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.”