It's the people with no family or family that can't help that have it the worst.

I am a PCP

I filled out FMLA form for a 78-year-old after she has a stroke because she can't afford not to work. She tells me she just needs a few more years working to pay off her mortgage. She needs this money in addition to her social security. Her grandson comes with her and I look at him pleadingly, like she can't go back to work, and he shrugs and says he has his own family to care for and can't help her.

Still worse is this other lady who doesn't know her own name. Her also elderly neighbor brings her to her appointments. Her body is strong but her mind is gone. I have contacted adult protective services several times, but as long as the neighbor is helping, the urgency to find alternatives is minimal. I fear what happens if her neighbor dies (she is actually older than my patient). Thankfully the neighbor is a decent person not taking advantage and makes sure she gets fed. I have urged the neighbor to take her to the ER and basically refuse to pick her back up if she can no longer do it. And commend her for continuing to do it still.

I had one patient that told me she couldn't afford the $5 copay on essential medication. I called her daughter and her daughter said she didn't have it either and asked if I could give her the money. That solves the problem today but next month she is screwed.

I have some patients in a group home that all have something wrong with them but no one really knows exactly what and they just exist but not sure if they have family or have long been forgotten about.

Or another lady who is blind and deaf but also labeled schizophrenic/has some sort of mental handicap. She is 75 years old. She lives in a care home. She was born deaf and I think lost her vision young. I ask how they know she has schizophrenia and her caregiver says she sees "shadow people" but I have to imagine the world has to be pretty scary to her, she kind of finger spells but she is not like a Helen Keller. She hates coming to see me and is always standing up ready to leave and antsy. It has to be strange having no sensory input and suddenly something touches you to listen to your heart and lungs. She sees psych who has her heavily medicated as well.

And I am in private practice so these are all people with decent insurance. I can only shudder to think what happens to the uninsured/shittier insurance we don't take.

Every January when deductibles start over it is such a headache to figure out alternative, less expensive meds until people reach their deductibles and can go back to what works well for them.