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How To Series: How To Create Your Own Financial Success As A Hospital (or how to take advantage of the elderly)
UPDATED TUESDAY JANUARY 19, 2016
January 2, 2016
Take a trip with me to a place of healing, a place where the statement "First, do no harm" should be emblazoned on every wall, on every door, on every document and in the mind of every employee. Then follow along as we travel through this hospital with a man who was acting strange, unsteady on his feet and acting out of sorts for some unknown reason which resulted in his being taken to the Emergency Room, only to be released as there was nothing discernible wrong with him. Follow along with us as we find him falling and bumping his elbow on the same day and is then transported back to the same hospital. This time he is found to be dehydrated and weak due to having had no food nor drink for basically the entire day. This time he is being kept overnight for observation and will be sent back to his assisted living quarters in the morning.
The next day he is doing better but is not able to stand comfortably, being unsteady on his feet. A CAT scan is taken to determine if he has had a stroke, mini or major. Nothing is found. Continued observation is decided upon and another night spent in the comfortable care of the hospital, full of people paid to watch over him night and day. Right.
At last check, 3:40 AM Monday morning January 4th, he is seen sleeping soundly in his bed, safe and secure. An hour later he is found writhing in pain on the floor, having fallen out of his bed onto the cold, hard hospital floor. How long has he been there? Five minutes? Ten? Fifty? No one knows. You see, this man who was checked in for having been transported to the hospital twice in the same day, once for being unsteady and out of sorts due to a suspected stroke and the other for having fallen and striking his elbow was not secure in any manner in his bed; the rails alongside the hospital bed were not raised into position to prevent a fall; did not have the alarm set to let the nursing staff know if he got out of bed as it should have been (their words, not mine); and was behind closed doors in a room all alone.
Now, he is in surgery with a fractured hip. To me, fracture meant a crack, small or not complete in nature. Now I understand that fracture means the following:
Broken completely off. That's right, the ball portion of the femur that connects and sets in the socket of the hip broke completely off.
Can you imagine the pain? Lying on the cold hard floor for possibly close to an hour with the largest bone in your body broken in half, pain shooting through the top of your skull with any and every movement that forces the bones to grate against one another. Pain that brings tears to your eyes even as it causes you to writhe uncontrollably on the floor.
Pain that was not there when you entered this facility.
And now, as we set in his room, waiting on him to return from surgery we wonder if he will be able to function as he was before. Not that he was in perfect health, no. With Dementia and Alzheimer's battling daily to pull him further and further from his past, he was still fairly healthy physically even while his mind was failing. But health-wise physically, he was decent. He could get up and walk unassisted; he was able to move about with ease for a man approaching 80 years old. He could dress himself, bath himself, walk from his room to the commons area to visit with others who live there, even to the dining area for meals and outside on the grounds if weather permitted it. But due to a health care facility's blunder and carelessness, that freedom of movement is now in jeopardy forever.
A part of me (that deep, dark conspiracy theory side of me) wonders if this was done, if not intentionally, then perhaps with thought; a thought of financial gain on the part of the facility at the expense of you and me. Not saying this happened, mind you; simply that a part of me wonders if this entered someone's mind.
No, you say. That's not possible, you believe. Think on it for a moment: a person comes in basically healthy yet with a frailness which comes with age. He is slowly losing his mind and appears worse than he usually is due to the dehydration making him less alert than normal when combined with his diabetes issues. A thought appears in the mind of someone; not a plan per se but still, a thought. If he were to fall and injure himself moderately we could perform a surgery; charge the government healthcare agency for the surgery and an additional several days, possibly even another week in the hospital followed by up to six weeks of rehab. Rather than a simple in and out at a miserly cost of $10,000.00 we might be able to run the table and charge an additional tenfold amount to a government agency that could care less what they pay for services rendered. Farfetched? Not to me.
