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I worked for the regional hospital system here for many years. When I took the position back in 2016, there were two regional hospital systems, and the local hospitals were generally fairly well-regarded, when considering the area's demographic issues.
Those two systems then merged, and quality metrics have consistently declined. Back in 2018, right as the merger was taking place, the three area tertiary hospitals all had either 3 or 4 star (out of 5) ratings from the Center for Medicare and Medicaid, a government rating body. Today, two of those three hospitals are 1 star (only 5% of the nation's hospitals are rated this poorly), with the other being a 2.
We used to have two level 1 trauma centers. That's now done to one - the former level one trauma center has been downgraded to a level three, and the other level two has also been downgraded to a three.
Many specialities no longer have on-call coverage or dedicated teams. Back in May, my grandmother had a stroke, and was taken to one of the tertiary hospitals. She was not seen for over ten hours. My last major project before leaving was implementing a new software system that the hospital switchboards use to contact on-call providers. I specifically remembered testing a stroke call group with that switchboard supervisor at the hospital my grandmother was taken to. I asked someone there to check if a stroke alert was sent to the on-call team, and it turns out that this hospital had dropped on-call stroke coverage between when this system was implemented and May.
I saw a Facebook post from a local lady whose grandmother had died at the same hospital. I don't remember exactly what was wrong with the grandmother, but in any event, the switchboard contacted the wrong provider for the on-call need. The person who was contacted was not on-call, never responded, and the correct team weren't contacted until hours later. The patient ended up dying. The switchboard supervisor has no clinical or call center background (she was a mortgage loan originator before coming there, and has always been in over her head), the staff turnover constantly, and they have no support from the administration.
Staffing levels at our area hospital system have gone down the toilet. Clinical staffing is a problem everywhere, but it seems especially acute here, and even typical office jobs are having constant turnover. That switchboard pays their operators less than what they'd make at Aldi scanning groceries. Experienced nursing staff have left for better paying opportunities elsewhere, leaving the system heavily reliant on expensive travel nurses. The tech lead on a $30 million project that I was on left, and they ended up hiring him back as a contractor for three times what he was making. Pre-COVID, RN-BSNs are out of college made $18/hr. The IT team I was on doesn't even half the staff that it did a year ago. Key people throughout the organizations have left in droves. A well-known Harvard trained cardiologist left recently after assuming leadership of the organization's cardiovascular institute just two months ago. Almost every day I hear of some significant doctor leaving the organization for various reasons, and seemingly more often those spats are becoming public.
If you have a complicated situation, it's likely there isn't sufficient local expertise at the regional system to deal with it. I'm going to a provider two hours today to deal with something because I simply don't trust the quality of the regional system.
It's not like there is even a choice here - this hospital system is the only option for acute, inpatient care in a geographic area the size of New Jersey, so you're driving a minimum of an hour and a half to two hours away to get an "other" option. There are some smaller provider groups, but they are limited and do not have the facilities that the big monopoly does. A lot of folks simply can't go that far for a variety of reasons, so they're stuck with the local system.
As people age, they're more likely to have medical needs. The local system here is woefully inadequate for anything other than the most basic of care. How big of a factor was the local medical system in your selection of an area?
Location: East of Seattle since 1992, 615' Elevation, Zone 8b - originally from SF Bay Area
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My wife just completed her post-cancer follow-up, I still have 2 years to go, and see 4 doctors regularly. Where we are looking at houses to downsize to there is a major hospital 11 miles away. Still, we will continue to use our current providers for routine appointments, despite the 90 minute drive.
Organized, no it wasn't. Unorganized, yes it was. That is, living in an environment that promotes my Cowgirl I believe does a lot for my physical health. Now as it turns out, there are lots of decent medical places around, too.
I would want to assure rapid stroke intervention, otherwise I don't really care. Mobile stroke units (big trucks that incorporate a CT scanner, medical staff, and everything needed for immediate treatment except embolectomy - but they can drive to the hospital for embolectomy) may make geography irrelevant in the future as far as stroke treatment goes, though mobile stroke units are expensive.
I have lived for 31 years, and will be also growing old, in Boston, so no concern about access to medical care at home :-). But I do continue to travel a lot, ie, a far greater concern is what if something major happens acutely when I'm away of home. Of course, I always have travel insurance, but still.
How big of a factor was the local healthcare system in selecting an area to retire to?
In another thread another poster asks about big city vs smaller area aspects:
Size counts because the higher quality medical schools are generally associated with the best hospitals.
The quality of actual 'care' is much harder to manage without the business volume of the bigger cities.
Not that exceptions don't exist ... but the one does tend to follow on from the other.
An objective measure I was once told about: Your distance to a Level One Shock-Trauma Center. LINK
Wherever you have those services you should be able to find every other medical service need too.
We don't have any serious health concerns so, while it's important to have convenient access to doctors/dentist/hospital care, it's not necessary at this point for us to be super close to top of the line specialists or anything too state of the art.
We don't want to be so isolated that we have to drive 30 minutes just to get antibiotics for a cold but we also don't need to be within walking distance of Johns Hopkins.
