How Bureaucracies Mistreat Old People
Monday, 31 October 2005
Last week, I found out up close and personal how hard ordinary life can be when you are old and infirm.
The New York City Department of Health held a free flu shot clinic for one morning at a neighborhood church. I arrived at the starting hour, waited in line to fill out a couple of forms, got my assigned number and then took a seat among the 50 or so early attendees in a large basement auditorium.
An hour passed and the public health nurses who would administer the shots had still not arrived. The auditorium was filling up. It was obvious from the start that I – at age 64 – was the youngest person there. Others were in their 70s, 80s and 90s, and about three-quarters of them needed help to walk – with canes, walkers with and without wheels, or with accompanying caregivers.
I could feel their pain with every halting or shuffling step they took. Nevertheless, each waited uncomplainingly to fill out their forms and then slowly made their way to an empty chair – farther and farther in the back of the auditorium as more people arrived.
Meanwhile, the dozen or so health department workers sat at tables in the front – unmoving and apparently unmoved at the difficulty the majority of people were having as they tried to navigate through the labyrinth of scattered tables and chairs.
When the nurses at last arrived and were set up – 90 minutes late – the health department workers began yelling numbers to the crowd now numbering about 300. “One. Where’s number one? No number one? Then number 2. No number 2? Okay, number three…”
A couple of very old people slowly, painfully made their way to the front of the auditorium where I was standing to one side. By the time numbers one and two arrived, the healthcare worker was already calling numbers eight and nine. “I called your number,” she said to one of them. “Where were you?” The old woman looked confused and the healthcare worker pointed her toward another table where there was more paperwork to be done.
As numbers were called, people got backed up at the paperwork table where they had to wait, leaning on their canes and walkers, uncertain they were in the right place. When the additional forms were finished, they were sent across the auditorium to a “holding pen” (without enough chairs) until it was their turn for the shot, when they had to walk, again, across half the auditorium to get to the nurses' stations.
And so it went with no consideration for the difficulty these people had in walking, nor for the fact that many couldn’t hear very well. In addition, no explanation had been given of the routine that would be followed and the tables of six and eight very old people were a continuing murmur of questions, confusion and discussions on whether someone’s number had been called or not, and which table they should go to at the front of the auditorium.
It is an excellent use of city tax dollars to make flu shots available to the old and very young for free, but it is unconscionable that they would make no accommodation for the age of the people attending. How hard could it be?
If I were arranging this program, I’d have the workers give each person a table number as they came in the door and accompany them to a seat at that numbered table where I would hand them their paperwork. Then, I’d have the nurses, using carts to carry their equipment and supplies, do the walking from table to table to administer the vaccines.
There is no doubt that by the time most of these people got home (after climbing two sets of stairs from the basement to the street) that they were done in for the day. It must have been exhausting for them. And those stairs! I counted 58 on my way out and wonder still how those old men and women, with their walkers and canes, got up them. It is unlikely that God would have minded if the clinic had been held in the church proper at street level.
What struck me hard was how uncomplaining and complacent the attendees were about the poor planning and execution of the program even though it cost them a great deal in pain and energy. Could it be that they, with decades of dealing with such bureaucracies as Medicare and Social Security, were conditioned to long waits and lack of consideration for their difficulties?
As the number of aged people increases rapidly in the coming years, the routines of bureaucracies cry out to be adjusted to suit the needs of the people being served.
A dreadful story, but unfortunately not untypical of the behaviour of large bureaucracies (public or private). There is a description applied to people like this in the UK - 'jobsworth' - as in 'more than my jobs worth to do it differently.
When I started work in government in the UK in the 1970s there was still around - to a degree - the idea of public service, that the job/organisation was there for the benefit of the people using it. (Too often they were not asked if that was the service they wanted, but that is another story.)
Now however the whole concept of public service has been destroyed - first by Margaret Thatcher and her government (in parallel I suspect with Reagan in the US) and now by the Blair/Bush axis of indifference.
Posted by: Ian | Monday, 31 October 2005 at 05:04 AM
Your story is just awful, but no different from what I see here and what I have seen my old uncle and aunt in a retirement home and my mother in hospital put up with. It makes me angry, just to think about it.
People get very hardened at older people, I suppose because they fear old age, as no doubt they'll get there one day.
Posted by: Claude | Monday, 31 October 2005 at 05:30 AM
It was a sad story and no excuse for the people who run such programs with such heartless attitudes. Unfortunately it's not uncommon and just another way the elderly and poor are forced to lose their dignity-- sometimes all they had left and there is a certain group in this country-- fairly sizeable apparently given our election results who think that's just fine for those who can't pay their own way. Makes you so mad and I was already mad this morning, as happens way too often right now, when I read the papers online :(
Posted by: Rain | Monday, 31 October 2005 at 06:47 AM
Indeed, what you describe is all too common. Sigh. In fact, I live in the community where a woman died waiting in line for her flu shot last year. It was too hot outside, and the people in line had to stand for around three hours before being let in to the area where the shots were administered. The lady collapsed from the heat, hit her head, and perished.
Posted by: Kari | Monday, 31 October 2005 at 07:22 AM
I could strangle someone after reading your report about seniors waiting for flu shots. No wonder some seniors take their own lives, rather than suffer these abusive regimes.
Next time, call me. I'd gladly take a bus to NYC and volunteer to assist a senior.
Posted by: doctafill | Monday, 31 October 2005 at 01:21 PM
I wonder if you wrote and explained your ideas to make it easier---and certainly for BOTH sides---that they would try to do it differently next year? I don't see why this has to remain the way it has.
Posted by: Tabor | Monday, 31 October 2005 at 02:06 PM
Funny you should mention that, Tabor. I've send off a note with a link to this post to the Health Department.
Posted by: Ronni Bennett | Monday, 31 October 2005 at 03:26 PM
Sigh. I work for a State Health Department and am in contact with local public health agencies. I have taken the liberty of copying your post to many people who plan 'senior' flu shot clinics. The ancient adage 'if you always do what you've always done, then you'll always get what you always got' certainly holds true here. Thank you so much for your observations!
Posted by: susan | Monday, 31 October 2005 at 04:44 PM
I think it is conditioning. Some of those people have lived through the Depression and a world war, and in the UK, rationing. They look back easily on days when people suffered and died because there wasn't actual cash in the house to hand over to a doctor :-( I used to work with old people and I could pick out at once the men who had been shop stewards in heavy industry, they were the only ones who ever complained. The rest, particularly women who had been through the NHS mill with a few babies, or worse, gave birth at home and went back to work in a factory a fortnight later, were so placid in the face of dreadful and unnecessary inconvience. I got thrown out of nursing school 20+ years ago for being "too empathetic" to old and mentally ill people... I'm on my way back now *grins* and God help the snooty Sister or Nursing Officer who gets on my case this time.
Posted by: Luz the Magpie | Tuesday, 01 November 2005 at 08:59 AM