her grandchildren she was visiting could be doing more. I bet if she were in her own country they would be.
"Give me your tired, your poor,Your huddled masses yearning to breathe free"
I guess since the majority of our ancestors came here & we have our freedom we should just forget all about this now, after all why worry about the others who are repressed since it's not "us" any more...
Universal health care for all I think would be a common sense idea, we'd pay less in the end if it was set up that way, people would be healthier, but hey lets just leave things the way they are now.
Well it's one thing to give that to the people we promised it to. We are in such bad shape now we can't even keep that promise. Those people came here the legit way. The ones in this article didn't or they wouldn't be undocumented. We can't take care of the whole world, that's why American's are suffering the ones that were actually born here.
Your quote is a poem about an ideal, not law.
this happened to my brother in Florida. If I had kept on the hospital to help him get medicaid I think they would have wheeled him on to the street and left him.
Yes the system is broken, and it has been broken for a long time. Obama tries to do something about it, and he get's thrown under the bus by every Republican plus a Republican that used mandated Health Care when he was the governor of Mass I bet you can't guess his name??? Granted I don't like the mandate but something has to give, and even though i said earlier that this ( I don't know how anyone can call what we have had for the last 25 yr's a Supreme court) Supreme Court will more than likely strike down Obamacare. we need something, and to be honest i have not seen anything coming from the Republican side of the aisle. Other than trying to cut program's that we shouldn't be cutting like education for our children, and a voucher system for medicare that would cover less than 60% of medical cost's for the elderly, and while cutting program's for our children, and elderly they want more tax cut's so you know already that the money they take from these program's that they are cutting is going to offset the new tax cut's that they want for Big Corporation's under the guise of jobs jobs jobs? How about lie's lie's lie's!!! There are several Western Countries that have universal healthcare,and everyone of them pay less than the United States, but hey we have to vote, and elect people that don't have 99% of our interest's, but back Big Oil companies' The Koch Brother's, ALEC, and of course the Other big Corporation's that take's the money they earn from here, and invest it in other Countries. so pick your poison someone who is trying to do something for our people right here in america, or support the Fascist Republican's. bought, and owned by Big Oil, and Big Corporation's, and the Koch Brother's since 1981!!! You say people who are on food stamps, and medicaid is govt welfare. I say Big Oil, Big corporation's, and especially the Koch brother's are the one's getting Government Welfare!!! Yes Romi the people you love most Big Corporation's. I am sorry I had to throw that in Romi was so worried about Corporate Hospital's losing money, and he wasn't at all concerned about people's well being!!! I already know which poison he plan's to pick this fall!!!
Universal health care should be funded by our tax dollars, just as our military and other federal programs are.
We pay for personnel in the military and government to have medical coverage; I see no difference in our (civillians) having it paid for (similar to Canada and other European nations).
However, I would eliminate elective coverage (i.e., you don’t like your body weight, size of your breasts, length of your nose, abundance of hair, etc…), whereby those procedures that aren’t medically necessary (to assure physcial health) should only be covered by the individual. No doubt those costs will go up, but then in my opinion, vanity should come at a cost.
As for the death-panels, I agree to an extent that someone whose prognosis is terminal shouldn’t be given unlimited medical procedures, other than to allow them to die in a pain-free environment (sounds rather like Dr. Kevorkian doesn’t it?).
There’s one thing everyone knows (unless you’re a delusional Republican or demented Tea-Bagger), that life ends in death, and it’s a great equalizer. Eventually it afflicts
everyone, and I see no need to spend millions to prolong the inevitable.
This statement would no doubt be difficult for persons who are afflicted with a terminal/wasting disease, or for their siblings/off-spring, but life comes at a price, and it’s doubtful that spending hundreds of thousands or millions of dollars on a patient (regardless of age or metal capacity) will benefit society in the long run.
Hence, rather than lambasting our existing system, I’d offer the following solution; Everyone receives a medical account with a set amount in it for treatment. If they don’t spend their allotment, it compounds (like interest) and grows with them as they
age. However, once they spent their allotment, then they either have to pay for any further treatments themselves, or request donations from others who still have funds in their medical accounts…
I myself rarely have required any medical assistance, and I’m 50 years old. I don’t have a GP, and haven’t seen one in 20 years. The only time I seek medical attention is when I’ve been injured.
My last injury was for a biking accident, whereby I was transported by ambulance to a nearby hospital’s ER. The ambulance ride was $2400, and the hospital bill was in excess of <$68k. No small sum, and I'd have been fiscally devastated if I had to pay for all of the care out of my own pocket.
The accident was just that, a malfunction that cost me a considerable sum (approx. $5k) for my out-of-pocket expenses, whereas I was lucky, as I did have insurance, and they covered the remaining balance.
So, would I deny treatment to a person suffering a similar accident because they were an undocumented or illegal alien? No I wouldn’t, as no-one should be treated as
disposable trash!
Life is a very complex journey, and there aren’t many situations where a challenge can be easily met, but when one is worthwhile and whose goal is true, the human spirit often rises to the occasion and over-comes all obstacles placed before it.
