Friday, February 26, 2010


When my mom did her tumbling act to the roar of an empty crowd the resulting breakage of her brittle bones began our back-and-forth dialogue with a host of doctors, insurance agents, social workers, therapists and nursing home marketers. Some of these worked with compassion and an altruistic desire to help while others saw themselves as cogs in a system doing their job of crossing all their “t’s”, dotting all their “i’s”, and racking up as many dollar signs as possible.
Our job was to follow through on our goal – to keep our mom as happy, comfortable and safe as possible for as long as possible. Our plan – to keep her from assisted living for as long as feasible, returning her to her own home, and supervising her as best we could without having to contract outside assistance. This seemed reasonable and it was the prevailing consensus of all five of us siblings. What it wasn’t was the consensus of the doctors, insurance agents, social workers, therapists and nursing home marketers and as we were to find out they were the ones holding all the strings.
As far as insurance agencies go my mom’s was no worse than most and better than some. They, along with her Medicare, took care of all her expenses from the opening ambulance ride to the hospital, through surgery, her stay at St. Mary’s Hospital, and then her subsequent recuperation and therapy at Oak Park. What wasn’t clear until our last meeting was that coverage was finite and not really connected to her recovery.  Under her policy and Medicare’s regulations she was entitled to a finite number of days of occupational and physical therapy and when that was completed they would re-evaluate her progress and recommend an additional number of sessions of physical therapy if they thought it was relavent. My mom’s a trooper but with one arm in a cast up past her elbow she still can’t pull down her pants when nature calls and pulling them up once she’s done has yet to be accomplished. She’s barely able to walk, shuffling along with her undies wrapped around her ankles. Although as amusing as this picture might be, it borders on dangerous for the time being. The problem is the insurers don’t really care about her condition. Their concern is time and when the time is up so is the care. They turned the hourglass of care over the minute she fell and when the last grain of care floated to the bottom of the glass the funding stopped even if my mom hadn’t yet recovered her dignity while still needing a nurse to wipe her hinny.
My sisters and I sat in various states of perplexity as the social worker delivered the news of my mom’s eminent release. Our eyes darted between us as we each evaluated which of us was now going to assume the duty of butt wiper when the social worker piped in.
“It is our recommendation that Florence either remain here or be placed with twenty-four hour care. We see you were planning on returning her to her home. You’ll need to hire a fulltime caregiver for her safety. We have a number of agencies we can recommend.”
The nursing home marketer’s gaze did a quick scan of our faces as he assessed our determination to actually tackle the job of full body care of mom. The social worker continued, “I’m sorry to have to tell you that should you choose to remove Florence from Oak Park or decide not to hire permanent fulltime help it would be against our recommendation and would disqualify her from further coverage.” Well it appeared as if they had us.
A couple of years ago my mom had been involved in a car accident where she needed similar care. My sisters had done their research and found an agency providing in-home caregivers. The feisty aspects of Florence’s personality were brought to the fore when after a six week stay at the same Oak Park facility she returned home and was introduced to Maria, a Spanish speaking spit of a woman dressed in the sherbet colored synthetic uniforms now popular on most hospital and nursing home floors. Even on crutches Florence was able to get to the kitchen, find her broom and chase poor little Maria around the dining room table whacking her several times with the straw end of her weapon in hand. Maria quit in 3.2 hours, a record for the agency. After this past attempt at in-home care the thought of going this route again was not very appealing.
The other option, leaving Florence at the nursing home, was something we had considered. We had even gone on a tour of their new memory care facility across the street from the rehab and assisted living facility mom was now quarantined in. The new facility’s tiny clean rooms were lovingly praised by our marketing tour guide. All of the amenities were presented for our viewing pleasure but the element of cost was kept secret until the last possible minute. When the costs were finally revealed we all released a collective gasp of horror.
“Your father served in the army during WWII didn’t he? This would qualify Florence for up to $1900 per month, coupled with her social security and if you turned over all of her assets we could make Florence very comfortable for the next couple of years.” Nursing homes like Oak Park are all private pay facilities, no insurance accepted. The funds have to come out of your own pocket and none of us had anything but a few pennies at the bottoms of our tattered clothes. The other flaw in the marketer’s spiel was the concern around the words, “the next couple of years”. Even if mom’s mind was floating down Alice’s rabbit hole her body and all of its internal organs were still holding up better than most people half her age. We had to couple this with the fact that longevity was possibly in her genes. My great-aunt Clara hung around long enough for Willard Scott to wish her a happy one hundred and seventh. We clearly weren’t ready or capable of buying into the assisted living complex.
Tomorrow mom goes to have her cast looked at. If they remove it and replace it with a shorter wrist cast there is a good possibility they will extend her stay because then they will have reason to give her new therapy to help her adjust to her new arm movement. If they decide to leave her existing full arm cast on for another week or two, mom loses. They can’t teach that old dog any new tricks even though the cast is what is prohibiting her from doing any independent walking. So they may have to release her, unable to walk on her own or pull up her pants reclaiming her dignity. The system sucks.

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