This blog takes an unflinching look at the conditions of overlooked people, especially the elderly and ailing — shedding light on the pervasive issue of healthcare neglect in universal systems.
Have you ever witnessed an elderly woman choking on her own spit and wondered if she might die because a nurse, indifferent to her suffering, refused to turn her on her side? A head injury this week landed me in the ER, granting a harrowing glimpse behind the curtain of healthcare neglect in universal systems — where the voiceless and vulnerable often fall through the cracks.
At its heart, this story belongs to the forgotten sufferers I encountered at my local city hospital and those who routinely go ignored worldwide. However, as a society, it is also our story. As you will soon see, the limitations of both healthcare and human compassion have grave and urgent consequences that impact more than just the people who aren’t granted proper medical attention.
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How deep are the calcified cracks of healthcare neglect in universal systems?
Universal healthcare often evokes an idyllic vision of accessible, equitable care for all. However, reality rarely matches the ideal. As a U.S. American living in Germany, I was initially full of unfettered pride in joining a universal healthcare system. But, as I’ve documented during my chronic pain journey, waiting seven months for an urgent neurological follow-up weighs heavy — even when your tax contributions eventually cover the surgery your body desperately needed.
Private vs. universal healthcare sparks a fierce debate, but it’s undeniably a double-edged sword. Consider this: I could fly back to the States, pay $500, and see a world-class doctor within a week — or I could spend months navigating bureaucratic hurdles, pleading for the paperwork required to petition for care in a system where appointments take half a year to materialize. It’s the classic conundrum: only with wealth can you hope to buy a shot at health.
Despite its promise of equity, healthcare neglect in universal systems becomes evident through numerous challenges, including:
- Long Wait Times: An overburdened and understaffed system means appointment delays can exacerbate conditions. Once-manageable problems become chronic or life-threatening.
- Resource Distribution Struggles: Urban areas may have more advanced facilities, leaving rural regions underserved. Contrary to popular belief, universal healthcare does not mean equal access to treatment.
- Healthcare Worker Shortages: Overburdened staff often struggle to meet patient needs. In addition to a struggle to book appointments within a reasonable timeline, doctors are overworked and hurried during eventual appointments.
- Budget Constraints: Funding limitations can prevent access to cutting-edge treatments or adequate staffing. Proper care is overlooked and replaced with the most convenient option — even if it’s outdated.
- Bureaucratic Inefficiencies: Excessive paperwork and administrative hurdles impede timely care. Bogged down by bureaucracy, patients wait weeks and months for permission to receive necessary care.
- Limited Preventative Care: Systems often prioritize treating illness over preventing it. There simply aren’t enough resources to focus on prevention when there isn’t capacity to treat existing conditions.
Many of these systemic flaws became painfully apparent during my recent ER visit. While these flaws have wide-reaching ramifications, healthcare neglect in universal systems is leaving society’s most vulnerable prey.
A Glimpse Behind the Universal Healthcare Curtain
First, a little backstory: last Tuesday, a dizzy spell and a nasty fall cost me and my boyfriend an afternoon of unexpected stress. My partner half carried me into the ER as I experienced limited mobility, pain shooting from my spinal implant, numbness in my right arm, and a burning sensation in my upper body.
How were we welcomed into the hospital? The check-in attendee promptly reprehended us for not going to the hospital where I had my surgery rather than heading to the ER, as we knew from experience. I was dumbfounded by the idea of being carried out by my partner and driven to another hospital when a blessedly sympathetic coworker intervened and approved my admittance. As I had previously waited in the ER for around 12 hours for stitches, I was prepared for a long wait.
Fortunately, I was called out of waiting almost immediately. However, after my vitals were checked, I found myself alone in a room post-head injury while I waited for a CT scan. I promptly fell asleep until the room was needed, and I was wheeled into a general waiting area full of other bedded patients. This was where I witnessed the true horror of healthcare neglect in universal systems.
Who is advocating for the voiceless and vulnerable?
Why did I think elderly people received more immediate medical care — when, in reality, their frail voices might be silenced the most through healthcare neglect in universal systems? After being told for years I appeared too young and healthy to have chronic conditions, I mistakenly assumed those who appeared outwardly unwell were treated with more immediate attention. This doesn’t seem to be the case based on my firsthand observations.
Picture this: the mechanical churn of a hospital, a whirlwind of beeps and quiet groans from silently suffering patients sharply contrasted with the casual discussions between nurses. Doctors in crisply starched white jackets glide through the halls with empty stares that move right through a person and don’t leave room for concern, let alone acknowledgment. The lights cast a greyish hue, and it smells at once sterile and vaguely sickly, as though the underlying scents have failed to be fully erased.
As I awaited my fate with my fellow patients in the trauma ward of my local hospital, I couldn’t help but notice our beds lacked one thing: easily accessible identification papers. This led to nurses barking demands for sick patients to name themselves faster while they feebly fumbled for words.
Only one patient appeared to have water, and it was stressful to command assistance to use the bathroom, as none of the beds appeared equipped with buzzers for nurses. Eventually, I found myself sandwiched between beds of ailing people — some of whom appeared to be barely breathing.
