So she's in her second week of rehab. Every time I visit she just wants to "lie down". Plus she has a completely unbelievable fear of falling, I mean she's comfortably in bed and gripping the railings like she's on a boat being tossed at sea. She says there's no vertigo or dizziness there either. Today I merely tried to raise the bed a little so she could eat properly and see me and she starts carrying on like it's the worst torture imaginable.
So I was talking to the therapist and she tells me that on Friday they had to change the mattress so there was no other option but to get her in the wheelchair for a while. This has been a goal since day one. She tells me that after a brief struggle she did get in the chair and remained there for a few hours with no issues. I was astonished as Mom never mentioned it.
So today I'm there and we figure let's go for it again. They sit her up and immediately the death grip begins. This little old lady who's always too weak to move was fighting off three people and resisting with everything she had. There was no risk whatsoever of falling. Eventually the therapist had to give up and i could see the annoyance there, as I felt it too.
I'm wondering if maybe it's me. When I'm there she never stops with the hapless routine and the fear of falling, then I hear that while I wasn't she's actually doing something. Perhaps i should skip a few days and see if it helps?
My plan was to go to the rehab this morning, grab Mom's stuff and get her scripts, take them to be filled, then hit the supermarket to load up on everything before she was sent home. The SW calls me at 9 and tells me there's a problem and the ambulance transport isn't covered because Mom needs stretcher service and I need to pay $500 up front. Uh, no, I told him, that's insane, find another way or she stays another day. Then I get there and none of her scripts are ready. However, after a while they got their act together and the ride home ended up being fully covered, so Mom wins that round. It's going to be really nice to be done dealing with those folks. Next up: the visiting nurse experience!
Fingers crossed that the nurses will be a pleasant surprise :)
So she's back home, very tired and restless right now, also prone to sleep-babbling (not screaming, fortunately) and still in that "patient" mind frame but noticeably more alert and "with it". Obviously she'll need some time to adjust and "decompress" after the last two "lost" months. Next step: the visiting nurses experience. We've dealt with them before, however that was back when Mom's ailments were still a huge puzzle no one could solve. Now that she's been diagnosed and treated I hope it'll all be more fruitful as there wasn't much they could do back when she was in such a sorry state. And knowing what I know now, if I'm in any way unhappy with them I will not hesitate to force changes, either.
He must have sensed you're a strong person and that triggered his Alpha Male aggressiveness... . Aha! A challenge! Watch me squash this guy and let him know who's in charge!
If you were a pushover, he might not have been as difficult. That's the way I saw it when it occurred with us.
The pre-paid ambulance charge is an example. Although I don't have extensive experience, I've never heard of that, especially if your mother has Medicare and the ambulance ride home is mandatory for her safety and health. Maybe there are other factors involved, but this sounds like pure manipulation and pettiness, or he didn't know what he was talking about and hadn't bothered to acquaint himself with the appropriate Medicare regs before he made his last attempt to unsettle you.
The discharge doctor should have ordered the scripts, and had them electronically sent to the pharmacy you probably would have designated in the application/intake papers. Getting paper scripts is kind of old fashioned these days. But given your other experiences at that facility, it doesn't really surprise me.
However, Mom's home now, and hopefully things will go well with the home care. If not, you can and have the right and obligation to make changes.
Good luck and best to your Mom.
I can't help picturing some of the nature documentaries I've seen showing 2 rams, or moose, or lions battling for cotnrol, beating each other to a pulp to establish dominance. (You didn't see any battle scars on the social worker, did you?)
I can't believe that he didn't know that Medicare would pay beforehand; staff check insurance before admission, in my experience, although your mother's situation has been kind of an uphill/downhill situation so there may be intervening factors.
The corporate relationship explains a lot of things, as you've discovered. And from speaking with medical people, it's going to continue changing, sometimes for the better, sometimes not.
I also know from local experiences that some hospitals that have been acquired by for profit corporations have evolved to be much more efficient with better care, but others haven't, depending on the management skills and focus of the new management team.
This makes me think of the mess the hedge fund managers made with the Sears and K-Mart acquisitions after K'Mart's Ch. 11. They weren't retailers, they didn't know retailing and they mismanaged, grossly.
Another thing to watch out for are the ACOs; I'm guessing you're going to be contacted by one if you haven't already. Ostensibly and on paper, their purpose is to provide follow-up post discharge.
I happened to be with my father when one contacted him and asked a lot of personal questions. He turned the phone over to me, as he usually does, and after listening to the spiel I advised I wouldn't provide any information until I investigated the entity (as obviously I hadn't heard of it before and had no idea if it was legitimate or not).
I did some investigation and learned that this particular one is a for profit corporation, being paid by Medicare to conduct this post-discharge follow-up. Interestingly enough, the referring doctor "participates" in the Medicare remuneration for this follow-up work. So it's an extra way to get funds from Medicare, albeit nominally.
