I am interrupting the chronological order of this blog. The information I am giving you may save you a LOT of money and a headache. It is about HOSPITAL STAYS FOR THOSE 65 AND OVER.

Do you think a 3 day continuous hospital stay while on Medicare will guarantee a paid admission to a nursing home? (For rehab, etc.)

Do you think if a person has a chronic illness they can be admitted to the hospital and have their insurance take care of it?

If you think the answers to the above are YES, you are sadly mistaken. This was just one of our experiences that I want to share about insurance and medical coverage.

June 2016

Mom was coughing a lot, and it sounded bad. My sister thought it was a cold or post nasal drip. After 2 weeks of this, I took mom to her doctor. They thought it was pneumonia. They took an X-ray and gave us antibiotics. The next day she sounded worse, so I called 911 for the first time in my life. They said they would take her to the hospital. The hospital said they would admit her, but just for 1 day because they were short on beds. They gave her lasics for the congestive heart failure, because her lungs were filling up with fluid. The pneumonia test came back negative, so now they said it was bronchitis. I took her home.

The next day I went over late in the morning and she looked really bad and she was lying on the couch. I made sure she got some food and I said I’d return later. That afternoon she looked like she was going to die. I called 911 again. This time we went to a different hospital.

Now this is the reason for my story and the questions above. They gave mom a form in the emergency ward and said, “We need you to sign this form. It is giving us permission to treat you.” She signed and they said nothing else. I was happy to have her in the hospital because I was afraid to let her stay alone. My sister was out of town and I was the only one checking on her. 

The next day, the doctor tells me my mother (staying in the hospital in a regular room) was not really “admitted.” I said,”What do you mean? She’s here, she’s being treated.” He said being old and having a chronic condition is not a reason to be admitted to a hospital. (Then what is?)

A social worker with long hair, a squeaky voice and looked like she was 14, told me we were going to have to pay by the hour because insurance was not paying for her stay. I said, “How much is it an hour?” She didn’t know. She said mom was not admitted so we were responsible

for payment. I questioned her more, and she said it was “All on the form mom signed.”

I said I needed to see it.

The form says: YOU HAVE BEEN PLACE IN OBSERVATION/OUTPATIENT STATUS.

Farther down it says, “Medicare and insurance companies classify an observation stay as an outpatient visit…..Medicare and/or your insurance company will hold you responsible for co-pays and deductibles associated with an outpatient claim.”

“You should be aware that Medicare and some insurance companies do not provide coverage for most medications administered while you are an Observation/Outpatient. 

Observation/outpatient services DO NOT COUNT (emphasis mine) TOWARD THE 3 DAY REQUIREMENT FOR PLACEMENT IN A SKILLED NURSING HOME. “

Then there is a box to check (no one checked it) I have a Medicare insurance plan and I have received information entitled “Are you a hospital inpatient or outpatient.”

I told Ms. Squeaky we never got a copy of that. She gave it to me.

The form talks about what insurance mostly does not pay for. It says you should always ASK if you are going to be an inpatient or outpatient. I am still fuming over this!!!

THIS IS ALL ABOUT THE MONEY AND THE NUMBERS FOR THE HOSPITAL. The elderly NEED hospitals and nursing homes!!! An old person does not just bounce back. Mom got dehydrated from the lasics, she got an infection, and death was at her doorstep. Before Obamacare, a person could easily be admitted to a hospital for 3 days and be released to skilled care. There is no way we could take her home. She could not even stand up, and she was in an independent living situation. None of us have a 1st floor bedroom, so we could not take her to our homes, and we would need a wheelchair and a different toilet.

Being old and having a recurring, chronic condition does not qualify a person for a good old fashioned hospital stay any more.

My dad was hospitalized and they released him to a skilled community for rehab. Once he got stronger (2 months) we took him to a community with Alzheimer’s care and a skilled staff. He did get the 2 months paid for by Medicare. Who knew it changed?

