Friday, May 29, 2015

Springing an Old Lady.....

Getting an old lady with decent insurance out of a nursing home is about as simple as infiltrating the KGB unnoticed without speaking Russian. She's too confused to be safe, too weak, too....what?  Seriously folks, she's walking, using the potty, and asking for her kitties.  Let her go.

So today, with the help of an understanding doctor (and an agreement to set up a spy cam so I can check on her from afar) I got her sprung.  Here's how it went:

After a week of several phone calls daily the nursing home agreed that she was ready to discharge to Hospice care.  The agreed-upon time was 11 AM.  Hospice would arrive at home at 1 PM.  Yesterday Babygirl and I spent a few hours trying to reconfigure Mom's bedroom (which is also her dining room - she can't climb the stairs to the bedrooms and has had a hospital bed downstairs since she moved in two years ago).  The current arrangement made her walk circles around her dining room table, dragging her oxygen cord with her.  Once it got wrapped around a couple of times she'd forget what to do about it and just take it off.  When she fell, she didn't have her oxygen on for this reason. While I was putting the finishing touches on this project this morning, the nursing home called and asked if I could come in a little early for some paperwork.  Of course. I knew there would be paperwork!

It turns out that the 'paperwork' they needed done was the required stuff that allows them to ADMIT her to the nursing home in the first place.  Somehow, in the three weeks that she's been there, no one asked me to get that little detail taken care of.  So I spent half an hour admitting her to the nursing home, and then went upstairs to do a half-hour's worth of paperwork to get her OUT.  It put us a little behind schedule.

She then got loaded into a medivan and brought home.  Two skinny guys hoisted her up the back stairs in a wheelchair, transferred her to her walker, and in she went to be with her beloved kitties. 

Hospice arrived, right on schedule, and we hit the rough patch I anticipated.  They outlined the purpose of Hospice:  To make her comfortable, but to not do any diagnostic tests or life-prolonging treatments.  "Hey!  Wait a minute!  You make it sound like you expect me to DIE or something!" says Mom. 

"Everybody dies, Mom.  You have at least four different diseases that can't really be treated.  We aren't taking anything away, but we aren't adding anything new because the new stuff would probably kill you faster than the diseases you have.  Besides, Hospice isn't a contract that says you HAVE to die in a certain period - you can take your time about it!"

Only in my family can you say something like that, get a laugh and not get sent straight to Hell.

The winning argument was this one, though:  "I need help to keep you from going back to the nursing home and this is the only way I can get it."  Done. 

So she is settled, I get someone to come in twice a week and shove her in the shower with more help further down the road when we need it, and it's covered by Medicare because it's Hospice.  It's sad that you have to be officially dying for your insurance to help your family keep you at home.

So, in spy-code, "The Goose has landed."  Moose and Squirrel are a whole different story.


Sunday, May 24, 2015

Sprucing Up.....

For those of you who don't know, we have a wedding coming up this summer!  Citygirl is getting married on August first, and the house will be buzzing with people. 

This means, of course, that we need to make the place look nice. Not that it isn't nice.  But nicer.  Party nice.  You know what I mean.

Expecting an upcoming invasion makes you look around with different eyes.  Clean and tidy somehow no longer look 'fresh.'  So we are upgrading a few things.

Yesterday I priced out new kitchen cabinets.  Redoing cabinets sounds extreme, but our current 'look' is cobbled together and was never meant to be permanent.  We were going to do a full re-do years ago, and then, well, life happened and we just got used to looking at the mismatched cabinets and paid for dialysis and got on with life. 

I came home with the designs and the prices and showed them to Hubby. 

"Wasn't it a lot cheaper to do the other side? That kitchen is twice as big and it cost a lot less!" 

True that, sweetie, but that was because the insurance company paid for most of the cabinets because we had that little fire, remember?  (It was me.  I accidentally set the kitchen on fire.  I put it out, too.)

Thoughtful silence.  Then, "Honey, you need to set the kitchen on fire." 

LOLOL.  I'm not sure they'd buy that a second time.


Wednesday, May 20, 2015

The Bite of Reality....

Clinical objectivity can really only take you so far in your personal life.

I had a meeting with the nursing home staff yesterday afternoon.  Mom is supposed to be there for a quick rehab stint - recover her physical strength and scoot back home to her beloved kitties so she can continue to sit and watch the jewelry channel (not sure what the attraction is, but it's what she watches). 

The nursing home staff do not feel this is going to happen.  Physical and occupational therapy feel that although she is not TERRIBLY weak, she isn't really very strong either.  She has no ambition or drive to become stronger. She doesn't really make any spontaneous attempts to get moving on her own.  She doesn't want to get up and get dressed, and personal hygiene is poor. 