I see UHC as one such challenge. I believe it worthy, and support UHC far more than I do our countries efforts at being the world’s premier military force. Moderation in all things is essential, as absolute power, corrupts absolutely!
Well you sacrifice as the military does and I will pay for your coverage.
Quite the republican mouth-piece aren't we Neal...
I've been paying taxes to pave our roads, send your children to school, and all the while working as an Engineer to help save lives in the medical field.
What have you done? Perhaps been in the military for a short-stint... peeing on the bodies of the dead left behind in some futile conflict?
Go peddle your extremist views in some other media, as for me, I've served this country with the work I've performed and the charities I'd worked at helping the elderly.
I highly doubt you've done anything for anyone but your own narsistic self.
Canada has free insurance, Seems to be ok. Maybe the U.S. should have this type of insurance.Why fine them or put them in jail. you will have every homeless person in the country in trouble with the law." plus" whos paying that bill. that will be," tax payers".Hears something, The cigarettte companeys settle with states for these resons.Are the states helping: some not giving anything or very little to help cancer people with no insurance or a home to go too.States are getting billons but tax payers and privite doners are getting the bill.Some one needs to speak up.Did some one welch on this matter.
When Canadians find themselve on waiting lists to see specialist or even get x-rays, they come to the U.S. (those that can afford it) for treatment. This is a successful Universal Health Care system? If we do like everyone else, everyone else will be deprived of this option.
Their native countries should be responsible for reimbursement and transport back home. If not the US should provide it...it would be cheaper than the long term care. The countries they come from have nursing facilities too. As far as the other guy I don't see why he wouldn't qualify for disability and then they should back date medicaid. I say the woman visiting her family knew she was falling ill and came over anyway. Our country is too gullible, we end up helping too many foreigners then we can't even help our own people...
money , money , money $$$$$$$$ i needz me a new porcha . this is also the only industry that if you are paying cash charges you more than if you had insurance . and the amount the insurance company pays . becouse they tell you that the insurance is a biger part of thier money so they get a deal where if you're paying cash your cash is not as good as thiers so you pay more . WTF /////// if you dont believe me call your dr. akt like your some one else and ask how much a procedure costs on your insurance // then call back to the same dr. and ask how much the same procedure is dont call back same day though for cash .
If the hospital's are losing so much money on these people and they claim that they could get nursing home care for a fraction of the cost, why don't they pay for the patient to go to the nursing home instead of racking up "millions" of dollars for their lengthy stay at a hospital?
Nursing homes have to make a profit or they will close. What happens to all the people that are currently in them now? The number of residents in nursing homes is dwindling and there are going to be many closures unless the ecomony improves. People are not having voluntary surgeries like hip or knee replacements because they can't afford it now. Insurance may pay a large portion, but there are still co-pays.
As for Medicaid....I am sorry, but I do not work so that someone who doesn't want to work or thinks they can't work due to a disability like alcoholism or drug addiction can have medical coverage. I have a real health issue that is serious and long term with death expected before the age of 60. Do I sit on my butt and collect a check? No! I still work full time, pay my bills, purchase insurance coverage and don't expect someone else to take care of me! I also don't expect that when or if I do get old that I can just expect my state to fork over nursing home coverage for me. Plan ahead people! Sh*t happens to everyone.
We are a nation of hypochondriacs!!! Do not get me wrong there are people with serious conditions that need medical treatment, but the vast majority of office calls are for people with the sniffles or a cold.
Heck I was contemplating getting a medical degree so that I could invent a disease. I think I could call it, "Not wanting to go to work" disease. As a doctor I would prescribe my patient to at least 3 office visits a week, and since the new mandates are place only on insurance companies, I could charge as much as I want to.
Democrats are naive to think this thing is going to reduce costs. No caps no limits on the amount of insurance one can draw will only lead to increased premiums. Also the fact that the ACA neglected to reform health care wholly rather than only targeting insurers, is a sham. The ACA does not regulate health care providers nor does it address tort reform (but then why would it??? After all trial lawyers are some of the dems biggest contributors).
I'm not so sure it's ethical or moral to tell some one who has already purchased insurance that they're own their own, meaning they are going to die, because their affliction costs too much. That's what a "cap" accomplishes.
Kind of an odd policy for a purportedly Christian nation.
Mark Thomas, with no lifetime cap, insurance premiums, even with the mandate, will have to rise. If not private sector insurance companies will simply go out of business and we will have a single-payer (the U.S. gov) system, who then will have to hold down costs by by limiting/capping care. (The infamous death panels).
So what's the difference between death panels and capping insurance benefits?
Mark, I am not sure its moral that the Federal Government steals a large sum of money from my paycheck every year. Obviously though I am a realist and know that we need to funds for infrastructure.
And trust me if you go into an ER with a medical emergency, no health care provider is going to deny you treatment due to the lack of insurance. It would be in direct violation of a doctor's Hippocratic oath.