So mom went to a skilled facility that cost us $305 A DAY! OUT OF POCKET.  There was no way she could go home. She would not eat. She was so weak we had to actually feed her. Her hands shook so bad she could not do anything but sleep. We made sure mom had multiple visitors each day. We wanted them to know she had a family that cared. She got a bed sore, too. When a person lies in bed it is so easy for their skin to break down. She complained of her back hurting, but it was a breakdown of skin on her behind. I took her outside in the wheelchair to get some air and sun, Brenda made her eat.  Dan visited whenever he could. Then they washed mom’s bedding and her cell phone was in the sheets. Dan had to get her a new phone. 

We had no idea how long this was going to take, but we knew $305 x 30 = $9,150. She is also paying over $4400 a month where she lives.  This was an expensive July!  I talked to someone who had a lot of nursing home experience. She told me to request a family meeting. I am sure they would have gotten around to it eventually, but the money was burning up! We had a meeting and we scheduled a home visit with a physical therapist so we could see how mom could get around. In the family meeting we learned that her progress was ok, but not great. The 

home visit was helpful. We got a high toilet seat and another grab bar in her shower. We had to get rid of all the rugs so she would not trip. We actually pushed for the discharge sooner than they wanted to release her, but we promised to check  on her twice daily and we ordered  physical and occupational therapy, which mom’s insurance paid for. We also had a nurse 2 x  a week and we requested VA assistance, since mom was getting VA benefits. The Home Health Care was a godsend, because there were plenty of eyes on mom checking her progress and her safety.

A well meaning friend told me mom might qualify for hospice care, but I found out you can’t get both Home Health Care and Hospice. Choose one or the other.  You don’t have to be dying to get hospice care. Call  your local hospice organization or look up their website for information on the services they provide.

Mom went home and immediately started perking up. She missed her apartment and her friends. She did not go out of the apartment too much, because she was too weak. The recovery was slow, but steady.

Georgia was on her mind.....

Dad had been dead for about a month now.

Email Nov. 7th:

Mom's insurance will end 11/30. I am working on getting her another plan or at least

 finding out about it. She can opt in to Medicare Senior Advantage Jan.1st, but she will need coverage between 11/30 and Jan. 1st. Dan, I know you are also looking into this.

I think her antidepressant has kicked in. She seems more level. She says no one is stealing from her since her locks are changed. But she did tell me her sisters stole all her hats when they were here 5 years ago. I asked her why they would do that and she replied, "They are all THIEVES.” (????)

 Just updating you all!  Sandy

An email 11/10/11 from Cindy (edited)

Remember, at one point we did go through her drawers to find checkbooks, policies, Dad's clothing, etc.  I did go through her pantry and refrigerator and throw away 2 huge bags of way-expired stuff.  I did buy a few things that I though she needed (cotton balls, witch hazel,  a bag of already-cooked Tyson frozen chicken), etc. Maybe Sandy or Brenda or Daniel has done something similar.  I told her that I did these things; full disclosure is the only way to go here. 

Changing the locks with NO ONE having the key was the only way that this could be solidly stopped.  

She can no longer accuse anyone in the family of theft.  She will have to file a complaint with the police if anything is missing.  Did anyone find out where the tractor went?  Has anyone filed a police report on that?  That is major screwed up. 

You are wonderful to go to her house and write out her bills in her presence.  Mom just wants to be in control once in her life.  Having a watchful eye is the best that you can do.  If a serious red flag goes up, then it will be time to intercede. 

Taking her to her appointments and looking in on her is wonderful, too.  I wish that I could be there to to that.  What I worry about is Mom driving one day and not being lucky.  I don't even want to think that out loud.  No one has ever mentioned that her drivers license be taken away, right?  I think that will be a red flag when it happens.

Thank you for the updates on Mom.  And Dan, you get better, too. 

love, Cyn

Brenda and I were having to step up and do some things for her. Brenda was taking care of the doctor visits and her medicine, I was helping with the bills. Mom accused me of stealing money from her. She canceled a bank account and took my name off it.  She was thinking all of us were after her things. She forgot to pay her car and house insurance. I found a notice and asked her about it and she was really nasty and told me she didn’t need my help. I was really hurt that my mother would think I would steal from her. 

I was thinking maybe she should not be alone, driving, or conducting her affairs. She wanted nothing to do with going anywhere but where she was. Apparently she really needed the antidepressant.

