I can’t remember my dad ever taking a sick day.

With a wife and four children and making less than $40,000 a year managing a chain seafood restaurant, it makes sense that he might have felt like he couldn’t. The long hours and grueling schedule would have made it seemingly impossible.

Editor’s Note

Disconnected is a series about economic segregation in San Antonio.

The series debuts a new story every Monday and looks at economic segregation through the lens of the major beats the Rivard Report covers. The goal was to create a human-centric look at one of the city’s biggest problems.

For more information on why we chose this project or to catch up on any missed stories, visit the Disconnected home page.

But my dad needed to take sick days. And he needed to go to a doctor. Given a choice, he did neither. Even after the onset of a flaky, reddish-purple rash that started at his shins and slowly crept up his legs, he still didn’t make his health a priority and saw a doctor only when my mom’s prodding became too persistent to ignore.

By the time he made it to a doctor’s office and learned he had high blood pressure and high cholesterol, we were a one-income family that couldn’t afford a potential onslaught of medical bills or a prescription medication regimen. It was easier – and cheaper — for my dad to pretend nothing was wrong – until he suffered a catastrophic illness.

My dad’s seeming lack of interest in his health is both easy and difficult for me to understand. I was the first in my family to earn a college degree – and went on to earn a master’s degree in mental health counseling. For the past two and a half years, I have reported on health topics for the Rivard Report, so I see my own health and that of the community differently than most people, including most of my own family members.

My perspective allows me to understand how lifestyle choices and the state of health care influence San Antonio’s profile as a city with the highest poverty rate among the 25 largest metros in the United States and a population overrun with obesity, Type 2 diabetes, stroke, and a host of lesser afflictions.

Despite my dad’s poor diet, lack of exercise, and smoking habit, he lived most of his life without serious health complications. But in 2017, at age 60, my dad had a massive stroke. The cumulative effect of him not taking care of his health created an array of problems that have irreparably affected him and the rest of our family.

Before my dad got sick, he seemed to approach health concerns from an “I’d rather not know” standpoint. It’s scary to go to the doctor. It’s scary to receive a large medical bill and wonder how you’re going to pay for it. And it’s daunting to take time off from your job when you need the money. It’s a perfect storm for chronic health problems.

In San Antonio, 32 percent of adults were diagnosed with high blood pressure and high cholesterol, and 35 percent were obese, according to the most recent data from the Centers for Disease Control and Prevention.

With many facing significant everyday obstacles to taking care of their health, Hispanic people who get sick are more likely to be diagnosed later in a disease’s progression. Those diagnosed also are more likely to live in medically underserved areas with high levels of unemployment and high rates of uninsured residents. Those are my people.

Doctors reviewing my dad’s brain scans after the stroke said he probably suffered a stroke several years earlier without realizing it, causing untreated damage. The stroke that sent him to the hospital by way of ambulance in 2017 turned out to be one of many he would have in relatively rapid succession, along with repeated seizures. Ultimately, he suffered significant paralysis, which left him unable to walk, with limited peripheral vision and depth perception, and with sensory loss in his hands. 

At the time of his stroke, my dad was unemployed and had no health insurance. When he arrived at University Hospital, the nurse on duty explained to me and other family members the options for paying for his treatment.

At age 60, he was too young for Medicare and didn’t qualify for Medicaid. In Texas, rules strictly limit which adults can get Medicaid, covering those under age 65 only if they have a diagnosed disability. But my dad found a safety net in the form of CareLink, a taxpayer-subsidized health assistance program that provides medical care on a sliding scale to Bexar County residents who do not have private or public health insurance.

While CareLink is not an insurance plan, it’s similar because it’s a type of managed care plan. People typically enroll based on a referral by a physician or other medical provider after they become sick or injured. Unlike people with insurance, CareLink members make a payment toward the cost of their care rather than a premium.

Under CareLink, my dad’s care since his stroke has included check-ins with a neurologist and a short-term stay of just under two weeks in a rehabilitation facility 30 miles from San Antonio. His rehabilitation facility options were limited, and the services provided were limited as well.

