Sunday, August 16, 2009

A Wake-up Call!

Nothing like finding your mother curled up in a ball on her bedroom floor to sound the bugles that she can no longer take care of herself. Although we knew this was coming and had tried to absorb stories from friends about their experiences with elder care, we still weren't ready for what followed.

My mother has always been concerned about placing a financial burden on us so she not only had medicare and medicaid (I'm quickly learning the difference between the two) but she was sure to have Horizon Blue Cross Blue Shield of New Jersey Medigap Super 65. Yep, like I really know what that covers.

To make this very long story short, my mother entered the hospital on a Tuesday through the emergency room. When the EMT's arrived they started asking her a load of questions which were difficult for her to answer - she didn't remember specific details such as her age, but she knew her birth date, how she fell, or any of the twelve medications that she takes. Therefore they looked to me. Yeah, like I know the different medications she takes. I just make sure she takes them every day. So I ran downstairs and quickly gathered up the bottles, juggling them in my hands as I hurriedly ran back up the stairs. One of the EMT's copied the name off each container. They then placed her in a chair gurney an proceeded to take her downstairs to the ambulance.

The highlight of her first and hopefully last trip in an ambulance was when the EMT's lifted her from the chair gurney to the flat gurney. By that time my husband had arrived at the house with all her medical cards and was standing next to my oldest daughter. Oh, and all the neighbors were out in concern of her health wishing her well. At any rate, she looked up at the two good looking EMT's (that's how she described the "doctors") turned her head towards my hubby and said to him, "Billy, I told you not to push me down!" then laughed. Yo, Mom, that's not funny!

I beat the ambulance to the hospital so I was the first face she saw when they opened the doors. Panic attacks are not uncommon with my mother when she has to go to the doctor's but God forbid the hospital could have caused her to have a heart attack!

It's amazing how fast you get service when you enter on a gurney through the emergency room. A physician assistant and three nurses gathered around her and immediately started firing off questions directed at her. Her confusion and anxiety were evident so I loudly cleared my and redirected them towards me. Hah, like I had the answers. How did she fall? How long was she on the floor? What is her previous medical history? (I knew most of that) Does she do this or that? Has she ever had this or that? What medications does she take, how much and how often? What is her insurance? I muddled through the Spanish Inquisition. However because of my experience I decided to design the Home Healthcare Information Card.

This is postcard size with a picture on the other side so that it's easily recognized and can be hung on the refrigerator or some other accessible place. Then I thought about it a bit more and redesigned it so that a picture of the patient could be placed on the other side. Now it would be easy for EMT's, doctors and nurses to match the image to the patient, turn the card over and have all relevant information.

I think this card is a perfect size for home health aides and others who service the patient in a home environment. If an emergency should arise they would have all relevant information.

Ok, I'm off topic as usual. It took over eight hours for them to decide to admit my mother. My son and youngest daughter waited for the longest time with me while my husband and oldest daughter held down the home front texting for updates. I remember the EMT's and everyone else asking me if I had noticed any change in her. Initially I hadn't but after six hours I could definitely say I had. She wouldn't stop talking. Anxiety, disorientation, and physical illness were taking their toll.

Once she was admitted and taken to her room they made her walk from her gurney to her bed. Ok, I know it's important to get the patient up and walking but she was extremely, and I mean extremely weak. They literally dragged her against protests of, get a wheelchair will ya? My youngest daughter and I remained while the transfer nurse asked us the same questions we had been asked three or four times before. I was proud of myself. I did maintain a professional demeanor but there was definitely an edge on my voice as I once more answered the redundant questions.

Due to the number of times I was asked the same thing over and over I decided to go one step further with the new Home Healthcare Information Cards.

These come in packs of 100 and are business card size. They can be easily carried in your wallet. Hmm... does anyone really need 100 cards for the same patient. After my first experience, yes. I'll be leaving information that may change blank but I'm certainly going to fill out 10 at a time so I have them handy.

As I finished designing this card I thought it might be better to design this business card sized without a patient image. That way they could be used with multiple family members.

Finally, I rethought this whole idea again and decided to keep the postcard size but put two on the card thus simply cutting it in half. Economically this is probably the best way to purchase as you can order one to whatever number you think is necessary for your situation.

Easily add images to the template on other side of the card. I'll be ordering each of these newly designed cards to verify which one seems to work the best. I think I like the two postcard sizes best for right now.

Back to my first experience with serious elder care.

The next day Mom was scheduled to have a physical therapy consultation. I tried to get up to the hospital in time to view it but of course I missed it by about ten minutes. However I was able to accompany her back to her room. Not before learning that she did much better with a walker then with her four legged cane. Not a surprise since my youngest daughter had been telling us that all along.

It's amazing how little information we could get. We knew that my mother had an infection that was made worse by her lying on the floor for an extended amount of time but we were clueless as to how long she would remain in the hospital and the results of the physical therapy consultation. A home health aide case manager had been assigned and I was able to speak with her assistant. By the way the assistant was very helpful and understanding of our situation - needing time to make arrangements for when my mother was discharged.

Since Mom's long term memory is her strength and she feels safe in her home, we intended to have her return there. She was and is adamant about not living with my brother or me. Due to her debilitated state we were hoping that she would be transferred to a care center for further therapies thus giving us a chance to get her house in order. As of day two she remained sitting in her chair watching TV or working on her crossword puzzles.

Day three I received a telephone call from her doctor. He is very good but limited I learned from Medicaid guidelines. It turns out that a patient must be hospitalized for 3 nights, require long term therapy and something else. Well, her blood levels indicated that she was on the mend and no longer required IV treatment. The PT's report suggested that she could receive home treatment thus she was not eligible to be transferred to a care facility. In short Mom was being discharged from the hospital - right. However the doctor forwarded her case to the Home Healthcare case manager for review.

So we sat again awaiting the final decision as to whether she could go to a care facility for a few days while we organized her return home. Now I ask you why should anyone think this was going to be easy. After a third day of Mom sitting in her chair and I in another awaiting her fate, it was determined that she did not meet the Medicaid guidelines and she was discharged. Oh, we could have appealed but if we lost we would have to pay the hospital bill - we're not lucky at gambling.

To add to this questionable move the Physical Therapist changed her report after Mom's second session indicating that she really did need long term therapy. Ah, my mother couldn't get out of her bed without help, she couldn't stand up without help and she could barely move her legs while using her walker. The only time during her stay in the hospital that she even walked were the two times she had physical therapy and to go to the bathroom! Didn't matter she was outta there! In all honesty I was rather relieved. After all they weren't doing anything but leaving her in a chair all day and if she did go to a rehabilitation facility, I wasn't sure the same thing wouldn't happen.

A very nice nurse from home healthcare came in to let us know that a walker and porta potty had been ordered but wouldn't be delivered until the next day - the store closed a 5:00 pm. She continued indicating that they would be in touch with the visiting nurse association of our choice - yep, like I know all about that - and they would call the next day to make arrangements for visits.

I called home to let everyone know. The new game plan was for her to come and stay at my house until we could sort this out and have her return to her home. That in itself is another story and will be shared in the future. I should call it "Adventures in Home Healthcare" or "Home Healthcare 101". Whatever name I settle on, I hope it might help others who may be in our same situation.

In closing, after our real first experience with government health insurance, I plan to examine President Obama's health insurance plan much closer.

For now have a Firecrackin Sunday!

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