I checked to see that there was a hospital, dentist and medical care within 20 miles of my prospective home, but beyond that, No. My husband and I were and are in good health, fortunately, and I have no desire to live a VERY long life. I figure that at this point in our lives, we have already lived more than a great many other people, so when it's our time to go, we'll go. No drastic measures for us.
I think people think of sudden emergencies more than slower serious illness. I thought of cancer (whole family died of it in different forms) and there is a cancer center 26 miles away, plus 45-minute flights to Denver if need be.
I used to live in medical Mecca (near Boston) and did appreciate the great services available if needed.
I worked for the regional hospital system here for many years. When I took the position back in 2016, there were two regional hospital systems, and the local hospitals were generally fairly well-regarded, when considering the area's demographic issues.
Those two systems then merged, and quality metrics have consistently declined. Back in 2018, right as the merger was taking place, the three area tertiary hospitals all had either 3 or 4 star (out of 5) ratings from the Center for Medicare and Medicaid, a government rating body. Today, two of those three hospitals are 1 star (only 5% of the nation's hospitals are rated this poorly), with the other being a 2.
We used to have two level 1 trauma centers. That's now done to one - the former level one trauma center has been downgraded to a level three, and the other level two has also been downgraded to a three.
Many specialities no longer have on-call coverage or dedicated teams. Back in May, my grandmother had a stroke, and was taken to one of the tertiary hospitals. She was not seen for over ten hours. My last major project before leaving was implementing a new software system that the hospital switchboards use to contact on-call providers. I specifically remembered testing a stroke call group with that switchboard supervisor at the hospital my grandmother was taken to. I asked someone there to check if a stroke alert was sent to the on-call team, and it turns out that this hospital had dropped on-call stroke coverage between when this system was implemented and May.
I saw a Facebook post from a local lady whose grandmother had died at the same hospital. I don't remember exactly what was wrong with the grandmother, but in any event, the switchboard contacted the wrong provider for the on-call need. The person who was contacted was not on-call, never responded, and the correct team weren't contacted until hours later. The patient ended up dying. The switchboard supervisor has no clinical or call center background (she was a mortgage loan originator before coming there, and has always been in over her head), the staff turnover constantly, and they have no support from the administration.
Staffing levels at our area hospital system have gone down the toilet. Clinical staffing is a problem everywhere, but it seems especially acute here, and even typical office jobs are having constant turnover. That switchboard pays their operators less than what they'd make at Aldi scanning groceries. Experienced nursing staff have left for better paying opportunities elsewhere, leaving the system heavily reliant on expensive travel nurses. The tech lead on a $30 million project that I was on left, and they ended up hiring him back as a contractor for three times what he was making. Pre-COVID, RN-BSNs are out of college made $18/hr. The IT team I was on doesn't even half the staff that it did a year ago. Key people throughout the organizations have left in droves. A well-known Harvard trained cardiologist left recently after assuming leadership of the organization's cardiovascular institute just two months ago. Almost every day I hear of some significant doctor leaving the organization for various reasons, and seemingly more often those spats are becoming public.
If you have a complicated situation, it's likely there isn't sufficient local expertise at the regional system to deal with it. I'm going to a provider two hours today to deal with something because I simply don't trust the quality of the regional system.
It's not like there is even a choice here - this hospital system is the only option for acute, inpatient care in a geographic area the size of New Jersey, so you're driving a minimum of an hour and a half to two hours away to get an "other" option. There are some smaller provider groups, but they are limited and do not have the facilities that the big monopoly does. A lot of folks simply can't go that far for a variety of reasons, so they're stuck with the local system.
As people age, they're more likely to have medical needs. The local system here is woefully inadequate for anything other than the most basic of care. How big of a factor was the local medical system in your selection of an area?
That is such a great question. It is especially true to anyone that considered being an expat. It is a question you have to have an answer for before you make a move or you could be in for a shock.
Years ago when I started considering options if retirement I considered several places. Healthcare was always a question I would get to quickly. Find out how hospitals were staffed, and where doctors were educated as an expat was very important. A lot of regional information can be found in a few sites. I like this site.It gives a lot of great information.
Anyway we looked at Ecuador as expats and found it okay and it wasn't the deciding factor in not choosing it. We looked at several options stateside like TX FL GA SC NC and TN. Many of the usual suspects for the usual reasons. We decided not to move because we didn't see ourselves there long term. There would have been too much disruption for us. But we are considering S Korea as expats because we have family there and it could be a great place to use as a travel hub for Asia. As for their healthcare system it is like almost every other country it is government run in that they pay premiums to the government. I found that medical services were not overly costly out of pocket and dental is also part of their system. I can tell you that my wife and I got about $75,000.00 worth of dental work (implants and bridges) for under $20,000.00. Doing a Google search I found that S Korea was highly regarded for dental tourism so it was an easy choice too.
Great question and I will say that how far away hospitals and emergency care becomes quite important in the later years.
Last edited by Yac; 10-05-2023 at 04:26 AM..
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