My mother and the medical care ad-hoc-racy (Reprinted from Health Affairs, vol 22, pg 238-42, 2003)

It was a phone call children dread. "Mom's fallen," said my sister. "She's in the emergency room at the hospital with a badly broken left leg. Her left shoulder and wrist are broken, too." My mother is an eighty-eight-year-old mentally alert widow who is fiercely independent and lives alone in an eldercare complex. She had tripped and fallen hard while leaving a "Friends of the Columbia River Gorge" evening meeting at a colleague's home in Portland, Oregon. She waited thirty minutes for the ambulance and several hours in the emergency room before she was admitted for surgical repair of her leg. After a two-hour operation to knit together the three fragments of her femur just below the hip joint, she remained in the hospital three and a half days. She was then transferred to a private skilled nursing facility (SNF) to receive the intensive physical therapy that would enable her to resume her busy life.