In response to the changes and propaganda surrounding Medicare and Medicaid I though I‘d take you through a real life drama. Certainly no one will have the gumption to consider it newsworthy, but let me tell you it is real! It came about because I’ve been solicited by a number of people to become an advocate for the elderly here in Spring Hill, Florida. My response was to explain that in today's world those who usually speak up do not receive thanks, but wrath. People are offended and afraid of truth and that certainly applies more so to the government. However, at their continued urging I decided to proceed, since I feel this is an issue of great concern for all of us senior's and those fast approaching that category. I hope the information will be looked at in a spirit not of vindictiveness but to simply bring about change. If anything we are all to blame.
First and foremost I wanted to speak to the care received and the issue of the cost. I agree that we are finally heading in the right direction. However, what I have seen take place in my mom's situation and in the situations of close friends, can only be described as sinful. I truly believe that while intent may be good the current systems process is not always beneficial to the family, the patient, or for that matter the government. I see no logical decision making or weighing of outcomes in any of what transpired. Frankly, it is eye opening and scary. I hope what is gathered from this provides a platform for discussion and change. Change to make the system work better, becoming more cost effective, providing needed services to families in distress and increasing the profit for those necessary facilities, which we all understand are a crucial element in the total equation.
History of a horror story- My mother was seen at a local hospital in June with severe pain. Her condition was exasperated when she was misdiagnosed at that hospital. We did not find this out until her second trip to the E.R. somewhat later and at a different hospital. She was released from this first E.R. and sent home with instructions for therapy. We then followed up with her doctor, who continued the prescribed treatment. However, the pain gradually became so severe she required another trip to the emergency room. At this time the true nature of her problem was diagnosed. It was recommended that she receive a procedure to correct a crushed vertebrae. As understood, this entire process was to take no more than a few outpatient hours, with recovery estimated from a few days to a few weeks at the most. Please keep in mind that up until the time of this injury she could walk with a walker and was not using a wheel chair and that she was a level one diabetic and she never took insulin and she was self sufficient. My mother was placed in a local health and rehab hospital for a day or so to facilitate this procedure. As we understand, almost immediately upon her entry a catheter was introduced into her even though this was done against family specific instructions and warning. My mom was present with the admission staff at the time we requested this. However, even though we had insisted it not be done, due to her propensity to develop an infection, they did it anyway. Needless to say she developed an immediate urinary track infection. She was then scheduled for the Outpatient procedure at the hospital, without us knowing and while she still had the infection. The hospital called me at about 9 or 10 pm the night before the scheduled procedure to inform us and I stated we had no knowledge it was to take place and that we understood she had an infection. After confirming her condition the hospital refused to accept her and the procedure was postponed. Also during this time she did not receive her eye medication until after we discovered it was not being done. Her right eye has now deteriorated significantly. She was kept in bed until required to be transferred another Rehab. Upon arrival at the new Rehab they did not insert a catheter. However, she developed another infection [which I pointed out to the staff ]. We asked for specific testing on that Friday, but the process took days to determine the results, and I was not offered those results until I pressed for such. They then confirmed I was correct. Also during this time we were highly disturbed about the diet. I was making frequent inquiries and follow ups concerning diet. In my opinion this was a major factor in her deterioration. After intervention the facility placed her on herbal and other medication and her urinary infection and other infection was stabilized. We were then finally able to squeeze the procedure in after a second postponement. We were now into August.