I don't dispute that some people do need followup, but what I dislike is that some of the physicians, according to what I was told by one of the ACO execs, were "encouraged" to participate and refer patients for followup by the ACO.
There may have some medical people on the ACO staff, but for the ones I investigated, the management is strictly corporate, not medical. If I had the time to investigate further, I suspect these management folks are in some way connected to the for-profit corporation management of the hospital.
But of course, and ostensibly, their purpose is to ensure that people get the proper care post-discharge, and that they get paid for it.
When the sweet nurse (who was probably one of those laid off when the for profit corporation acquired this particular hospital) asked what she could do to help, I suggested a problem which I hadn't yet been able to solve. If she could, then it might be worth keeping them involved. She couldn't, any more than I could, so I told her we weren't interested and intended to so advise Medicare, which I did.
That annoying PT from rehab struck again today. After insisting that I need a better wheelchair for home, yesterday she said it was ordered and would be delivered today. Today came and went, no wheelchair. Now I have to track her down and find out the deal but I'm not wasting a lot of time on her, if necessary I'll go elsewhere. Things are busy enough without playing phone tag with people all day.
State attorney General , state insurance commision, joint commission on nh accreditation , nh ombudsman , nj state senate committees on health care and elder affairs, ditto your Senators and Representatives. Perhaps local consumer advocacy group and or eldercsre/health care advocate group. Social work licensure board?
Don't get mad, get even, or at least cause them to have to do A LOT of paper work because of your complaint. These complaints get logged. When they see the numbers add up, action gets taken . Add to the pile.
This really isn't the social workers' fault; once the order is placed, the DME schedules delivery, and it frequently depends on (a) urgency of need and (b) delivery schedules. Some of the DMEs have such a large constituency that they aggregate deliveries to specific areas by days.
That's especially true with oxygen since Medicare went to competitive bidding. We used to get our DME to come out the same or next day but now deliveries are scheduled once a week when the technician will be in our area alone.
2. Mandatory disclosures of interest.... that's an interesting concept. I think it would have to be legislatively mandated and I don't think that will ever happen. The public constituency isn't strong enough to lobby for it, while the medical lobby likely is.
But these overlapping interests might eventually compromise delivery of health care to the point that some crusading legislators may put on their suits of armor, mount their trusty steeds and take up the cause.
Unfortunately her grandkids are once again fumbling the ball, one brief visit so far and absolutely zero "help" to speak of, unless you count annoying texts which I do not. One awful group visit, barely twenty minutes and featuring some needless teary-eyed melodrama and that's all so far. Mom keeps asking me where they are and I really don't have an answer for her. Excuse after excuse, in fact if they can't get it together enough to visit at least semi-regularly (and stay longer than fifteen minutes) I'm just going to tell them not to bother at all, their loss. It's sucks that I have to play the "villain" here but it's time to step up or step back IMO.
Give them a schedule and say turn up at this time for this purpose or stay away. They have GOT to understand that right now you've got enough on your plate without being appointed communications officer for the entire family. Be ruthless, villain be dam*ed.
I'm thinking you might have to help guide them to learn how to behave under the circumstances. I don't know offhand of specific articles here or on other sites that help people understand how to interact with someone your mother's age and who is also recovering from a complex medical event. Maybe someone else here has suggestions. But I suspect that they're kind of flighty young pre-teens with boys on the mind and little experience in dealing with situations that require maturity.
One thing comes to mind is to let each of them know what your mother's particular interests are....cooking, reading, etc. and they can decide which one they want to focus on, study a bit and then plan to have an adult conversation. That's a way to turning the situation into something more positive, but it depends on whether the girls can and will make the effort to channel their interests.
You could also give them homework assignments on the topics that interest your mother. That will give them a chance to learn how to study in a nonacademic environment. And when they are conversant, they'll be better company for your mother.
I'm also wondering where are the parents of the granddaughters? Can't they provide some guidance on behavior with an older adult recovering from illness?
Right now I'm waiting on another visiting nurse again and honestly it's already frustrating. This one is doing an "eval" regarding physical therapy needs and equipment and etc. and based on her phone call I already know it'll be next to useless. I don't know how many times I've had to explain that my mother cannot use her legs right now, yet all these PT people seem to be interested in is "sliding boards" and ramps. I just really want to get to the part where someone actually attends to actual medical needs.
And I had no idea how difficult it'd be to find a in-home physician. She'll need her scripts refilled by the beginning of October and right now there's no way I can get her to her primary doctor without an ambulance transport. I think I've found one, however there's some issue with her insurance now. If we have to just pay out of pocket we will, as in the long run it'll probably break even anyway.
I hope your mother, who is I think a lot stronger than we realize, comes through this well and is back home soon.