At one point, I was crammed rail-to-rail between two elderly women. One had her head fully bandaged, and she sat in the practiced silence of one unfamiliar with the state of things. The woman to my left, however, was routinely terrified. Hers is one of the two stories I wish to examine from my time in the ER trauma section. Together, they shed a troubling light on healthcare neglect in universal systems.
Healthcare Neglect in Universal Systems: Patient A’s Story
If the eyes are the window to the soul, then this woman’s soul was pleading for help. The woman next to me bore the white hair and well-worn skin of a grandmother, and it was easy to imagine her face crinkled in a friendly smile if it was not scrunched in terror, because she wore her fear with a gentleness. Never did she resort to harsh words or demands — just frantic pleas.
Despite her fear as she lay on her back — dressing gown slipping off one shoulder and IV dripping in her arm at a snail’s pace — I watched her communicate with the nurses. She tried in vain to get their attention. (I discovered she was seeking a medication check and water, as she was having difficulty swallowing.) Unfortunately, her pleas went largely unheard.
At one point, she started choking on her spit as she feebly yet frantically tried to get the attention of an orderly. The response of the young man was to meet her terrified gaze and give her a flippant gesture of finger guns before continuing to walk by without helping her. (In my own disoriented state, I helped her drink a beverage multiple times, as it appeared she was going to choke.)
Later, I waited for my discharge papers to exit the grim trauma center. But I positioned myself carefully so that my eyes faced her bed. The woman often signaled for help, but again, it was rarely acknowledged let alone answered. I came to her multiple times and called for indifferent nurses. Would these attendees really offer the same dismissive level of care to people they knew? Is this how they would treat their own mothers and grandmothers?
Among the chaos, I saw the woman lift her head and turn to me to meet my gaze. I tried to appear calm and reassuring. She knew that I couldn’t help her with her medication. Did it give her comfort to know that if she started choking, someone would notice and surely intervene? When I was finally discharged, I felt a sense of guilt accompanying my great relief. I knew in my gut that no one else was keeping watch.
The story of Patient A highlights a distressing example of healthcare neglect in universal systems, as her pleas for basic assistance were met with indifference and dismissive gestures. Such neglect, unfortunately, wasn’t isolated; instead, it appears to be a symptom of a broader issue I witnessed during my stay.
Healthcare Neglect in Universal Systems: Patient B’s Story
Most of the patients were elderly and hardly any put up any kind of a fuss. When you have experience healthcare neglect in universal systems for decades, do you become numb to the reality? Why did the man with the badly bruised face ruminate in silence for hours? Was he not entitled to medication or a room?
I saw this man, perhaps in his sixties, slumped in bed with a dazed look as I awaited my CT scan. He was transfixed in the same position many hours later as I kept my watch and awaited my discharge. Dozens of people walked by him without turning a head, until finally, a young nurse or doctor eventually approached him.
This woman must have been around my age. Compared to the dozen or so bodies curled into beds, she appeared freshly oiled. Only her shoes squeaked as she sauntered over to him and loudly and rather patronizingly if he wanted to leave. She informed the man that he couldn’t stay in the ER forever and asked if he wanted to go home or be moved to overnight care.
The man murmured back and expressed his uncertainty. The woman asked in a brisk tone if he had someone who could bring him stuff, and he said no. His eyes didn’t meet hers; instead, they stared into a vague and seemingly unlit distance. Her eyes, on the other hand, only met mine. The entire time she demanded answers, she looked at me with an incredulous reaction as though we were sharing a private joke. What was the punchline? This old man’s utter lack of options?
The medical worker eventually stalked away from the man and cried to her coworkers multiple times in front of the patient in a loud and sarcastic voice, “Ich liebe meine Arbeit,” (I love my job). Her mocking tone left no doubt about her disdain for her job — or perhaps the patients themselves.
Later, the man asked multiple times to use the toilet — a request that the nurses ignored. I eventually voiced his request, and he was finally taken to relieve himself by the one nurse who appeared to care about the patients.
Whose job is it to bear witness to overlooked suffering?
I believe I occupy a unique position. Though I outwardly resemble the healthy appearance akin to the nurses (and was referred to the entire time as the “young woman” in German — because, yes, they discussed all patients and their issues openly), I was also a patient.
I was likely regarded with a degree more dignity during my stay due to my age and appearance. But these are both factors that will fade. And I couldn’t help but wonder — don’t the nurses and doctors realize their youth and vitality are also in limited supply? If they cannot care for these patients due to the duties of their job, then they can at least consider that they, too, will be in such a position one day.
But here is a grim point that we need to face when it comes to healthcare neglect in universal systems: a society that neglects its most vulnerable risks eroding its very foundation. When the elderly become invisible, we lose not only their wisdom but also our humanity. What does it say about us when we prioritize efficiency and personal ease over empathy? And what does it mean if we witness this treatment but remain silent and immobilized?