Once the procedure was completed she was returned to this same Rehab where her sugar levels rose alarmingly high. They stated this was stress related due to her age. However, they were never able to gain control right up until leaving the facility. Her sugar readings rose to well over 300-400 and up for days and she was being given multiple doses of Insulin throughout the day. A fact we found out later because she had not been going to therapy. However, when at therapy the therapist was not satisfied with her progress, She had been having bowel problems each time she tried to stand. However, I ask any of you, how can one expect a person to take therapy when fighting all of this- temperature, sugar, medications? Also, the therapist insisted she could not get up out of her chair. However, two new CNA's managed to get her into her wheel chair and to the bathroom with minimum intervention. Also, while true she was having difficulty standing straight up on her own, the key fact was they were able to get her into the chair with some help and support. Isn't it strange as health "professionals" the appropriate tests were not administered at that time to evaluate her condition as to nerve damage or diabetic problems and if continued therapy was appropriate? Certainly the extent of her atrophy could have been determined at that point and minimized. Also, during this time we changed doctors! In fact we changed multiple times during this entire process. We found out your personal family doctor is not required to visit or treat you while at a rehab- although welcomed - in Hernando few to none do come. Treatment is left to "volunteer doctors or their assistants" who have no prior knowledge about the patient. Most of these come once a month and treatments are mostly via phone. During this time the issue of fear was also discussed. I suspect you might be fearful as well after all she had gone through? Requests for physiological assistance proved fruitless. This continued for a short while and then we decided to move her to her last facility for health concerns. At this location the health care was much better and she was making small progress. However, they were still fighting the high sugar and her atrophy originating from her extended stay at the other two facilities. An exam by her doctor indicated the surgery went well and pain was almost all gone. We asked for testing to determine the extent of her atrophy. Only one test was ever conducted and that was done a few days before her discharge. We did not get the results until we insisted and only after her doctor got involved. They had misplaced them. That test proved ok. The second test was not conducted until recently as an outpatient. It was eventually confirmed she had nerve damage brought about by an increase in her diabetic condition and lying in bed for so long. It was common in the elderly. Well- hello, after 4 months in multiple "health" facilities and no one treating her understood this was possible, nor took action?
Also, during our stay at the last facility we requested counseling evaluation for her fear, which had originated as the cause of her not walking at the prior rehab. Once again our requests proved fruitless until the last weeks of her stay. The doctor who eventually evaluated her saw her for a few moments and then provided medication. This turned her into a complete zombie. From the 11 steps that she started taking she went to sleep 22 hours a day! Out of all of this they then said they could not help her. I requested she be given retro care to facilitate bed to wheel chair transfers for her arival home. Once again, this was not administered until we followed up! She was then released to home care because her days were running out and the therapist said they could do no more. They recommended long term care. Why not, that is why they are in business for. However, their prognosis [as explained to us] indicated she was capable of walking, her health was good and she had all her cognitive factors. Her only obstacle [according to them all] was her fear.
Eventually she was released home incontinent and unable to stand and on a Saturday. I was told I would get no help until the following day [Sunday] and no CNA care at all that day! That's real compassion and logic isn't it? Her care at home has been defined as excellent, with 3 therapists stating she is in good shape and can walk with continued therapy. She does have fear because she has undergone three major hip surgeries in the last three years and a back procedure and two out of three problems due to misdiagnosis by health care professionals. The bottom line is that at home she is making excellent progress. Her sugar is under control, her vitals are excellent, no infections, minimum pain and she is gaining strength. We all believe in time, and with continued help she can get up and walk some.
However, we now run into Medicare, [whom everyone is immensely afraid of dealing with] which only provides limited hygiene care and therapy- about 30 hours a week max divided between CNA, Nurse, Therapy. I had to do most of those aspects myself or pay for help. In fact Medicare has already pulled out after one month of limited care. I now have to wait three weeks to get her into outpatient therapy and all work will most likely be lost! The experts say it takes three to five months to restore muscle strength and for every day in bed you lose three of therapy. I also ask you, do we not all as humans use the lavatory daily? We of course continue paying out of pocket for the things she requires. Who is the person who develops these care regimens? They evidently know nothing about care. I suspect they can count beans good. Also, why is it that government can state mom requires professional, licensed and certified care, yet provides minimal care at best at home, and expects the family can administer medication and drugs and provide her hygiene, therapy and nursing with no training, certification, or licensing? That they require a person on site 7 x 24 with no concern as to how I have to pay my bills. Once again, spend all her money and then apply for help. Do I sense Hypocorism brewing it's ugly head? Has anyone in government ever had to perform these functions on their own parents, or is that not a concern for them? How can any person, or for that matter anyone who claims any religious affiliation, or who practices the "Golden Rule", not consider hygiene as a prime health issue? While not destitute as yet, the laws basically take away what of any dignity people finally have and force people to eventually, in effect, become a ward of the state. Being cared for by people who's only concern is profit and who leave them in a dazed state most of the day to minimize their cost.
