The Doctor is Out

When was the last time you saw an independent doctor? Nowadays, they are contracted as employees of hospital organizations. It’s easier for the insurance companies to set network rates and for the hospital to order medical supplies on economy of scale.

Hospital organizations now deal with their medical staffs like professional sports management and their athletes. You can’t tell who the doctors are in any hospital group without a scorecard. The players- I mean, doctors- come and go too frequently. More than a half year ago one of the specialists my mother sees left the group. She is still waiting to meet with her replacement in another two months. Until then, if she has any issues related to that specialty, it is handled by the bullpen (keeping with the sports analogy).

This was the third of her doctors to abandon ship in the past two years- one of them a surgeon who did some mighty fine work using a new device to implant into one of the regions of her body.

Three months ago her primary care physician (what we used to call ‘family doctor’) up and quit. She gave a short advance warning but there were no replacement doctors available. Any new doctor she was to visit would be considered as a new relationship even though she had been a patient in the hospital system for more than twenty years. Luckily, after throwing a tantrum as well as begging (me, not my mother), she was able to get scheduled a replacement doctor only three months away.

My mother saw the new doctor two weeks. She was beautiful, young, fashion model-like in appearance. She wore four inch red stiletto high heels (not kidding). Even though she was not well experienced, as she talked with my mother, she knew how to use the computer system to research issues.

She set my mother up for appointments she needed to do with other doctors as well as adjusted her medicines. She told her to schedule her annual wellness visit with her three months hence.

Oh- one other thing. She mentioned that she too was leaving the practice but not for at least five months. Oh, well. And so it goes…..

Emergency Rooms With a View

By Larry Teren

Recent circumstances caused me to become an informed critic of Hospital Emergency Rooms and health care. Ma had the misfortune to visit two of them in one week. The hospitals were located about three and a half miles apart along the same major road in north suburban Chicago.

The short part of the story is that Ma and I were brought by ambulance to Hospital A’s emergency room a week ago Friday night at 1:45am. She was experiencing severe abdominal pain. She begged for morphine several times but was denied any type of relief until they had a modicum of an idea what was wrong with her. However, they did not bother to try to find out until they took a CT Scan at around 5am. Exactly- we were at the mercy of the hospital personnel for more than three hours. Continue reading “Emergency Rooms With a View”

In The Middle (Class)?

Not being a middle child but the second oldest in a group of five, I don’t have that ‘being in the middle’ complex when it comes to attention. And if you know me, you know that I’m not shy. But the thing is I usually look to find the middle ground. That is what bothers me so much about politics more than ever. Continue reading “In The Middle (Class)?”

Rehabbing Is Good But You Can Go Home Again

That poet who said “you can’t go home again” doesn’t know what he is talking about. On July 16, Ma returned to the house Dad and she bought in August 1968 after spending the previous seven weeks at a rehab facility. For close to two months, her life was regimented by health care professionals who told her when to wake up each morning, what to do in twice daily therapy sessions and barged into her room whenever they felt like it to give her medicine and check her condition.

After Ma had two weeks earlier seen the surgeon who repaired her broken hip, she felt frustrated when he told her that she still could not put sufficient full pressure on her left foot to warrant walking stairs.

He said that she needed another 10 days of boring repetition of what she had already mastered in order to give more time to the fused bones and pins to secure themselves.

Two days earlier on July 14, we did a dry run where we wheeled her to my car in the facility parking lot and she rehearsed getting out of the chair and into the front seat of the four door sedan. Just as the therapist had told her earlier in the day regarding her first effort to climb stairs, once again she did it “like a pro.”

That Friday she took the ride home and back to her house that she had not seen in weeks and readily climbed the stairs to the front door. She even walked up the stairs inside to the second floor to sleep in her own bed that first night.

This is what doctors, nurses and other healthcare professionals hope to see and hear. They want their patients to be success stories. But it comes with a price. People live longer now and expect to live it as healthfully as possible even into their 90’s. Most people with few exceptions would go into the poorhouse to be able to pay back the cost of surgery and recovery. The Federal Government is at a crossroads because the cost that they are underwriting for seniors is out-pacing the ability to fund it.

However, there is no alternative. The Feds must continue to finance senior care or there will be a lot of seniors lying and dying on street curbs.

Physical Rehabbing is another Way of Saying “Hurry Up and Wait”

Everyone wants to be healthy and wealthy. If not wealthy, then have enough to at least stay even with the crowd. If not totally healthy, then at least enough to maintain a level of dignity and self-support as much as possible. Such are the dreams of those sleeping the night through in rehab facilities. “Hurry up and Wait” pretty much describes what goes on during physical rehabilitation as a result of injuries or surgery.

