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Why Does the Richest Country in the World Rely on Volunteers for Emergency Healthcare?

Paramedics with man on stretcher in ambulance, low angle view

The call was for a 64-year-old woman with a cough and inability to walk.

But she did not appear to be having a medical emergency. I was confused about why 911 had been called. “Do you want to go to the hospital, Helen?”

“I’m sorry to have called 911,” Brody answered. “I just can’t manage her anymore.”

I asked Brody for more details. In addition to her regular bouts of bronchitis, Helen had cirrhosis from her alcohol use disorder and lymphedema, a condition that results when lymph nodes are unable to drain lymph fluid, with resulting fluid retention in limbs—in Helen’s case, her legs. She had also developed urinary incontinence with her most recent bout of coughing. For the last three weeks, every time she coughed, she involuntarily urinated.

Brody had been managing the situation by changing her frequently and using menstrual pads in her underwear. But Brody weighed less than Helen, and Helen’s immobility compounded his difficulty lifting, changing, and otherwise assisting her. After three weeks, Brody was exhausted. He wanted Helen to go to the hospital to receive care for her incontinence.

Brody openly articulated that he had called 911 because he’d needed a break as a caregiver. His situation is far from unusual; many families care for loved ones who are physically or mentally ill or disabled. If these loved ones had home health aides, or lived in institutional facilities, they would receive care from professionals on their full- or part-time schedules. But family caregivers are on duty 24/7. Ideally, Brody would have been able to access healthcare support for Helen in their home. Such a solution might have prevented him from becoming exhausted and protected Helen from being exposed to COVID-19 in the hospital.

Brody also called 911 because he’d hoped the doctors could solve Helen’s incontinence, so that she would be able to return home without requiring him to provide such intense and regular caregiving.

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