Tuesday, January 5
While we waited for news following his surgery (which was planned for the afternoon as of yesterday, but moved to early morning this morning) we sat in the sparkling new cafeteria which feeds staff and guests alike. This is not your daddy's cafeteria; no this is today's cafeteria. While the cafeterias of yesteryear featured cans of soda resting in a bed of ice, pre-made sandwiches of unknown origin wrapped up tightly in clear plastic wrap and bags of chips hanging on a rack by the cash register, this cafeteria would be right at home in an upscale restaurant. A center surround featuring the finest cuisine made to order; coolers standing tall holding any number of sodas, water, juice and more; a buffet style ordering area where one can peruse any number of entrées such as tacos, burgers that would cost one up to $10 on the open market nestled in beds of fries; pizza by the slice; salads galore; chicken strips that taste as though they came straight from the farm that morning in addition to any number of other foods that would be at home on a menu of a five star restaurant. Everywhere there are food service individuals in puffy white hats and starched white jackets which would be at home in the finest French restaurants on the coasts.
I was moderately shocked as I stood there watching and looking. Then we meandered up to look closely and make our decision. Two 20 oz. bottles of soda $1.69 each. Chicken strips $0.99 apiece for three. Cheeseburger $3.49. Fries $1.59, 1/2 order of onion rings $0.79. A moderate meal for two adults which came to $12.27. Then a meal eaten in silence as we each weighed the thoughts on our minds, thinking the same thing individually. As we finished we were summoned to the desk, and given the update: out of surgery and heading to his room soon.
We made our way to his room and waited for him to arrive. On the door to his room we saw the sign, red in color as a warning. "Set Bed Alarm" it says, and I wondered if this was in place before. We enter the room and find a place to sit. About an hour later, he is wheeled in. He is still under anesthesia and groggy. It isn't long before we begin to converse to a degree. In between those moments he is snoring softly and grimacing in pain. His pain becomes ours, as we know this didn't have to be.
We have done a bit of investigation into broken hips, broken femurs and such. What we found is disturbing, to say the least. For example, 25% of older individuals who break this bone die within one year. That's right, 1 in 4 die in less than a year. Another 1 in 4 make it back to their previous level of movement and quality of life. So a person who breaks their hip of femur in this manner is as likely to die as to heal up. What wonderful odds.
Per the Mayo Clinic, 1 in 5 will have another similar break within two years. Great.
We meet with the doctor and nurses. The doctor is upbeat, saying he will be up and around tomorrow. He explains that the break was clean (hello, the whole top of the femur came off!), and once they drilled into the femur, cemented the steel pin in place, glued the new artificial ball on top and put his leg back together he should be just fine (after six weeks of rehab, of course).
We speak with the social worker for the hospital about the prognosis and his rehab. Where can he go, what we need to expect, will he be able to be back to the quality of life levels he had prior to entering this facility. Expectations were good, although we are hedging our bets and hoping he responds well to therapy. We find that he will not be able to enter the rehab center of our choice as his insurance carrier which is tagged to his Medicaid and Medicare says this one in out of network. Wait, out of network? So you're saying his insurance will be in effect here? So, you're saying you are not paying for this incident? Well, well, well.
Further conversation leads us to understand that he may be able to go to the sister facility if he is willing to work hard, up to three hours of therapy per day. If not, he will be relegated to a lesser facility and left there to do as he will. We are still unhappy with the decision and are told someone will contact us later. This person exits the room and shortly thereafter her father feels an urge to use the facilities. My wife attempts to find someone, anyone in the halls; I call the number written on the board in his room. A voice answers and a promise is made. Several minutes later someone comes to his room but it is too late. We leave the room as two more nurses arrive to assist in the cleaning and we stand in the hall, anger and tears our comrades as we hear him yelling, roaring and screaming in pain as they turn him first one way then another, replacing the sheets and causing further harm to this man already deep in pain.