The rehab therapist sends an assistant to the patient’s room and rushes him or her via wheelchair to the exercise room despite whatever the beneficiary of the said workout is doing at that moment. Once there, the patient is told to wait while the therapist works with someone else.

The therapist finally focuses his or her attention to the said patient. He or she demonstrates for a moment or two what the patient is expected to do for the next few minutes but runs off to help someone else. After a wait of another few minutes, attention is again returned to quickly demonstrate another task to perform but off goes the therapist once more. Eventually the patient is wheeled out into the hall and told to wait until someone can wheel him or her back to his or her room.

Another type of ‘hurry up and wait’ is for the healing process itself. It can be a long duration depending on the injury to a broken bone and surgery to repair the damage. In Ma’s case, she fell and broke her left hip. That same night she had surgery and six weeks later, she sits in frustration at the rehabilitation facility. The other day she met with her surgeon who told her she was progressing fine but that six weeks was not enough time to heal back to her old self.

For one, older people have an issue with osteoporosis, which is a polite way of saying they suffer from soft bone tissue. Simply put, Ma’s bones break too easily and if she rushes the mending earlier than it should be, she runs the risk of re-breaking the left hip. Seven years prior, she fell and broke her right hip, had surgery and was back to her normal self- whatever that means- after two months. However, the break was not as thorough as this time and she was seven years younger and stronger.

The doctor also said magic words. “Look, Medicare gives you 100 days to get better on their checkbook. Take advantage of it as much as you need.” For her it means two weeks of putting at least 50% pressure down on her left foot whereas up until now it was four weeks of no pressure. She has used a walker during exercise time with the left heel down and her toes up. It is up to Ma to go about her business of proving that this next phase is a piece of cake.

After two weeks, it will be the sixty day mark from the time of the surgery. She will be able to try 100% weighted pressure on her left foot as well as walk stairs. The surgeon said that when she can put 100% pressure down, she can go home but that it would not be wise to do so if she cannot master going up and down stairs.

This obviously generates lots of frustration. She feels better than she did six weeks earlier and can do some things again but she wants total freedom. Who doesn’t? Healthy people take for granted that they can take care of themselves.

When I was sixteen and a half, I did a stupid thing- one of just many in my lifetime- and jumped over a fence that I knew had an eight foot drop to a cement floor. Naturally, I broke a metatarsal bone in my left foot which has never healed properly ’til this day. But, being 16, I was also young and strong enough to ignore the fact that I had done damage. Other than wearing a shoe with a wooden sole to act as a splint and cushion the pounding that walking did to the sensitive break, I went about my normal business. I even went to my high school graduation with that stupid wooden shoe. No cane, walker or crutches. I probably would do the same today. But if this were to happen twenty years from now, I suspect I would be grounded for several days as well as using a walker for a while.

That magic word- Medicare- helps soothe some of the pain for those in the same boat as Ma. American society decided that the age of 65 (or whatever it will be in the future) is the special passport to government financed medical care. The first twenty days after surgery, Medicare pays 100% for her recovery provided she is able to show an effort in cooperating with said recovery. After twenty days, Medicare pays 80% and the Medicare Part B co-insurer pays the other 20%. Ma has up to 100 days in a calendar year from the time of surgery to take advantage of all that Medicare will finance. If Ma stays in a rehab place for sixty days and then goes home, she can still return and use the other 40 days up to the anniversary of the surgery.

Once upon a time- sounds almost like a fairy tale, huh?- retired social security recipients were not asked to pay much at all for Medicare benefits. Now, each monthly payment they receive automatically withholds Medicare Insurance premiums. For some people this can be over $300 per month. That is a lot of money to take away from someone who is ending up with anywhere from $1400 to $2000 a month in social security money. And there are those like Ma who saw their social security money drop 40 percent when Dad passed away as well as lost Dad’s pension. The biggest slap in the face to senior citizens is that for the past couple of years there has been no increase in social security benefits due to the “Economy”. But there has been an increase in Medicare premiums withheld. Beneficiaries in 2010 are receiving less social security money in 2011 than in 2010. The situation does not look any better for 2012.

Hey, baby boomer- do you know what medications your parents take?

According to a recent study most children of elderly parents are clueless to what the various colored pills are that they see their parents take when they come over to visit. This is despite the fact that these same unobservant – myself included- scions intend to take responsibility for the care of their mother and/or father when the situation should arise.

Ma asks me to pick up her medicine from the pharmacy. I think she orders seven different items although all are not actual medicines. One or two items are testing devices. I’d be the first to admit I do not remember the names of all that she orders. I just give the person behind the counter her name and indicate the number of items I am supposed to pick up. I also give them a special credit card to pay for it. She asked the pharmacy to issue her a second card in my name so I would not have to always go to her to get her card first, pick up the medicine and return her card.