(Um, well, none of this is a particular surprise to me.  Even when my mom was working, if she had a day off, she stayed in her nightgown all day.  Remind me not to get in this habit - it apparently makes nursing home staff think badly of you.  And I've known for two years that getting my mom into the shower is torture, and don't talk to me about her nails.)

Furthermore, they are concerned about her level of confusion.  Her overall in-and-out orientation is a risk.  Although she's never been a wanderer, and she's never ever turned her stove on (the benefits of being ambition-less, I guess), what if that changes?  And she remains, in their opinion, a fall risk.  A fall is what got her in there, and another could happen.

So they suggested three things:  1) Keep her permanently placed there.  Her insurance will cover six months and then we apply for Medicaid.  2) Take her home and send her to Granny Day Care at $70/day (not covered by her insurance, that's $350/week, $1400/month+ when her entire Social Security check is less than $1300) and keep her in sight at all times when we are home with her, including at night.  3) Hire full-time aides to watch her ($13 - $25/hour, also not covered by insurance, making Granny Daycare a bargain by any standard).

And the bottom line on all of this:  Mom is dying.  She doesn't really understand that she is dying, but she is, and she wants to come home to her kitties.

The reality of that brutal, dark truth hit me right between the eyes in the middle of that meeting.   

I have to say that my response earned the respect of my younger brother when I told him about it:  "Stop bringing her meals into her room.  Food is her biggest motivator.  Make her walk to the dining room to get her meals and you will see her get stronger pretty fast.  Work with PT to get her to be able to go up and down four steps - that's what I'll need to get her into the house. Meanwhile I'll call her doctor and see whether she qualifies for hospice services or not, and I'll see what we can set up in terms of family, friends and monitors to keep her safe at home."

She's no more confused now than she was three weeks ago.  If she falls, she falls.  She needs to be home.


Monday, May 18, 2015

Maybelle's View......

Adding a new family member has both joys and challenges.  An adult dog has quirks, and it takes some time to find them.  Maybelle is no exception.

She is sweet.  Everyone who sees her (those not put off by her sheer size) loves her.  She never says 'no' to a pat on the head.  Small children can hug her and squeeze her and kiss her and call her George and she just doesn't mind. 

She is humble.  If another dog does not want to be her friend she will back off and sit down and wait it out.  If Mom's cats want to whack her upside the head a few times, she's willing to take it and walk away.  If Simon wants her leftover dinner, even if she isn't really ready to declare it 'leftover' yet, she'll let him have it. 

She is an excellent timekeeper.  At 5:20 AM her nose touches mine, EVERY morning (scared the SNOT out of me the first couple of days - that's a big set of eyes to be looking at before I get my glasses on!).  She knows when it is time to eat and when it is time to go for a walk.

She knows what she wants.  Cars can drive by, no problem.  Motorcycles, no big deal.   School buses, big blue University buses and most trucks?  Drive on.  But she is determined that someday, somehow, she is going to catch herself either a City Bus or a Ford F150.  Or maybe an ambulance.  Yeah, that would be okay too.

She is enthusiastic.  She will walk, anywhere, anytime, any distance, and come home and be ready to throw a tennis ball around the house.  She will yank your arm out of the socket if there is another dog to meet and greet across the street.  She will happily run behind any jogger.  And whenever she sees Squeaker she gets so happy she blows him off his feet.  ("I'm OTAY!  Maybelle missed me!")

She is NOSY.  No matter what is happening, she needs to be in the middle of it.  She wants to go over to Mom's side of the house and check on the cats and explore several times a day.  She wants to check out the basement, the insides of closets, and anything behind any closed door.  Oh, and what's in that gym bag?  Huh? Huh?

To anyone who has ever considered getting a dog:  Don't pass over an adult in a shelter.  You could be missing out on a Maybelle.


Monday, May 11, 2015

Sixty-six Years of Monthly Payments.....

Babygirl's Medicare went away at the end of February, three years post transplant.  She is now entirely dependent on my work coverage, which has a pretty huge deductible.  So far I've had to pay nearly 100% of my and Hubby's medical costs for the year. 

Babygirl's, however, are in some debate.  I've had some difficulty convincing our insurance company that Medicare has, indeed, signed off. 

Babygirl was admitted to the hospital in March.  And again in April.  She had blood work in between and since.  And our insurance has steadfastly insisted that they aren't responsible.  And they gamely suggest that we aren't either, since Medicare is supposed to be picking it all up.


I've faxed Medicare's letter to them twice.  The second time I got the name of the person who received the fax, spoke to her and confirmed that everything from March 1st on would be resubmitted for payment. 

