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Recently, I diaried about my elderly father breaking his femur, requiring surgery and hospitalization, and how he was concerned about how he'd pay for the needed care He's Worried About How To Pay For It  and we're worried about him  Many of you gracious Kossacks wished my father well and I'm very appreciative of your good thoughts and kindness.

Well, Dad had his surgery and came through the anesthesia.  It looked like things were taking a turn up for him.  Then, he was released from the acute care hospital to a rehabilitation/convalescent care.  My sister, an RN, expressed her concerns that it was too soon and he wasn't ready, but the transfer was performed in spite of that.  

It is true that convalescent care is less expensive then acute care.  Although I have no evidence, I cannot help but wonder how this played into the decision to release a frail 85 year old, with multiple health issues, so quickly after such a serious and invasive surgery (a rod, plates, and bolts were placed in the length of his femur.)  He was transferred about 80 hours post-op.  15 years ago, when I was fairly young and very healthy, I had a similar procedure on my left wrist and was in acute care for ten days, so his quick release took me very much by surprise.

Dad was only in the rehab facility for about 24 hours when numerous problems began arising.  Luckily, my sister the RN knows her stuff, recognized the signs that Dad was in trouble, and called an ambulance.  Dad was readmitted back into acute care, where he still is today, six days later.  

Upon his readmittance, it was noted that he was dehydrated and in severe pain.  He had not been able to hold any food or liquids down since his surgery and was still vomiting profusely. Also, his theraputic levels of medications were dangerously low; not surprising since the staff was not properly administering them according to prescribed dosages and times. He had an infection from the surgical site and the wounds had not been properly cleaned. The leg was extremely swollen and the wounds were seeping.  He had a UTI, likely from the catheter site not being cleaned properly.  He was having difficulty breathing, because he had not been maintained on sufficient levels of oxygen (he has asbestosis of the lungs and oxygen is continually needed.)  I won't give the full descriptive list here, but this is sufficient to give an idea of his deteriorated condition due to a lack of proper medical care.

This fiasco of an excursion certainly didn't make Dad's treatment any less expensive; to the contrary, it will add to the overall costs. Dad's share of the uncovered costs will be larger, yet we were allowed no input into the decision making process regarding his care. In point of fact, if my sister had been heeded, my father would have been spared a great deal of pain and his total treatment would have been less costly.

I can't help but remember how uncomfortable the surgeon looked when my sister was questioning the medical wisdom of releasing my father so quickly.  I can't help but wonder if it was done for the insurance company to save a few bucks.  I can't help but realize, aside from the physical pain and risk my father endured, how much more this little fiasco cost financially because of that hasty transfer to a lesser facility before he was physically ready.  I can't help but to be amazed that more people aren't as outraged and angry as I am at this moment at the great gamble being taken with our lives for the profit of insurance companies.

And I can't help but wonder when this insanity will end.  

Originally posted to RoCali on Fri Nov 06, 2009 at 11:45 AM PST.

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Comment Preferences

  •  You know, (14+ / 0-)

    it really sucks to be at the bottom of a food chain that is topped by predatory and unfeeling insurance companies.  

    You are my brother, my sister.

    by RoCali on Fri Nov 06, 2009 at 11:45:46 AM PST

  •  Reminds me of (but much worse than) (4+ / 0-)
    Recommended by:
    SyntaxFeline, scotths, RoCali, MsGrin

    my experience with my mother in hospice care.

    In June 2007, Mom had experienced one stroke at home, then another at the hospital, and so on. After a week and a half in a stroke unit, she had experienced both types of strokes (bleeding and clotting), so there were no drugs they could give to stop the strokes from happening. That was it... there was no good outcome. Fortunately, early on, we had had "the conversation" (in the presence of the doctors and a hospital social worker) about her wishes, her charts were marked "DNR," so with that news it was clear what our next step should be.

    At that point, she was awake, but unable to speak... except from her eyes we could read a lot. Love. Fear. Resignation. All of that.

    We transferred her from the hospital to a highly recommended hospice. And from all appearances, it was a very nice facility. It turns out the staff "doctor" and the administrative staff was not so great.

