AUTHOR: ARTSY CHOW ROAMER

Limping into Medicare

OUR HEALTHCARE SYSTEM AT WORK

As you may have noticed, I have been absent for a few weeks. I would rather say it was vacation…but it was something more unexpected.😱 A visit looked forward to was turned nasty by a simple accident with somewhat dire consequences. A story that leads me to tell you what my plan is.

My mother arrived so excited, with more outfits and jewelry than any sane person would bring for a four day visit. My next oldest sister was having a birthday and I reached out to try to put together a last minute dinner party. (You know…think Bruce Willis in Die Hard…come on out….we’ll have a party…you’ll have a good time…).

My mother was apparently feeling some symptoms of a UTI (urinary tract infection) and was drinking copious amounts of water and taking cranberry pills to flush it out. She said later that she felt she had done it and was feeling no symptoms after all her efforts (can you say antibiotics please?)

NO! I CAN’T HOLD IT!

Because she was flushing, she had to come down the stairs from the sleeping loft to pee at 2 AM. 😲 In a different environment, perhaps even a little confused from an untreated issue, she thought she was on the last step, let go of the rail and launched herself into space rather than onto floor.

She fell; with a heavy enough thud that woke me. I sat up, listened intently; nothing. I decided to check anyway. There she was at the bottom of the stairs; grunting as she tried to access her situation.

I rushed to help and asked how bad she thought it was. I don’t think she really knew. My Mom has been a dynamo way longer than anybody else she lives around.

Living in a retirement community, she consistently is the caretaker of others, not the receiver of care. We got her to the couch and began icing everything down for the next six hours.

It became clear to me that we were not going to be able to get her to the hospital and by daylight my husband was on the horn to the ambulance and she was off for a five day tour of the newest hospital in our area of Georgia.

EVERYTHING BUT A BROKEN HIP

Well the good news is that it wasn’t a broken hip.

The bad news is that it was everything but a broken hip. An acetabular fracture to the pelvis which is in the ball and socket area of the hip, a wide crack to the back and three broken ribs where she hit the leading edge of the stair going down.

YOU WANT HER TO GO WHERE?

At first, set to leave the hospital after only a 3 day stay, my sister and I had to rush around and look at skilled nursing facilities in and around our area (crazy…let me just say…eye opening…and vewy scawy). I mean have you seen any of them around you?

We had to give our top three….two not really close to us were new and decent facilities; several were not and depressing at best. You don’t get to pick…they have to have a bed and want to offer it to you. 😬

She transferred to a very nice facility built in her own community for at least 4-6 weeks of intense non weight bearing physical therapy before she could even think about the weight bearing therapy of another 4-6 weeks.

This after a hair raising five hour trip in an ambulance that had my sister and me hysterical feeling we were being taped for a Candid Camera episode. A trip that Medicare paid the base rate of $236 and my Mom had to pay for the mileage of $1,350 because I was told that portion would be denied.

The ambulance would bill it but it would be denied and I would have to appeal; not medically necessary they would say even though she had to get back home. Ambulance guy even said if he was actually taking her home it would be paid; that is necessary but the facility-not so much! What?? 😲

Can we all do a group moan please???? Ahhhhhhhhhhhhhhh!!!!!! 😮😒😠

WAIT…WHAT DO WE DO NEXT?

So the first thing I started doing in the hospital was using the nifty pen and notepad they gave us because they know you are going to take a LOT of notes. So many that you won’t believe it.

Doctor’s and nurses names, caseworkers names and phone numbers (yes, you will have a caseworker-and if they are any good you will get down on your knees and kiss the edge of their tunic). 😂😬🙄

Medications that will start, be added or deleted. Specialists where care will be handed off to. The questions you want to ask who and the to do list that grows ever longer. The names of facilities they give you three days to go look at…you get my drift.

You write all of this down so you can keep everything straight because you will really need to. Don’t count on the facility to keep things straight-it won’t happen. They are good but everybody makes mistakes. You are the holder of the keys when it comes to being an advocate for whoever is in your care.

IS THAT EVEN COVERED?