Email Nov. 10th

Mom is getting better since she knows no one is entering her home without her knowledge.  Just today she found her pink sweater that she told me Sandy must have taken.  I said, "See, Mom, I told you that you just misplaced it "  and she agreed.  I rescheduled Mom's eye surgery for 12-14 so I can take her since I have a dental appt on 12-7.  She is going to Ga. to visit her family over Thanksgiving and plans to stay 2 weeks.  When she gets back, she needs another pre-op and then her surgery on the 14th.   I'll keep in touch- Bren

My mother was born in Columbus, Georgia. She moved to Ohio when she was about 19 years old. Then she met my father and they got married. She visited Georgia and Alabama  a few times over the years. Columbus is on the border of Alabama, so some family lives there.  She had some contact with her family and some of them came for a family reunion to Ohio in the early 2000’s. That was only the second time I ever saw her family members.

After Harry died, mom decided she wanted to go to Georgia. For years she talked about moving there some day, but that didn’t seem realistic. She wanted to visit her brothers and sisters. So she did, and she had a wonderful time. They showered her with love and affection. It was good medicine to her hurting soul. She went over the Thanksgiving holiday and got to see everyone she wanted.  

12/8/11

Hi my Sisters and Brother!

I talked to mom last night. She has every intention of moving to Alabama. I just listened. I knew this was coming. I told her that she and dad had an "unsocial life" and I figured she would not like it when he passed.

Don't get excited-she isn't going there just yet. It seems that there is "more family" there and she thinks her social life will be better, she can see her sisters and there are lots of relatives. I told her it was Thanksgiving and probably not like that all the time-she said, "It WAS."

 What she didn't acknowledge is that she cannot remember anything. I said, "Isn't it going to be difficult getting around driving and you will have to learn a new city? She has an answer for everything. She said it's a small town and she knows it by heart. How can a town not change in 64 years (this is sarcastic me) and she says it's the same. They tried to sell her a home that was new (built by a relative) but it was not in a nice neighborhood.

I have dealt with mom and her finances and some of her health issues. I think it is NOT a good idea. My psychologist said it is not a good idea as well...but how are we going to stop her? But we either have to just let her GO or make her feel as loved and cared for as possible. I opt for #2 for right now. I don't know how long her life will be...She has a funeral plot here. But she has been saying she will go south for years.  She said we never visit her.  Not totally true.  San

12/8 later that day

Hi-

When Mom came home from Georgia, she told me she remembered a conversation she had with Dad a while back(maybe even as far back as 2001 when dad had his shoulder surgery).  He said if anything happened and he should die, that she should promise not to do anything big like sell the house for at least a year.  She seemed to think that was a good idea.  We just need to call Mom often and try to see her a bit more so she doesn't get any crazy ideas. I will have Christmas dinner and invited mom but she said she might be doing something with Danny. Danny, you and Connie are invited to our house if you like for Christmas dinner as well.  Let me know what is going on.  Brenda 

THANK GOD MY DAD HAD THIS CONVERSATION WITH HER!!! It helped a lot in the months to come. This was the ONLY voice of reason in her head. She would have moved in a heartbeat.

I began to call her youngest sister and so did Dan. We tried to underscore how difficult it would be to have her  move there in her state of mind. I told them that mom had dementia and paranoid type symptoms. I told her she would have to take care of my mother if she moved there. I know that she listened, because in the next few months mom stopped talking about moving there altogether. All of us kids tried to talk her out of it as often as we could. Being in a state of grief and making a major moving decision would not have been a good idea.

Whew!

CHANGE BEGAN AFTER THE FUNERAL...and someone is in the house!

October  2011

Email from Dan (still in the hospital after the funeral) 

Sandy

Thanks for coming last nite. It always nice to see you dead father via tv. He will go in the ground today and that seeing him before that happened will mean a lot to me.

Thanks for all  that you have done to help me and mom. 

I am going to take mom to see where my mother-in-law  lives. Introducing her to independent living slowly will give her security knowing that there is a better place that serves three good hot meals a day,  has work out facilities, nurse on staff, daily activities and field trips, gives mom the social networking she craves and has not had in years, if ever.