Even though I don’t know her medicine list it doesn’t mean that it is not recorded somewhere. And I can get access by requesting it. A couple of years ago after Dad passed away, Ma signed some legal papers that gives me authority to handle her legal and medical obligations for her in case she cannot do it herself. I’ve forwarded these documents to insurance companies and banks so that I can readily help her out without having to go through a song and dance to get the customer service person to cooperate.

Also, how about who your parent’s Medicare Part B Supplemental Insurance Carrier- do you know who it is and their policy number?

Both my sister and I have asked Ma to write down what she takes and make the list available to us. I suggest you do the same.

Medicare Part B and Counting….

By Larry Teren

“Get to the Point” is usually spoken about a minute or two into a conversation between Ma and me or Ma and my older sister or Ma and my brother or my brother and me or my sister and me…. You get the idea.

As part of our bloodline, we suffer from impatience to listening to the long version of a story as opposed to hearing the bottom line. So, you can imagine what it must have been like as the four of us sat downstairs in a fancy dining room that was turned into a makeshift office for our benefit at the nursing home (excuse me- rehab) facility. Ma was now at the magical twenty day gestation period in which Medicare agrees to pay 100% of the costs for her to recover from the broken hip and aftermath surgery.

Sitting in this round table discussion along with a portion of the family- two sisters were in other cities and could not attend- was a representative from the nursing staff as well as an occupational and a physical therapist at the nursing home. All three ladies agreed that Ma was doing quite well and on the road to recovery.

The next step would be to go into the Medicare Part B phase in which Medicare covers 80% and her supplemental insurer covers the other 20%. At least, we hope so. The nurse representative explained that Medicare allows a patient up to 100 days of resources. This means that Ma can take advantage of an additional 80 days of rehabbing provided they deem it is necessary. It doesn’t need to be done consecutively. She can leave the nursing home (yes, some people actually do not in a body bag) after sixty days and still have forty more days to bargain before a calendar year is up.

In the meantime, with three of her children visiting her for now on an almost daily basis besides a handful of friends, her focus and attitude is positive. Today, I witnessed her walk half the basement hall with the therapist while she put only heel pressure on the ground.

All three ladies agree that Ma should continue with the same level of rehab treatment for another two weeks until she sees the surgeon. He will be the one to approve her to apply full pressure on her left foot down to the ground as she steps. This will make a dramatic improvement to the style of therapy she is going through. It will also most likely mean that she be allowed to stay another two weeks after that until she ‘plateaus’ with what they are able to do for her at the nursing home /rehab facility.

Then comes getting used to living at home again in a house with two floors and a basement. Ma will have to traipse up and down stairs. If she cannot handle it whatsoever, then some serious decisions on the future of living in the townhouse need to be resolved.

With all this pressure on Ma, I did not want to bother her about the letter in the mail she received at her house a day earlier. It was a statement from the hospital indicating that they billed both Medicare and her Medicare Part B supplemental insurance company for the four day stay including the surgery. There was a detailed list of around thirty different services for which they charged. The total came to over 80,000 dollars. Obviously, Medicare will tell the hospital that certain fees are overstated and that they can only expect to receive so much. This is a ridiculous cat and mouse game that goes on between health care providers and insurers. The health care providers inflate the fee knowing full well that it will be reduced. But they feel a need to state what they believe the service provided is truly worth. And I feel that I should charge 200 dollars an hour for my consulting services but then I realize no one will pay it so I charge something much more reasonable.

It will cost Ma out of pocket whatever is left on her deductible that she has not yet paid. What is not clear is what else she is responsible to pay once the deductible is met. For a person receiving very little social security, this is enough aggravation to send him or her back to the hospital or nursing home for a new round of therapy.

My brother would now say, “get to the point.” I would then answer, “okay- check back in two weeks after the doctor examines her and looks at the x-rays.”

Rehabbing Medicare

There has been a lot of talk lately about the concern of severely curtailing Medicare benefits. Some of us who are years away from the curse of old age do not appreciate the situation. Medicare takes care of the rehabbing that a senior citizen endures in an authorized facility as long as the patient shows signs of improving.

Knowing this Federal largesse, everyone who recovers from hip or shoulder or knee surgery and bone injuries in general tries to get placed in the best care facility possible.

Ma was no different. She knew about the excellent rehab center three blocks from my condo and we lobbied with the social worker at the hospital to get her placed there. Luckily, there were several bed openings and for at least one week she had the pleasure of having the room to herself.

Another quirk in the Medicare laws apparently is that if one has surgery on the injured bone, Medicare will pay for two therapy sessions a day. Without surgery, the patient receives only one session. When two sessions are involved, one session covers some occupational and not only physical therapy.

