When the Foundation Is Shaky, You Do Not Keep Adding Weight
When the Foundation Is Shaky, You Do Not Keep Adding Weight
Sometimes the problem is not that people are not trying hard enough.
Sometimes the problem is that the structure itself needs reexamined.
I learned this lesson in medicine through Alex.
There were times when his body did not respond the way people expected. A situation might look like something familiar, but treating it the usual way could make things worse. Dr. Lidsky taught me something important through those years: sometimes you have to back up, rethink, observe differently, and stop forcing a standard answer onto a body that is not responding in a standard way.
I call it the square peg in the round hole. Some people will get close to the round hole and no matter how hard they push, the square peg will not go in. They are so determined to prove it will work, they push harder, and harder . Soon both the round and square pegs are in pieces, the hole is destroyed…it’s a mess.
There are others, who, when they start getting close to the round hole, they can see that the square peg will not work. They step back and think, and think. They are not hesitant to bring in others to help “think” but they also understand that not just anyone can see what might work.
That lesson applies far beyond medicine. It applies to home care, to waiver systems, to provider oversight, and It applies to medically complex people living in the community.
If the same approach keeps producing gaps, confusion, unsafe assumptions, and preventable risk, the answer is not to press harder.
The answer is to back up and rethink.
Too often, medically complex individuals are treated like round pegs being pushed into square holes.
A diagnosis category.
A staffing model.
A facility option.
A provider type.
A billing code.
A form.
A process.
But if the person does not fit the structure, the answer should not be to hammer harder.
The answer should be to ask whether the structure was built for the reality in front of us.
Home care has been carrying more and more weight as medicine advances and people survive increasingly complex injuries and conditions.
But if the foundation underneath home care is weak — weak oversight, broad categories, generalized qualifications, lack of case-specific competency, incomplete documentation, and facility-default thinking — then adding more pressure will not make it stronger.
It may make the cracks spread.
Home care cannot be strengthened by building more weight on a shaky foundation.
It has to be examined honestly, repaired carefully, and rebuilt around what vulnerable people actually need.
That means better questions, better oversight, better understanding of medical complexity, better distinction between fraud and legitimate care, better protection for people whose stability depends on individualized supports.
And better humility when the current structure is not working.
Because doubling down on what is not working does not make a system safer.
It makes the foundation crumble.
And vulnerable people are the ones standing on it.
Doubling down on what is not working does not make a system safer.
It makes the foundation crumble.
And vulnerable people are the ones standing on it.
Comments