If Cindy wants to take her to Florida for a month and I think it is  a good Idea....for mom to take a little break from the house. Anything is possible. Mom can continue to live in independent living and keep the home or do other things.

In any event if she ever runs out of money I will help her, I have already told her.

If you guys want to meet before cindy leaves let me know. I will crawl out of here by monday 

Your #1  brother

GETTING ALONG WITHOUT HARRY

Now mom was alone in the 1900 sq. ft. home with a basement on 2 acres. She was sad and very agitated most of the time. She had made a practice of seeing Harry every day for months.  She would make her meals and get dressed up to go to K House. She made a social life out of talking with the women who were there to see their ailing husbands. She would have a good attitude and seemed to enjoy it. As long as he was alive, she was happy.

Now she had nothing to do. We got a service to shovel her snow and mow her lawn. She rarely left the house.

Dad died in October. This meant we had his birthday in November, Thanksgiving and Christmas  without him,  shortly after he passed. It was a huge hole in our family routine. Mom was starting not to cook like she used to. Since I am the oldest, I offered to prepare or organize the holiday meals. We still met at her home, but I coordinated the food. Everyone brought something.

Mom was acting as though she lost her mind. I have seen this more than once: women who married young and lost husbands after 50+ years of marriage  are rendered helpless and unable to cope. One of my mom’s childhood friends lived in a nursing home for 6 months after her husband died, then returned to her home.  My mother forgot to pay her bills and she didn’t remember anything. She was married for 62 years and she could not handle the loss of her partner. 

I understand the loss, but what surprised me was mom always seemed so competent and strong, able to deal with anything. Now she would sit around, doing nothing. Mail and papers began to pile up. The house was getting messy. She didn’t care any more.  She was going downhill and it scared me. When we talked to her about moving someday, she would glare at us and say, “Harry built me this home and I am going to stay here.” She accused me of stealing money from her. She canceled a bank account that had my name as a beneficiary. She lost a checkbook and canceled it altogether.

It hurt me that she thought I would take her money. Sadly, the accusations would become an almost daily occurrence in the future. She forgot to pay some bills and someone needed to help her. I was the one in charge of her money.

Email October 28th from Dan:   

Hello Everyone

Today I went to moms. before anybody gets weird I want to say mom loves all her children. She just lost her husband. She is alone. And most of all she wants control of her own life.

 Now there have been some gremlins in her house yet mom is not a danger to herself. She is freaking out a little though, and like all of us this manifest itself in stranger behavior

than normal. 

(THIS WAS DAN’S WAY OF SAYING MOM WAS SURE THERE WAS SOMEONE IN HER HOME, AND THAT WAS NOT TRUE.)

 The sky is not falling. None of us have control over mom. 

 We all have control of her home and her money. 

 Mom wants some control....changing locks etc. 

The locksmith is coming Monday at 3 pm. She said she would give me a key and  I said NO!  I want her to have as much dignity and control as she can muster in her last years. If she sees things and none of us has a key then SHE WILL UNDERSTAND SOMETHING IS WRONG. Right now it just seems like everyone’s against her.  Let’s all step back and breathe a little. A lot has happened to all of us these last couple of years. If all of moms money burns up (because she does something that we cant control) then I will personally guarantee her care.  I want nothing in return EXCEPT all of us stop the general insanity (which effects all of our health  and relationships) 

If anyone wants to communicate their feelings do it by email and send to all the other kids. None of us have to hide our feelings. It is unhealthy, and time consuming to call each other and vent anxiety, fear and misplaced anger.

So mom thinks she has a tractor missing. I stood there and went through papers with her and after 20 minutes I thought I would get the real story. Brenda, your version is right. However, if mom thinks she gains control, dignity, or her identity back by getting a stupid tractor. Please give it back. I am not trying to be a dick by saying I would buy it back, I'm just trying to make something right for an 83 year old women that was told what to do and how to feel for 64 f……g years by a tyrant of a husband. Can’t we all give mom a break!

How many years do you think she has left?  Dan

We did not know mom was going to behave like this for the rest of her life, although sometimes it wasn't too bad.