Once the patient’s doctor and therapist agree that the person has plateaued, Medicare cuts off funding. At the place that Ma is at, this means that the patient is either sent back to their own residence or to a long term care facility in which chances are they will never be able to leave. This is because there are a percentage of facilities that recognize it is in their own long-term interest to keep the patient, now called a resident, there as long as they can.

Of course, not many people are able to pay the six to seven thousand dollar a month cost to stay at a nursing home. If they do not have long-term care insurance, which most people do not have, then they may have to apply for Medicaid, in which the State agrees to finance their stay but requires the patient to pay down all their assets befre getting assistance. This will include, of course, the sale of the house. Exceptions are made if a spouse is still living in the house.
Continue reading “Rehabbing Medicare”

A Senior Moment

Having split her right femur bone in half nearly two weeks earlier, Ma was now resting comfortably at a rehab facility four blocks from my condo. She insisted that she go to a place dedicated more to helping a person regain their walking skills rather than to a “shut up and lie down” nursing home environment.

She was starting to get used to two-a-day grueling therapy sessions where she was not babied in the least bit. I thought about that movie Ruthless People where Bette Midler is kidnapped and tossed into a basement but given free reign. She uses the time to start exercising and by the time she is released looks like a sculpted athlete.

On Sundays and holidays there were no therapy sessions because the management did not want to pay extra to the therapists. This meant Ma would be sitting around doing nothing on Memorial Day Weekend.

I dropped in on the Monday holiday afternoon figuring she would be miserable watching the Cubs lose another ballgame. Instead she was not in her room. Instinctively, I went downstairs to the lower level entertainment center where I caught her watching a live (well, he wasn’t dead) musician play an electric violin accompanied by a Karaoke instrumental background music-making machine.

My sister was sitting there with Ma as well. Show business is in our family blood so the three of us unabashedly sang the words to the songs being played and we corrected along with another member of the audience the mistakes made by the entertainer on the background information to each piece. (Stuff like- Marlon Brando sang Luck Be a Lady in the Guys and Dolls movie, Sinatra sang it on a hit album.)

About a half hour after the performance was over and Ma was ensconced back in her room, I decided it was time to depart. I went down to the first floor at the entrance area and gave the attendant my name so she could record that I had left. As I was about to walk out at the electric sliding door, the two ladies who had been sitting to the right of Ma during the violinist performance stopped me. One had hair that was dyed black while the other a very white bouffant. Whitey was sitting in a kind of contraption that not only enabled her to be mobile but also provided a shelf for her to store accessories.

They both said in unison how much they enjoyed my singing voice. I told them that I wasn’t that good and figured they suffered from loss of hearing. They insisted that I was being humble. Trust me- I wasn’t. The younger one then went on to gush how she had seen the performer twice before and thought he was just grand. That’s when I knew she was definitely no judge of talent.

I asked the presumably younger one how long she had to be there. She said she had hip problems and had been in the place on and off for six months. I then turned to the white haired one and carefully tried to frame my question so it wouldn’t sound as if I thought she was stuck there for the duration.

I bravely asked, “and how long do you need to be here?” wincing as the words came out of my mouth. She replied, “oh, I’m just visiting. She’s my daughter,” while pointing to the alleged brunette.

Double Whammy

A little after 12 noon this past Thursday, while working with the chief financial officer and in-house computer network specialist at a client site, I got a phone call from my sister. She started off with, “I got bad news and worse news.”

Earlier that morning I got into the car to drive out to a Western suburb of Chicago that was at least a twenty mile destination requiring two tollway fares. All the way there I fretted about temporarily running out of stories to add to this blog. To my dismay, that didn’t last long.

“I’m listening.” I said in a hushed tone. She said,“ma fell down in the house and broke her hip. She is in the emergency room at St. Francis Hospital in Evanston.” That was the bad news. Now came the worse news. “Mrs. So-and-So (my sister’s mother-in-law) had suffered a massive stroke resulting in heavy hemorrhaging and was at death’s door. She was lying in wait, so to say, in ICU, also at St. Francis Hospital.”

My sister’s mother-in-law had come home from playing cards after 10pm Wednesday night. She lives in the condo down the block from mine, the one fancy enough to be able to afford a doorman. The uniformed fellow let her in and she proceeded in the hallway to the elevator but never made it to her apartment. She was found lying on the floor in an unconscious state.

On late Thursday afternoon I finished visiting with Ma on the fifth floor of the hospital listening to her mentally prepare to have surgery on the right hip where a surgeon would place a rod and bolts underneath the skin. This gave her a sort of symmetrical artificial reconstruction of her torso. Five years earlier, she broke both her left hip and shoulder.
Continue reading “Double Whammy”