The Long-Term Implications of Universal Healthcare Neglect
The systemic neglect I witnessed in Germany’s healthcare system is far from an isolated issue. Similar challenges plague universal healthcare systems across the globe, from Canada to the UK. The figures below illustrate the troubling scope of this problem:
- Long wait times: According to research from the Fraser Institute, Canada’s healthcare waiting time hit the longest ever recorded in 2023 — an average of 27.7 weeks to receive treatment after a referral from a general practitioner. This is 198% longer than the 9.3 week waiting time recorded in 1993. Issues with access, scheduling, wait times, and specialist accessibility can lead to both mortalities and once manageable issues becoming chronic.
- Staffing shortages and mortality risks: A 2024 study published in the International Journal of Nursing Studies found that avoidable in-hospital mortality could be realized with increased planning and working hours, as there is a slight, but potentially critical increase in patient in-hospital mortality associated with both nursing understaffing. Limited nursing work experience was also associated with increased in-hospital mortality.
- A study published in The Lancet back in 2014 similarly found that hospitals with low nurse-to-patient ratios experience higher mortality rates. Specifically, each additional patient per nurse increased the likelihood of patient death within 30 days of admission by 7%. On the other hand, higher nurse education levels reduced deaths, with a 10% increase in nurses holding bachelor’s degrees lowering patient death risk by 7%.
- Elderly neglect: Research indicates that elderly patients are more likely to experience neglect in overstretched hospital systems due to mobility issues and difficulties in self-advocacy. The National Library of Medicine highlights the vulnerability of elderly groups, indicating that as much as 10% of all people over the age of 65 experience some form of abuse. While this isn’t limited to universal healthcare systems, there are many harrowing accounts of elderly patients falling through universal systems — enough to elicit a response from the World Health Organization.
While these statistics are alarming, the root cause of these failures is often systemic rather than individual. Staffing shortages, inadequate training, bureaucratic inefficiencies, and limited accountability all contribute to an environment where even the compassionate workers can struggle to provide adequate care. We simply cannot just blame the workers for these issues.
If universal healthcare systems are to live up to their promise of equity and accessibility, addressing these systemic flaws must become a priority. The cost of inaction is far too great — both for the patients who endure neglect and for the societies that bear the burden of these inefficiencies.
Is there anything we can do to change healthcare neglect in universal systems?
What are the implications of a system that renders the elderly invisible — and what is our place in addressing it? Do we bear any responsibility for healthcare neglect in universal systems? How many times have we witnessed neglect in the system but walked on by, convinced it’s someone else’s job to address it?
These questions are understandably difficult to address. But perhaps it’s time to face them. While we certainly aren’t to blame for the entire system, that doesn’t negate our ability to act as individuals. And even if we live in countries where there aren’t universal healthcare systems, that doesn’t mean that society’s most vulnerable groups are treated to dignified treatment options.
Addressing healthcare neglect in universal systems requires systemic reform, increased empathy in elder care, and policies that prioritize dignity and accountability. While I can barely advocate for my own medical needs let alone solve the issues I witnessed during my stay, there are some practical steps we can take if you also feel frustrated, infuriated, and helpless. These include:
- Advocating for systemic reforms in healthcare, such as mandatory training in elder care empathy and better staffing ratios.
- Encouraging policies that hold medical professionals accountable for neglect and promote patient dignity.
- Supporting organizations or initiatives that raise awareness of the rights and needs of elderly patients.
- In everyday life, challenging ageist behaviors ensuring the elderly in your community are seen and valued.
Perhaps we don’t all possess the capacity to change healthcare neglect in universal systems. But we can provide this: a call to look into the eyes of others and acknowledge that they exist when they need it. Meet pain head-on and bear witness. If not for others, then for yourself — because one day, when your bell tolls, you’ll damn well want someone to answer it.
Continued Reading: Medical Gaslighting & Healthcare Stigmatization
Global Resources for Healthcare Advocacy
- Global Health Council (GHC): A leading membership organization that supports and connects advocates, implementers, and stakeholders around global health priorities worldwide.
- Global Health Advocacy Incubator (GHAI): Provides support and training to help organizations bring critical health issues to the attention of governments and the public, driving policy change to save lives.
- Health Action International (HAI): A non-profit organization based in the Netherlands, working to expand access to essential medicines through research, policy analysis, and intervention projects.
United Kingdom
- Older People’s Advocacy Alliance (OPAAL UK): A national charity focused on promoting and developing independent advocacy services for older people, ensuring their rights and interests are represented.
- The Patients Association: A national charity dedicated to supporting the rights and interests of patients, ensuring their voices are heard within the healthcare system.
- Age UK: A leading charity providing services and support to older people, including advocacy, to help them maintain their independence and well-being.
Germany
- Patientenvertretung im Gemeinsamen Bundesausschuss (Patient Representation in the Federal Joint Committee): Leading nationwide advocacy groups in Germany that represent patient interests, including those of the elderly and chronically ill, participating in healthcare discussions and policy-making.
- European Patient Advocacy Institute (EPAI): Established in Germany, EPAI acts as a patient-led education and research platform to strengthen patient advocacy and involvement across Europe.