    When my brother and I checked Mom into the hospice, we were told that under her insurance plan (a combination of Medicare, a Medicare Supplement plan, etc.) limited her ability to stay in a private room. If after 3 days she didn't appear to be likely to pass in a day or two, she would have to be moved out of a private room and into a room with several other patients.

    We told the woman at admissions that we would personally cover any extra to keep Mom in a private room. They said we could do that, they would make that notation, and we shouldn't have any problem. We paid for 5 days of extended private care beyond the basic 3, just in case it was needed, right then and there.

    I stayed at the hospice day and night (working free lance, I had the more flexible schedule), and my brother and his family spent most nights, as well. On the fourth day, she appears to be fading, so I call my brother and tell hime to gather his family up, get the kids out of school, and get here quick.

    While I'm waiting for them to arrive, 3 nurses showed up, and asked me to leave the room. Thinking it was time to turn Mom and tidy her up, I stepped out into the very nice lounge area that served as the hallway in this very nice hospice.

    The next thing I know, the door opens, and her bed is being wheeled out. I'm informed she's being moved to a shared room. When I mention the payment we made at check-in, and the agreement we had with the administration, they say I need to talk to the administrators.

    By the time I track down the administrators, Mom is already settled into a shared room (with 3 long-term comatose ladies). Seems the staff doc had reviewed my mother's case, and determined she would likely survive a week or more. A woman who was suffering multiple strokes every day. I point out we paid for private care. They look it up, and say, oh yes. Well, after the next shift change in 2 hours, they will move her back into the private room.

    My brother and his family arrive. My mother passes in less than 45 minutes after they arrive. The good: we were all able to be at her side. The bad: a staff doc that clearly was in over her head, and administrators who didn't bother to read their own records, unnecessarily added confusion and upset to my mother's last moments... something a hospice is supposed to prevent.

    All because our system has placed arbitrary limits on care. And if your case doesn't fall within that pattern, and even if you take special measures, the system will crush you.

    I think that people want peace so much that one of these days government had better get out of their way and let them have it. - Dwight D. Eisenhower

    by scrape on Fri Nov 06, 2009 at 12:28:23 PM PST

    •  Oh, scrape (3+ / 0-)
      Recommended by:
      scrape, scotths, MsGrin

      I'm so very sorry this happened to you and your family, particularly at such a painful and vulnerable time.

      You have brought me to tears and words fail me.  

      Thank you for sharing this.  People need to know what is happening before it happens to them too.

      You are my brother, my sister.

      by RoCali on Fri Nov 06, 2009 at 12:39:03 PM PST

      [ Parent ]

      •  Thanks so much. (1+ / 0-)
        Recommended by:
        RoCali

        My Mom was a great lady, all the way around... she was a wonderful cook. I know everyone says that about their mother, but my Mom was the mother the other kids said was a great cook. And she was a great mother and grandmother, a great hugger, and someone who was always busy helping out with our Scouting programs, Little League. Then, when we grew up and left the house, she got busy helping out at soup kitchens, food banks, women's shelters, etc.

        Mom was a life-long Democrat, born poor in Texas, and raised in San Francisco during WWII. She was a precinct captain for JFK, my first memory of her political activism. She was convinced that RFK could have been truly transformative and worked hard for him in the Calif. primary. She thought he could have prevented every problem this country has ever faced since. (My Dad was the token registered Republican in the family, but I think he voted for more Democrats than Republicans.)

        After his DNC speech in 2004, my Mom was convinced that Obama was the successor to the RFK legacy. Everyone in the family got each of Obama's books as unexpected gifts in the mail, the first week they were published... courtesy of my Mom.

        I was for Edwards, and before she got sick, our weekly phone calls were pretty lively.

        After she passed, I used some of the money she left me to max out to the Obama campaign in the primaries (while I was still contributing to Edwards).

        And then "Mom's money" helped me max out to Obama in the general. I used more of it for MoveOn and other group. And I used it to "subsidize" my work for the Obama campaign (basically, I cut back on my client work, and devoted my hours to the Obama campaign instead, mostly phonebanking from here in L.A. to Nevada).

        In the final week, I traveled to Las Vegas on "Mom's dime" and canvassed the four days leading up to Election Night... just like she did for JFK back in 1960. I got to see Obama in-person, from about 50 feet away, the Saturday before at a rally in Henderson.

