The Circle of Life - Part 1

Medicare and Makin Money

Mom is nearing release from rehab once again. The plan they were enacting was to send mom home and have her return a few times a week for out patient therapy, thus continuing to make them more money by accessing mother’s Medicare benefits. I know this game all too well, I put a stop to it.

If this were to happen, mom would forfeit her home care and only get $1,840, Medicare's limit for out patient therapy. For mom, the home care provision is much more important. This may not be so for everyone.

Upon release from a rehab stay, with doctor’s orders, home care provides her with 2 weeks of in home Occupational Therapy (OT), 2 weeks of in home Physical Therapy (PT), a weekly nursing visit, and a caregiver for bathing and small household chores, twice a week.

On top of that, she is given a home medical monitor that takes her weight, blood pressure, pulse, oxygen level, and asks a series of questions pertaining to how she feels and transmits the vitals back to a health care center and reviewed everyday. She had home care for several months in 2009! I’d say that’s worth more than $1,840. But then I’m not the nursing home/rehab center trying to make a buck. Where do their interests really lie? Just my opinion!!!

In addition to what is provided by Medicare, mom has a private nurse and caregiver that helps with household chores and miscellaneous errands. I feel mom is well cared for, but at great cost. She is still very ill and needs so much assistance, yet her mind is as clear as a bell. She is fully aware of everything. I think this comes from the fact that she reads 3 to 4 novels a week, Nora Roberts being her favorite. She reads so much, it's hard keeping her in books. Aside from the television, this is her primary means of entertainment. What else do you do when you can't leave your bed?

Wednesday 1-27-2010

I’m so excited! I’m on my way to finally bust mom out of rehab! Mom has been in this nursing home since November. She’s finally going home! She has worked very hard to get her strength back over the last few weeks. Mom tells me, “They’re busting my ass!” This was done at my insistence because I was beginning to feel mom was just income for them. She wasn’t being workout like she had on past visits.

From my perspective, this is how it appears: she has Medicare and AARP/United Heath, a supplemental insurance that gives her a combined total of 100 days of fully paid rehab. So, why not take your time and use the full 100 days? Who’s it gonna hurt, right? Let her rest and relax and enjoy the stay. BUT, if she has a second episode after this stay and it’s before the 2 month Medicare reset period, (you need to be out of hospital and rehab for a total of 60 days before Medicare will again pay) she becomes self-pay to the tune of $7,000 a month. Either way, rehab wins. Unfortunately for mom, this has happened many times over the years and the bills are staggering.

Let's Get Sprung!

The rehab center has arranged a home site evaluation to make sure mom will be safe and that all obstacles are out of her way. I picked her up and one of the rehab agents met us at the house. Mom is in a great mood! She’s so happy to be home after 3 months! The evaluation goes well and mom is cleared to be released. She’ll have to go back to the rehab center until all the paperwork is finalized. It could be a few days.

Mom excited to be going home!

I get to keep her home for the day, but she must return before 8 PM. While she’s at home sitting in her recliner smiling from ear to ear, she makes a few phone calls. She calls her sister, who lives in Michigan, and they have a wonderful conversation. She then calls her brother-in-law, “I’m bustin out!” I hear her laugh and explain all her recent events.

Mom is happy and is looking great for a change. Her attitude is positive and she seems excited, but a few hours at home and she’s tired. She’s ready to return to rehab.

That evening, back in rehab, mom begins to experience abdominal pains. She complains to the nurse, but was told, “The stomach flu is going around and you probably just have a touch of that.” Mom feels she might need to go to the hospital and the nurse dismisses that thought.

What a Difference a Day Makes

Thursday 1-28-2010

Mom’s stomach pain is getting worse. She demands to go to the hospital and asks her roommate to witness that she is now demanding to go. My mother NEVER wants to go to the hospital. I sometimes have to beg her. So you know this must be bad!

I get a phone call from rehab, “We are sending your mother to the hospital. Nothing serious, but just to be safe, we’re sending her as a non-emergency." She was ready to be released. She was fine yesterday. What happened? I'm assured it was just precautionary.

I’ve been down this road too many times before, so I wait one half hour and head for the hospital. Small problem…mom’s not there. I called the rehab center and ask if she has left the facility. She has and she’s now missing! WTF?

After an hour of phone calls and research trying to track her down, I was informed she was sent to the hospital I was standing in, but the emergency room was overflowing and they closed it, diverting all new patients to the next closest hospital. Does Costco sell Xanax by the case???

Mom has never been to this new hospital. In fact, I had never even heard of it before. When I arrived, I insist on seeing my mother. They tell me she’s not here. After I let off a few F-bombs she miraculously appears in the emergency ward barely able to speak, eyes rolled back in her head, moaning in excruciating pain, now on heavy morphine, with slurred speech.

The doctor explains that she has an intestinal blockage. This is her third in the last 4 years. It all began 20 years ago when she had diverticulitis and her colon ruptured. Since that time, she has lived with a colostomy bag. She has never been a candidate for a reversal due to everything else wrong with her, mostly due to her COPD and CHF. She almost died from this event, but after being kept alive on a ventilator for several weeks, she survived. We come from tough stock!

To make matters worse, she has a double hiatal hernia that has slowly emerged over the years. During her last emergency, it was explained that the ball outside of her belly that appears to be a basketball, (she looks pregnant) is actually a mass of muscle, skin, and intestines all intertwined. As the muscle and skin tissue grows, it will continue to squeeze and cut off the passage of her bowel. Surgery is not an option.

Even though the emergency room doctor has diagnosed the problem very quickly, I’m worried because she has never been admitted to this hospital and these doctors don’t know her complicated case history. Sure, records can be ordered and reviewed, but that takes time and is subject to interpretation.

Her Last Words?

Mom is barely able to speak at this point, but she’s strong enough and angry enough to tell me how rehab blew her off saying she had the stomach flu and how she had to beg and finally demand to be taken to the hospital.

Now I’m enraged! This is a woman with a colostomy, a history of intestinal blockages, a double hiatal hernia, and now green liquid bile fills her colostomy bag, a tell tale sign of a blockage or intestinal problem...and they dismiss it foolishly as the stomach flu, sending her to the hospital with a non-emergency status!

Mom will spend the next week, once again, fighting for her life!

Another Battle Begins

More to come...

Peace B

***To the best of my knowledge the Medicare information is correct. I am not an expert. Please consult your Medicare guide for clarification and which services are best for your individual needs.