When we re-enter his room, he is passed out, a look of intense pain written on his face, Brow knotted, lips compressed and turned down in a severe frown, he sleeps yet we know it cannot be a restful sleep. We gather our things and make ready to leave.
Late afternoon January 5
On the long drive home, we receive a call from the hospital. We are told there will be no billing for anything resulting from his fall while under their care. I surmise they are doing their best to forestall us from seeking an opinion from a professional, intent on heading us off by assuming this will be sufficient in our eyes. What about getting him back to where he was when he came in to see you, can you promise that? What if he never makes it back to the level he was prior: walking, talking, able to dress himself and feed himself? What if the statistics are true and within a year he develops something which causes him to slide faster and faster downhill; something which would not have happened so soon but for your mistake?
What if he is unable to return to the facility he was in and we have to search for somewhere that will take him in at a higher cost? We have no funds available to assist him, and he has no other funds with which to pay for such costs. Will you then cover anything else which arises? Will you care for him if he develops pneumonia or falls and breaks his hip again due to he weakness you placed there? How many scenarios must we think of to force these "caregivers" into making sure he has the best care that can be provided? Or are we to assume that they will happily step up to the plate and shoulder the responsibility in two months, six, eight months? A year? Two? Next week?
Sorry, I don't trust you as far as I can throw you.
Monday, January 11
He remains in the hospital. He still has sufficient pain to halt his participation in the multiple daily rehab sessions. With his Alzheimer's he will refuse one time then when they return a half hour later might take part in it. Of course, each refusal is documented; this can cause a Rehab Center to refuse him based upon that one fact alone. If he does not willingly participate they will not "waste" their time on him. If that occurs, he will be sent to a nursing home, there to wither and die in bed. At present, he cannot return to the facility he was at before as he cannot care for himself. Of course, the money for this month has already been paid to them and they will not refund any part of it although he has not been there since the second day of the month.
We have contacted multiple facilities and each one desires to wait until the hospital makes their decision as to his participation level on rehab. They will not pay for anything beyond his hospital stay at this point. We have no funds to send him anywhere nor does he have any we can use for him; he and we are trapped.
We have contacted three attorneys that say they are injury attorneys. The first two said "No thank you" in a letter, both siting the fact that they do not practice this type of law. Excuse me; you are personal injury attorneys, right? Both of you advertise on television that you have offices across the country built for personal injury and neglect cases, right? Well yes but we only chase ambulances and auto accidents and deal with insurance companies; we do not pursue actual negligent cases against hospitals. That is too specified and difficult. The third one did try to help us and will be contacting us again today. They have some ideas and time will tell if they are good ones. As it now stands, we have an empty bag we can rely on. Nothing in it, nowhere to turn, and no chance of helping him find a place to go to in order to heal.
It infuriates me that this hospital, this place of healing caused this accident by their negligence. They knew he was a fall risk; they were aware he was unsteady; they knew he had already fallen. And yet, here we are. He may never recover; he may never be able to return to the facility he was at; he may end up in a bed in a nursing home, lying down every single day waiting to die; waiting for pneumonia to set in, to fill his lungs, to suffer. All of this could have, should have been avoided by simply setting an alarm! Nothing more than that would have been required! And yet, we are facing a road we should not have to face yet, that of his imminent demise.
In our research it appears as though this is closer to the norm rather than the abnormal when speaking about our elderly. They work for years and years and once their productivity is done they are cast aside to rot. We found early on that, due to his serving in the military in time between a war he received no veteran's benefits. This was the first of our "Thanks but go away now" moments in attempting to gain assistance for his declining years. We also found that even though a person swindled him once he was vulnerable (post stroke but no one knew of it at the time) and took literally hundreds of thousands of dollars, leaving him owing the IRS tens of thousands of dollars and banks the same in loans they are not culpable in the eyes of the law. He gave of his own free will they say. Well, maybe but he was impaired through a health issue at the time. Sorry, no dice. So no help there.