You can say what you want but the bottom line is THE ISSUE! Government has also legislated away people's right for just compensation under the guise of reducing overall health Care Costs. You lump all into one bag and you deal the same sorry lines and excuses for every person regardless of their circumstances and mitigating circumstances - "Quality of Life", "Loss of income", "Advanced Age", the buzz words of lawyers, big business and of inept health care. Few are concerned about the impact to families in physical, emotional and financial loss and few businesses are concerned about the cost to the government. We have seen first hand this despair in others who are losing all they worked for. I realize people can profess anything with their mouth. But the simple fact in my belief system is that all that has been mentioned can be summed up in one word- SIN. While certainly the care providers involved will have different stories, and I do not doubt there are health factors which did contribute to some of the circumstances, which in fairness to them I may have not been aware of, or understood, the bottom line is the system failed everyone. Their ability to provide quality care and at a profit, the patient and the families and certainly the taxpayers.
Finally, I ran into a person by accident at a local car dealer and we got to taling. He explained to me "that is the way it is". That he spent his entire professional career helping these very same care providers pass their government inspections even while they and he knew they were woefully understaffed and inadequate at providing the level of care needed. However, to operate and make a profit they had to do what was necessary. Regretfully, he did not want to share his name. Lastly, if you think these same profit driven organizations will provide better care you are in a sorry state. That they will reduce and minimize cost is a fact, but lets see the service you receive. In closing I have made the following recommendations to my representative. What changes do you think they will make? You can be it will favor those with the wealth!
Mumber one is that all government political employees should be required to use the same services mandated for the people regardless of their new worth. You will see change and fast!
Suggestions are-
1- take into consideration mitigating circumstances which encumber therapy, and which in the long run may create additional costs and inhibit recovery. Force testing and mandate it be completed in a timely manner to ascertain if continued facility therapy will work. 2- Create a long term care plan for at home, with consideration for nursing, human needs, therapy and family needs and hold those care providers responsible. 3- Force family doctors to be actively involved with the patient as they are with patients in any facility. 4- Limit the time in Health / Rehabs...they are understaffed and over worked and care is minimal at best at a very high cost. They have a propensity to keep their beds full. Revert to suggestion # 1 above. 5- Assist the families with at home care by improving their ability to provide hygiene and other essentials without depleting any resources they may have. This perhaps would negate the need for Medicaid, encumbering the government and place a long term hardship on families. 6- You need to pass laws that state that any distortion of facts relating to inspection of facilities, etc, be a felony for any persons, private or government employee who alters, omits or changes anything of record. You should also insist on the comments of family members as part of the medical record. If you leave it up to facilities they will continue to omit essential and critical information which may speak to their inefficiency or for that matter negligence. 7 Allow for monetary damages in cases where intelligent people can determine the circumstances are beyond reasonable. 8- Finally-Increase the amount of money windowed persons and single persons can have before going into a Medicaid situation. As stated initially, I hope this will serve as a forum for discussion and eventual change and not lead to lengthy bureaucratic processes that solve nothing but spend money. May God have mercy on them that make these decisions!
Post Script update Jan 03, 2006- I just found out the beloved state allowed an increase on the charges on my moms medical AARP supplemental plan about $25.00 per month. That's great for a widow living on less than $1000.00 a month. Thats what you can expect from the crowd in control. Don't worry -all is well- they go to church!
Update january 2006 - Mom went in for a small procedure, came out and was rushed back to the hospital within 4 hours due to an infection. We had to help them recognize it. After a big messup over her discharge they sent her to a Rehab center. WE were contrlling every asopct and she was doing well and making improvement. Then they placed someone with a severe conjestive problem in the room and Mom came down sick. She hasn't been up in two weeks. To boot hey never even followed up even though we asked the nurse to take specific action. Her "family" doctor won't see her at that facility. What oath did he take? The doctor in charge said we have to cut back on Medicare Medicaid it is too costly. It sounds like he's a conservative. Although he's from some third world country and probably got his education with our dollars? I took a look at all the patients that were there the last time and they all are either gone on to that place in the sky, or their bodies are here but there minds are somewhere else. "Calling Doctor K, Calling Dr. K" and you fill in the name.
Update, February 2006, we now get to see more cuts in Medicare, especially for those who depend on Oxygen to breath. One asks rhetorically, after all there is enough air all around why should we have to continue paying for it? Besides we do need those new armaments and some more money for illegals. I watched my dad suffer for years with a breathing problem and thank God he did get the help. We saw a few more good years of having him. What a sin that they could even consider this. See you in the Pew!
Jul 2006 newspaper update -The elderly cost for Medicare premiums next year will cost more- with monthly payments of close to $100.
Author: Robert T. Melaccio Sr. Copyright ©2005 Robert Melaccio
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