Then I got the letter from CHOP, warning me that everything would soon be billed to 'self pay' because our insurance wasn't covering. The total is nearly $20,000.  Twenty.  Thousand.  Dollars.

I called CHOP and got the lowdown from them.  I am on the brink of going into collections for some of the March bills.  Crap.

I then called our insurance company, and the young lady I spoke to informed me that Medicare was responsible.  I informed her that I had in front of me proof that I had faxed the Medicare sign-off letter to them more than two weeks earlier, discussing in rather heated terms the meaning of the phrase "NOT covered."  She was not amused.  After several sessions of bad on-hold jazz, she came back and confirmed that Medicare, indeed, no longer covered my child's healthcare.  She then told me that all of her medical bills from March 1st to the present had been send for 'review.'  That didn't sound like 'resubmitted for payment' somehow, so I asked how long does 'review' take?  Thirty to forty-five days for our insurance plan - up to 90 days for some others. I asked to speak to a supervisor.  She said, "I don't see why you would need to do that."  I insisted.  She agreed, and then we were somehow 'disconnected.' 

I called CHOP to fill them in.  They took the information, but said that they couldn't keep the account from going to collections.....unless I was willing to set up a payment plan. 

The poor soul who suggested this to me was clearly used to hearing sad insurance stories from desperate parents, and she was audibly prepared to duck-and-cover under her desk at whatever tirade I might loose in her direction about needing to set up a payment plan for a bill I clearly didn't even OWE yet. 

"What's the least I can pay to keep it out of collections?"  "Twenty-five dollars a month."

Seriously?  To keep my credit rating high enough to qualify for a low-interest mortgage?  To keep from paying collection fees?  To keep creditors from harassing me at the office??  "Sign me up, and keep it going monthly until I tell you to stop."

I did the math. If the insurance doesn't pay, I'll have the whole thing paid off in a mere sixty-six years of twenty-five dollar monthly payments.  What a deal!



PS  I did call our insurance back, reaching the lovely young lady who had received my fax more than two weeks ago.  She checked the case out, added some details and transferred me to a supervisor without any difficulty.  They need ten of her and NONE of the other girl.

Saturday, May 9, 2015

Help Help HELP....

Mom was moved to a nearby nursing home in the middle of the day yesterday while I was at work.  Her friend came, packed up some clothes for her and went over to try and minimize the confusion. 

Babygirl and I went over today.

The first thing we were confronted with as the elevator door opened was an old lady in a wheelchair yelling, "Help! Help!  Help me!"  Babygirl was astonished that I simply walked past her and on to her Grandma's room.  "Shouldn't we go get somebody?" she asked.  By the end of an hour she understood why I'd just walked by.  The cries for help never let up for more than a few minutes at a time.  As we were leaving she asked me, "How do they know if she really needs to use the bathroom or something?"  "I have no idea, baby."

We were lucky enough to arrive just as Mom's aides were coming in to help her get 'cleaned up.'  I filled them in on what she was doing here and what she had been capable of at home only 10 days before.  They were a bit surprised - they'd been afraid to let her out of bed.  I filled them in on the need for her 'panties' (I brought along a bag), helped them get her into her favorite nightie, and promised to come back with her own walker so she could get around better. 

While they were getting her settled Babygirl and I met nice lady who was walking the hallway, fully dressed and carrying a handbag.  She was clearly planning on leaving, but carefully introduced herself to everyone in the hallway.  She  introduced herself, told us she was a nurse and told us we were beautiful - especially admiring Babygirl's black hair. "I always wanted dark hair - I'm just a 'dumb blonde!" she joked, pointing to her patently grey head.  She gave us each a kiss on the cheek, introduced herself to us again, and then to the aide, and then announced she was going home and headed down the hallway.

Mom wasn't hallucinating, was pretty sure she wasn't in the hospital, and was also pretty sure she needed to go chat with the lady who needed 'help.'  "Maybe it would calm her down if I just sat with her."  Good idea, Mom, you go for it.  Make sure you introduce yourself to the nice blonde nurse lady.

Here's hoping the place inspires her to get up and get moving and get strong and get HOME.


Wednesday, May 6, 2015

Alien Visions.....

Mom is still in the hospital.  Her UTI is under control.  As predicted, she doesn't remember that she has cancer.  She is still pretty weak, and her blood sugars have been a little crazy, but the plan right now is to discharge her to a nursing home for rehabilitation for a bit to get her able to walk on her own before bringing her home. 

Visiting her each night has put some other stuff on hold, but it is what it is.