Then we learn, after the fact, that having Medicare is not sufficient if you do not have the right type of Medicare. Venues for healing are off limits to those who do not have the proper type, thus eliminating choice from the equation. "Oh, you have this type? Then your only choice is door number 17."
People, if you are not to this point with your parents get involved! Inform yourself of the why's and wherefore's regarding this minefield we call getting old. Do it for yourself as well, so as to not cause your children undue grief. Have a will in order, both regular and living. Have the future of your end of life scheduled, in writing, planned well before you arrive at the door marked exit. If you do not, I can promise you and your family there will be heartaches enough to go around that have nothing to do with your illness,
Friday, January 15
He was released from the hospital on Wednesday and transported via ambulance to a facility in our home town. It is a triple threat facility: rehab, Alzheimer's, and a nursing home. So no matter what, he will live out his days here.
No further word from the hospital; no word from the attorney. It is as though everyone has washed their hands of him and he is now out of sight, out of mind. He will begin in the rehab portion of the facility and hopefully he will progress. If the pain is to much, or his will fades, he will be moved to the nursing home portion. If he does improve, he will get moved to the Alzheimer's care portion.
We go this weekend to clean out his old room, bring his few things back to our garage to store. He will never return to the location he spent the last two years at, never again be with those who have been a part of his life and ours, assisting both we and he in this journey from total independence to assisted living. Now we leave them behind and travel a new road, that of round the clock care and observation for his remaining years.
We will take a few items to his new location, clothes mostly. No personal television set, no personal fridge, no queen sized bed as he had before, no pictures on the wall such as he had in the private room he lived in before. Now he will live out his days in a narrow hospital type bed in a semi-private room with curtains for doors and a roommate. He will be behind locked doors and will not be allowed to walk across the grounds unaccompanied in the sunshine or sit in a comfortable chair watching the cars drive by while having the sunshine shine down on his face. His future, what little remained of it, has been stolen from him through the negligence of a hospital, and there appears to be nothing we can do about it but wait for the end to come.
Monday, January 18
We took a trip to recover his personal items and clear out the room he has lived in for the past two years today. One of our sons and his friend assisted and it took but an hour or so. While we were cleaning, an elderly woman who lived there came to the room. We knew her, as she and my wife's father had developed a sincere friendship in their time living in the same facility. As she spoke with us her eyes filled with tears. As she hugged me tightly, she sobbed and told me to tell my father-in-law that she would love him until the day she dies.
What am I supposed to say to that?
As we finished and began to leave, a new anger began to simmer within me; deep, dark, anger. This woman has Alzheimer's and a form of dementia much like my father-in-law yet somehow, someway she has formed memories of him even when she should not be able to do so. Powerful memories, lasting, long, ongoing memories. And now, because of the hospital's negligence which caused the accident she is being harmed. She is innocent in this as is my wife's father yet we are the ones who are being harmed in this. My wife's father, this innocent elderly woman who will live out her life never again seeing this man she has formed an attachment to, my wife who is being forced to do something she should never should have had to face, the imminent demise of her father.
While we were with him yesterday, we assisted in moving him from a wheelchair to a lift chair. AS we helped him to his feet and moved him the scant few inches to the chair, we noticed he literally was unable to do more than shuffle his feet. A little over two weeks ago, this man was up and walking, well if not quickly. He could move about from room to room comfortably without assistance. Now he is completely reliant upon outside help to even stand, let alone move. The look in his eyes is dead, hopeless. He is unable to know where he is, whose room he is in, if he has eaten recently. This is not the same man we spoke to last month and it is all due to the hospital's not caring for him! Not watching, preventing, looking out for! If he had not fallen out of his hospital bed we would not be dealing with this now. All it took was their setting a bed alarm and raising the bed rails. That's all. They knew he was a fall risk yet they ignored that completely and we are left to clean up their mess until he dies.
People, that's not right.