He got some physical therapy while in the rehabilitation facility, with his days consisting mostly of nurses coming in to change sheets and clothing; loss of feeling due to the stroke made it difficult for him to know when he needed to use the restroom. The goal seemed to be to keep him comfortable rather than working on improving his mobility.

If you asked him, he would say they didn’t help him with anything at all. But helping someone like my dad is no easy task.

He isn’t an easy patient. He doesn’t like doctors. He doesn’t want to be poked, prodded, or asked questions that require him to be vulnerable. Because I grew up around lower-income people, I’ve come to understand that being vulnerable tends to be off-limits for them for many reasons, the biggest of which is that it takes time, time that people who are often working several jobs simply don’t have.

A great example of this would be my dad’s viewpoint on depression. He won’t say he doesn’t have the money to be treated for depression –  he’ll just say he doesn’t have time to be depressed. But the problem is that people who experience poverty or are barely making it from paycheck to paycheck do have depression. They often have diabetes and high blood pressure, too, and they often have less access to healthy food because of where they live or because they can’t afford it. And because they don’t have the time or the resources to address these concerns, health issues – both physical and mental – often build up over time, becoming significantly worse and harder to treat.

Credit: Garza family

After the 2017 stroke, my dad went from being completely independent to completely dependent in the blink of an eye. He needed handfuls of medications, a specific diet, various doctor appointments, and help with everything from eating to bathing to using the restroom. The best way for someone in his situation to make progress toward recovery would be to live in a nursing home with around-the-clock care.

Because he had no health insurance, that wasn’t an option. With minimal therapy or other services provided in the rehabilitation facility, he showed no improvement. And once he was released from the rehabilitation facility, that was that. He returned home, and his health has continued to deteriorate. He had another stroke, then another. He had seizures resulting in major falls, and at other times, he fell as a result of trying to do things outside his range of motion. Most recently, a gallbladder flareup resulted in another trip by ambulance to the emergency room.

When an ambulance responds to a 911 call, the patient doesn’t necessarily get to choose which hospital they are taken to, so in addition to receiving care from University Hospital, my father also was transported on a number of occasions to Methodist Hospital, where additional paperwork was generated, along with more explanations of payment and treatment options for a person without health insurance. Unsurprisingly, those options are limited no matter where he goes.

That’s not to say that he didn’t receive great care during his hospital stays; he often did. The problem is that someone with his complicated health concerns needs more than just emergency care.

While CareLink aims to provide a medical home for people in the program, the majority of people who enroll do so after a medical emergency. Often, as in my dad’s case, that emergency resulted from chronic health issues that were ignored until they became life-threatening and more difficult to treat. 

Figuring out the logistics of his care has been up to my family. Who has a car that can get Dad to an appointment? Who can help pay for medication, if needed? Who is staying overnight in the hospital, possibly missing a day of work? Who is going to sift through the medical bills and help him apply for benefits? The list goes on, and it is long.

Thankfully, through CareLink, my dad is eligible for an in-home caregiver to provide assistance with physical therapy, meals, bathing, and more. However, instead of a trained provider, a local home health agency pays my brother to be my dad’s caregiver. And while the situation is less than ideal, I am indeed thankful because it is highly likely that if my brother was not caring for him, my dad would reject the idea of someone he did not know coming to his house each day to help him take a shower and eat breakfast.

That said, my brother is not necessarily qualified to provide care. He and my father aren’t sticking to any formal plan aimed at improving my dad’s health, but my brother ensures that he makes it to doctor’s appointments and does some physical therapy exercises at home. My brother is paid $10 an hour for five hours, five days a week. That’s the maximum benefit available to my dad through CareLink. Still, it has helped the entire family’s emotional burden.

While there is no easy solution to problems that have come as a result of decades of people like my dad ignoring signs and symptoms of potential major health concerns, it’s clear that something needs to be done. Patients like him cost taxpayers thousands of dollars. Would mandated paid sick time help? Absolutely. Would universal health insurance coverage help? Absolutely. But I know it will take more than that.

People will need to learn that reaching out for help is OK, and that annual check-ups are important. Health care providers and policymakers need to make sure patients from all walks of life have access to care.

Not impossible, but we have a long way to go.

Roseanna Garza

Roseanna Garza

Roseanna Garza reports on health and bioscience for the San Antonio Report.