It's incredible how the course of life can be changed in a blink of the eye, a flutter of the eyelash. My best friend has described life as a river. I think that's very apt, because, since Wednesday night I have been trying to navigate the white water of the medical system.
My 86-year-old Mom fell in her driveway on Wednesday evening, on her way to get in the car with her 89-year-old sister-in-law. They were going to choir practice. Now Mom is in a nursing home. She broke her left arm and cracked her right kneecap and lacerated her forehead above her left eye. She was in the emergency room at the hospital for seven hours while they SLOWLY decided that she would not be admitted to the hospital and therefore we had to get her out of there. Our options were ugly: take her home and try to maneuver her into her bed without the use of a wheelchair or several strong men OR admit her to a nursing home. The ER doctor and social worker were pushing heavily for the nursing home. I was trying to convince them, and myself, that taking her home would be the better idea. I was in a state of confusion and anger already because, as part of the decision process, I was told by the social worker that Medicare would not cover Mom's nursing home costs if she had not been in the hospital for at least 3 days. I was not only trying to make the decision about what to do based on my mother's welfare but on her financial health, as well. She is like many 86-year-old widows who have always been housewives: she has a pension from her husband's civil service retirement and a tiny amount of social security each month, a savings account that I have built up in the years since I took over her finances and a small account at a brokerage.
This post makes it sound as if I was rational and only trying to pick the best of two rotten alternatives. The reality is that the minute I was put in the position of having to make this awful decision my innards turned to water and I reverted to the little girl in me and all I wanted to do was go home and hide under the covers of my own bed, in my own warm house, next to my husband and cry. But I was in the garishly lit emergency room, in cubicle #6, with my Mom on an unforgiving sheeted platform euphamistically called a bed, with 6 stitches in her head, a 2 foot brace on her leg and an "immobilizer" on her broken arm. (I could have used a superhero called The Immobilizer at that point. He could have swooped in, immobilized everyone in sight with his immobilizing super-stare and swooped us both away to a safe place with all the wheelchairs and bedside commodes we needed.) Alas The Immobilizer did not appear, so Me/Little Daughter was left to make the big decision.
I hemmed and stalled and finally asked the social worker if I could speak to the "person" at Bremerton Health and Rehab on the phone. Bremerton H and R was the ONLY nursing home that would admit a person, no matter how in need, at 2:00 a.m. They had two empty beds and they were ready to take our money. The horrifying equation was 2 weeks at $4500, paid in advance, out of either Mom's pocket or mine. In my 30 minutes on the phone with Kristy from BHR, I told her I couldn't get my hands on that money until the next day and she finally understood that I wanted Mom to be home within a few days to a week and agreed to a lesser amount up front. I think she was willing to have me pay for only 3 days, but I ultimately decided to pay for a week. It is nearly a week later and Mom is still at the facility, so it was a decent decision, though it kills me to take that much money out of her savings. One of the truly stupid and unforgettable things the social worker at the hospital said when trying to convince me that the best route would be a nursing home, was, "You'll be using up that money soon anyway". That may be, but Mom should be able to use that money on a nice trip to see her granddaughter in San Diego, instead.
The nursing home has turned out to be okay for Mom. She is getting a degree of care, not fabulous care, but on-call care, three meals a day, people around to talk with her. My Mother happens to be an extremely upbeat person who takes each day as it comes and "tries to make the best of things", as she says. She likes it when the young aids and others come in to see how she is. She reports that they are all very nice and helpful. She has a couple of books, a big NY Times crossword puzzle book, some magazines and the newspaper every day. She likes the food, but then she also likes Denny's and Shari's and Dominoes Pizza and most middle of the road food--she's a housewife of the fifties, so a dish of frozen strawberries, or lime jello or a sloppy joe on a Langendorf bun is alright with her. I've felt so much anxiety over having to put her in there, but she has been cheerful most of the time and thinks it's for the best on a short-term basis. I can rest at night because of her good attitude.
My bigger problems have centered more around getting a response from her doctor. Both my Mom and brother have used this doctor for several years now. My Dad saw her for years before he died. She was my doctor before I had to change to Group Health after retirement. You would think there would be some level of caring or concern shown because she has been so involved with the family, but that has not been the case. It is as if Mom is a stranger to her. I have been promised that phone calls will be returned and they haven't--I've tried to speak with her nurse and haven't been able to get to her. I wanted Mom to be seen at the nursing home but was told the doctor "doesn't go there". On advice from friends I went to the clinic where she has an office and demanded to speak with her nurse. Her nurse came out, tersely told me the doctor had written the prescription for the wheelchair and other medical appliances we'd need at home and that if we wanted an appointment I should make it with the appointment desk and then she swished out, all dispatch and dispassion. Should I expect more or is this the way it is in the medical profession now? When we see the doctor tomorrow I am going to throw away any caution I have about ruffling anyone's feathers and let the doctor know just how many of MY feathers have been ruffled. It seems to be the only way to get results and I have been told this same thing by many friends recently who have had sick relatives in the past few years.
My son remarked that if we lived in Canada or Cuba or England none of this would have happened, that Mom's care would have been paid for. If you've seen the documentary, Sicko, you would agree. My experience in the past 5 days has taught me that ER doctors, nursing homes and family doctors are not in the business of taking care of people in need--they are in the business of paperwork that protects their asses. I have signed so many forms that claim to be protecting my Mom's "rights", but which actually protect the hospital and the nursing home. The medical system in this country is terribly, terribly broken and I don't see either one of our presidential candidates promising anything other than "insurance for everyone". Well, Mom has insurance and it's not doing her any good at all. The insurance doesn't mean her doctor will answer the phone or provide a prescription, it doesn't mean that her nursing home care will be covered or that she will even get GOOD care while there, it doesn't insure her safety or sanity or my sanity, either.
Tomorrow, one way or the other, Mom will go home. I am hoping that her doctor will write the order for her to "release her to home" immediately. If she hesitates to do it, I will bust Mom out of there without the blessing of anything but my good instincts. And you can bet that I will have to complete a form that covers the asses of everyone involved, except for my Mom.
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