Stress Test

By Larry Teren

Dear Diary,

Just between you and me, I laugh at those celebrities who brag about going to psychiatrists. It’s like a birthright for them. Almost as if it is one of the prerequisites in order to become famous in show business. Me- I don’t need a shrink. I self-analyze, right?

Remember when I wrote that Ma said I needed to go to anger management class? I told her that I needed to go to impatience management class instead but that I just didn’t have the time to do it. Well, now I realize it isn’t impatience I suffer either- it’s stress.
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Aging Report

By Larry Teren

Most of us who get involved with the running of a business understand what an aging report is. An aging report is a good barometer of a business’ health and ability to stand on its own two feet. This story, however, is not about business but a report on the aging of a couple of humans.
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Medicareless Rehab Billing Practices

By Larry Teren

Okay, you want to know why Medicare is going bankrupt? Because of policy-making decisions such as the following that recently happened to Ma. Continue reading “Medicareless Rehab Billing Practices”

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”

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.

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.”

A Time for Healing

Some will tell you that time flies, others, it marches on. Shakespeare says that tomorrow creeps in a petty pace from day to day. As for Ma, she and her roommate at the rehab facility are caught in that time-worn frustrating web of hurry up and wait to get better.

On one hand, Ma is in better condition than that day nearly three weeks ago when she fell and broke her hip. On the other hand, due to the nature of the bone breakage, she is not allowed to put any weight on her left foot. So, she hops holding onto a walker twice a day in the therapy room from her wheelchair to the bed she is asked to lie down on and do muscle strengthening exercises. This can go on for two more weeks until she is permitted to progress to the next step in the road back to self-sustenance.

Later in the coming week, she will be re-evaluated and told whether the rehab will continue at the facility or as an outpatient at home. This obviously is of concern because she cannot be by herself for now. In today’s world the decision is made by those who finance the effort to help her recover. Medicare pays for the first twenty days at a 100% rate for all allowable billing. After that, Medicare pays 80% and the private insurance company that handles the part B coverage pays the remaining 20%.

The fly in the ointment is that Medicare has to be persuaded that she can recover in a realistic time frame of six to eight weeks. Otherwise, all bets are off with funding.

The lady who shares her room also improves each day. However, she has a greater road to recovery. She was found by her son laying at the bottom of the stairs in her basement after 8 hours suffering from
a partially broken neck, facial cuts, fractured arm and other surface injuries.

When I first saw her, she was lying flat on her back all bandaged up like a mummy. Now, she can sit in a wheelchair and even goes through daily therapy. Her wit is about her, too, as she readily switches between speaking in English and Swedish depending on with whom she converses. What helps make the sharing of the room pleasant for both ladies is that they are also both long-suffering Chicago Cub fans.

Ma asks me if I write about her and I nod in the affirmative. So she says, “well, make sure you spell my name right, ha ha.” Like I’m gonna screw up two letters?

Ma is impatient to go back home and to the way things used to be. She has been down this road before. Five years ago, she fell and it was her left hip and shoulder that took the brunt and both required reconstruction. At that time, it was while visiting my sister in the East coast. So she spent two months rehabbing there only to find out when she returned to Chicago that the doctors butchered their medical decision out East to ignore the shoulder and let it heal on its own. It required a re-break and more surgery.

How much can a person endure pain and the aftermath of getting better? I guess time will tell.

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.
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