Last night Babygirl went with me to visit her. Mom told us all about how she had mistaken the morning phlebotomist for one of her granddaughters, and refused to let her take her blood.  Apparently she was so convinced (and absolutely sure that the rest of the grandkids were there as well) that they had to get the nurses in, and finally get a different phlebotomist since Mom was sure my niece was not competent to draw blood (true that, but she rocks at massage).  While we were there she got a call from a friend, and we listened while Mom explained to her that she had fallen, and that she has a "prostrate infection."  Um, really?  Not only is it actually called a 'prostate,' you don't have one.  I thought we'd die laughing, and we could hear her friend gasping for air on the other end of the line.

Tonight I went alone, and was privy to a conversation about how Curlygirl has an alien, and how she is pretty persistent about alien rights (but she's so stubborn about everything, right?).  Mom herself saw an alien, a short bald thing.  Mom had some trouble with the alien language barrier, and didn't get his name - aliens are private about such things,  you know.  Then she changed the subject to how the frogs are damaging the doors.

All of this was straight-faced matter-of-fact conversation, held while we admired the sunset out the window.  She had a CT of the brain on Friday night, so I know there are no tumors in there, but I'm guessing she's had a small stroke.  Her dad had hallucinations regularly as part of his dementia - there was an Indian in his living room pretty regularly, and a small dog.  No aliens that I recall, though.

I can hardly think of anything that sucks worse than this.


Sunday, May 3, 2015

A Full Moon Kinda Life....

After our failed attempt at a visit with the pacemaker clinic, Mom just had a rough week.  She complained the next morning of feeling 'disoriented,' although what that means when one already has dementia I really have no idea.  She was acting off, somehow, and was forgetting basic like toileting.  I changed bedsheets, nightgowns, socks, and floor mats.  I checked in a little more often, was really compliant with daily weights and blood sugars and encouraging healthy diet.  I thought maybe the pain in her knees from the near-miss fall on Tuesday was slowing her down so I added Tylenol to her daily medications.  Maybe the upcoming full moon was throwing her off.

On the way home from work Friday, while waiting (behind a police car!) at the ATM, my cell rang. I almost didn't answer - POLICE! - but I snuck it onto speaker.  It was hubby. 

"Em found your Mom on the floor a few minutes ago.  She must have fallen.  We can't get her up.  Should we call 911?"

I love that man, I do.  But, seriously, you do not need my permission to call the Boys in Blue.  By all means, give 'em a call.  (They were rude to him.  Apparently the dispatcher didn't think that an old lady on the floor was an emergency. I told him he'd've gotten more respect if he'd thought to mention that she was unconscious when they found her. It's all in the details.)

I arrived home just a few moments ahead of EMS.  Mom was incoherent, in pain, and freezing.  To the best of her (admittedly poor) recollection she'd fallen shortly after I'd left for work at 8 AM.  It was now nearly 6 PM. 

Off to the ER we went (it's 0.4 miles according to the ambulance mileage record.  We should just build a ramp and coast there).  She was diagnosed with a UTI and admitted. 

Old ladies. They don't get normal UTI symptoms, like cramping an painful peeing and fever.  They get weak and confused and they fall down.  Sigh.

The problem with lying on the floor for 8+ hours is that it causes decreased circulation to the muscles, which causes muscle damage.  Damaged muscles sort of dissolve into something called myoglobin, which leaves the body via the kidneys.  And the kidneys HATE that stuff, so they frequently fail following this kind of event, so it's normal for patients to be admitted and super-hydrated.  Of course, if the patient has congestive heart failure, super-hydration is not the best idea on earth either - our typical tightrope walk with Mom. 

Because every part of her body hurt, the ER scanned her.  Brain - no change, no new strokes.  Belly - no injured internal organs.  Bones - healed 9th rib fractures on both sides (?!?) but nothing new.  Chest x-ray - no pneumonia, mild heart failure, like always.  But on the chest CT.....

There's a mass in the lung, well over an inch big.  It doesn't show on the last two chest x-rays because it's parked behind the aorta.  It's up high, likely not easily reachable for biopsy, but there isn't much doubt that it's lung cancer. 

Her kidneys won't tolerate the dye needed for a PET/CT to evaluate for metastatic lesions, I don't think.  She's a crappy surgical candidate - anesthesia didn't want to take a lesion off her face last year under mild sedation.  No way they are going to want to put her under. 

I told her about it tonight.  I laid it out, kept it as simple as I could, answered the same three questions four times.  And in the end she took the Scarlett O'Hara approach and said, "Well, there's no point in being sad about that NOW.  I can be sad about that LATER."  I'm willing to bet she won't remember it tomorrow, and hey, nothing wrong with that. 

Wish I could say the same.