Then you get into how long is the rehab; does Medicare pay for it? Ahhh…three weeks…oh OK…so what about the supplemental (thank God she has it). It will pick up for another number of weeks and than she is out-and in home care or with family until cleared to drive again and go to appointments for physical therapy outside the house. 😫

It’s a process made very difficult for an aging population; some with health advocates or kids and some not. How do they do it if not we wondered? Caseworker no longer applies after leaving hospital but social services take over in the rehab facility.

Lots of questions; do you live alone, do you have stairs in your house, do you still drive, do you have support or help…all coming down to what medicare and supplemental will pay for and what you will have to pay for. 🙄

Don’t forget those lovely appeals. I have appealed the ambulance bill and await the decision of the gods on that one. Did I mention that Medicare decided my Mom was well enough to go home in 18 days in with a total of 24 days of care? I’m on my third appeal for that money!

Facility asked for 30 days of care in advance should we opt to keep her in rather than taking her home before the evaluation from her orthopedic doc who said she couldn’t go home yet. I begged to just pay two weeks instead until that appointment which was four grand out of pocket! 😲 OUCH!

LONG TERM CARE AND NAVIGATING THE SYSTEM

Don’t get me started on long term care policies and the 90 day kick off of out of pocket expenses that must happen before that can be used should your situation go sideways. Purposeful I have decided… for a maximum effort to NOT pay out anything as most don’t make it that long if they go sideways.

Dementia diseases are about the only thing those useless policies are good for. My father never got any use out of his before he passed. Then there are the questions about whether you have a living will or medical proxy or power of attorney…what do you want and what don’t you want?

Those questions can only be answered by the patient if they are lucid but there is no real explanation of what the consequences might be for those choices (like my mother probably doesn’t realize that CPR will likely get her already fragile and cracked ribs broken…and a breathing tube can sometimes be necessary to get you over pneumonia…the first of which she chose and the later not…whhhaatt??) But how would you know that stuff if you didn’t? 🤔🤷‍♀️

JUST SHOOT ME NOW

Talk to anyone who has had to go through this with either a sick parent before Medicare or hurt parent after and they will all tell you pretty much the same nightmare scenario of time, energy and money. I have lived in Europe and I have Canadian and European friends.

They all say they have never seen such a difficult health system to navigate. I would agree. The difference is that we have all been trained to think we just need to limp into Medicare and all will be well. What I have learned is-not so much!

It is still extremely hard to make your way through and signing up is only marginally better than the ACA I presently agonize over every year. Don’t get me wrong-I am happy I have something and this was only intended as a first step by using a Republican plan from Mitt Romney’s days as a governor.

Hard to argue with it but they did anyway and said it was the plan from hell and have been trying to mess it up and dismantle it every since.

CONCLUSION

Let me say this just one time…..if you need car insurance…you need health insurance.

Everybody needs to pay because everybody will eventually need it; some sooner and some later. But everybody is going to get sick and die.

It is a right …not a privilege because of the very nature of our ultimate demise.

If you are rich or poor you are still going to get sick and die.

If you are white, brown, yellow, black….legal or illegal…immigrant or not….you are going to need healthcare. Nobody escapes it.

In discussing the stupidity of the ambulance ride denial with a Vice President of the company-more than a few choice words were said. They call me potty mouth Lou for a reason. He asked me if I had a plan….I said yep….I think I do.

He asked if I cared to share and I said; “I’m saving up all my pills, a bottle of single malt and I’m just gonna walk out on an ice flow if there are any left, sit down, take the one, enjoy the next and just say adios before I go to sleep….” I hear that is a relatively easy and fast way to go.

My British friend who worked up in Alaska said a worker did just that her first week on the job at the hotel. Hmmmm…..

Have a plan? Fasten your seat belts, it’s gonna be a bumpy ride if you don’t and now you know what mine is as promised. If you liked what you read, you might like reading other posts under Just Because. Hey, don’t be a stranger! Let me hear from you on your horror healthcare system stories and what you think the answer is OK? Until next time…

Cheers,

ArtsyChowRoamer

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TO MY READERS: This blog was updated with info, pics and upgraded content on 11/19/2019 and 3/8/2020