        Instead of joining all the other campaign workers at the party at the Rio hotel on Election Night after our last GOTV canvass, I went back to my hotel, watched the returns "alone with my Mom" and cried with joy. "Mom's Dime" made it possible to experience some of that excitement and commitment and hope for the world she had always felt when she advocated for JFK and Obama... and every candidate in between.

        I think that people want peace so much that one of these days government had better get out of their way and let them have it. - Dwight D. Eisenhower

        by scrape on Fri Nov 06, 2009 at 02:00:38 PM PST

        [ Parent ]

    •  Yeesh. (2+ / 0-)
      Recommended by:
      scrape, RoCali

      Am so sorry for all the trauma you guys went through in spite of all you had done to prevent it.  Horrible.  What a country we live in...

      Blessings to you all.

      Torture: An act... specifically intended to inflict severe physical or mental pain or suffering upon another person within his custody or physical control.

      by MsGrin on Fri Nov 06, 2009 at 12:39:15 PM PST

      [ Parent ]

  •  Blessings to your dad and whole family (2+ / 0-)
    Recommended by:
    scrape, RoCali

    Thank good ness your sister knew what to look for.  How have we arrived at this place where people with resources can't get what they need?!  Truly scandalous.

    Torture: An act... specifically intended to inflict severe physical or mental pain or suffering upon another person within his custody or physical control.

    by MsGrin on Fri Nov 06, 2009 at 12:41:20 PM PST

    •  Your kind thoughts are appreciated. (2+ / 0-)
      Recommended by:
      scrape, MsGrin

      My Dad has Medicare and a supplement to it.  But still, this isn't the first time he has not received proper medical care.  Several months ago, just before my mother passed, we almost lost him to dehydration.  They kept him in the ER for two days, not having a bed to admit him.  My sister finally arranged to get him home and she administered the necessary IVs and treatment.  If he had not been so fortunate to have a nurse for a daughter, I'm not sure he'd have survived.  

      What about all those with no coverage and no nurse in the family?  Well, about 44,000 of them die each year.  It is a disgrace.

      You are my brother, my sister.

      by RoCali on Fri Nov 06, 2009 at 12:46:32 PM PST

      [ Parent ]

  •  We had something similar to the diarist with my (2+ / 0-)
    Recommended by:
    scrape, RoCali

    mother. The plan administrator said that it did not matter what Medicare gave her, THEY only gave her, would only approve,  six days a year in hospital and tried to move her to a nursing home, which would also have made it impossible for her ever to come home as the nursing home admission made her no longer a resident of her housing and the housing admin was standing there ready to evict her for that. We took her back to the hospital, where she died very shortly thereafter. All the Plan administrator said was "We didn't give her permission to do that.

    •  Christy, I am so sorry (1+ / 0-)
      Recommended by:
      scrape

      this happened to you and your family.  How inhumane of someone in the healing profession to callously speak those words, adding insult to most painful injury.  

      Thank you for sharing this tragic experience.

      You are my brother, my sister.

      by RoCali on Fri Nov 06, 2009 at 01:09:36 PM PST

      [ Parent ]

  •  RoCali, I hope your father is able to (1+ / 0-)
    Recommended by:
    RoCali

    recover well from this point.  I'm so sorry for the callous and inattentive treatment he's received.

    It's scary to hear stories about rehabilitation facilities -- where many of us are likely to end up at one point or another. I've just heard a lot of bad stories. But of course in many cases the bad experience starts with being booted out of the hospital too soon.  When I think of an old man, dehydrated, vomiting repeatedly, not getting the right amounts of medicine or the oxygen he needs, getting infections in his wounds and catheter site from lack of careful cleaning -- it's just infuriating.

    Strength to you and your family; and thank heavens you have a nurse in your family.

    •  Thanks for your kindness, Fiona (0+ / 0-)

      Dad is now getting the proper care, and he has a strong will, so we're thinking he will heal.  What really concerns me here is that we got lucky and tens of thousands don't.

      You are my brother, my sister.

      by RoCali on Fri Nov 06, 2009 at 03:13:45 PM PST

      [ Parent ]

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