<p>Dharma, did they decide that the wound on her leg is a cellulitis infection? My dad was hospitalized for that several times. They put him on IV antibiotics for a week, standard course. The social worker at the hospital should know about Medicare and what it covers.</p>
<p>I agree that you should probably go and check up on what’s going on with her. Often when I visited my dad, I spent much more time out of the room taking care of business than in the room with him.</p>
<p>Here’s a reason why you should go to the hospital, though not necessarily to see your mother: Her state of health right now, frail and weak and old and increasingly having hospitalizations, is exactly when elders get on the train they should have stayed off, the train of increasing interventions and medical procedures leading to interventions and more medical procedures. Right now is where you need to start being very clear about what should be done and what should not be done. </p>
<p>Many, many of us here can point to a time where either we consented to a procedure/treatment that we should not have consented to for our parents, or a procedure/treatment was recommended for our parents but we researched it and realized that it was inappropriate and would just lead to more and more inappropriate treatment. This is the time to pay attention. This is the time to be skeptical, and not to accept every recommendation every provider offers.</p>
<p>Fang is right, Dharma. At this stage of aging, we all have to start asking ourselves if aggressive treatment is necessarily the best thing for our parent. I’m not saying that’s the case with your mom, yet, but be aware that sooner or later, it might be.</p>
<p>Very true, CF.</p>
<p>Here are some examples of interventions on 80+ frail people that might be mistakes:</p>
<p>Anti-psychotics for behavior control
Drugs for tight control of blood sugar
Sleeping pills
Antibiotics for asymptomatic UTIs
Back surgery
Knee replacement
Hip replacement
Stents
Pacemakers
Feeding tubes</p>
<p>Statins, too, especially if they are having negative side effects from them.</p>
<p>Dharma, I was worried about your mother’s leg awhile ago. It is quite important that you speak with the MD to see what is the exact diagnosis, what was cultured and the anticipated course of treatment. This infection could have been a factor in her confusion. What does her blood work show. It is important that she does not get MRSA while in the hospital or C-dif as a result of the antibiotics. Are they giving her probiotics? What is the status of the wound site itself, what type of treatment if any will the wound require? It is early in her treatment, BUT, you need to contact the case manager ASAP as Cardinal Fang and LasMa stated. You need to be aware of the possibility that she may not be able to return to AL depending upon the treatment that the wound may require or she could return to AL and need to have transportation to hospital or clinic for wound care. The case manager will also check the Medicare reimbursement schedule as well.</p>
<p>Excellent ECMom. Thats the sort of detail.</p>
<p>My God, I’m gone for a few hours and come home to such excellent advice. I am always fresh early in the morning and will study everything carefully. I cannot begin to know how to thank you all for the depth of such caring and informed detailed analysis. The septic analysis is tomorrow; as soon as I find out when the men expect to be finished (when I have to return and give the supervisor a check for $1,007) I will head down to the hospital and proceed along your guidelines. I amextremely tired and cannot absorb it all tonight. Too tired to talk to the nurse assigned to my mother, but if I lie down for a half hour I may be able to do that before I go to bed.</p>
<p>Just wanted to mention one thing. CF asked me for a follow up regarding the visit to the Priest. When I came home from the AL on Monday, on the church’s voicemail I left an appreciative thank you, but cancelled the meeting for Wednesday morning. Twenty years ago, I knew the priest I consulted deeply; I do not know this new priest, although certainly I trust him.But the circumstances are entirely different, and besides, 20 years ago I was in a graver crisis than I am in now. I am a coping adult. I have attended Mass with this new priest a few times. But he doesn’t know me. I would be wasting 40 minutes of his time, a complete stranger, especially if I started crying, a certain show-stopper/disaster. Also important, this priest has the impossible job of running two parishes, since the Archdiocese (sp) retired the priest 15 miles north of me, and my Village priest (the priest I am talking about) is serving TWO parishes, which must be a near-impossible job.</p>
<p>But the leg wound stuff we’re talking about is serious and the issue of importance and I will address your posts attentively tomorrow morning (I am waking up at 4 am and get out of bed at 5:30 am) and visit the hospital asap and try to talk to not only the nurses but the Case Manager tomorrow.(And also visit my mother) Thank you for the helpful, attentive posts. DW xxx</p>
<p>Dharma, I can understand that after reflection, you feel that this new priest would not be helpful to you, since you don’t feel a bond to him as you don’t know him well. And certainly we are all glad you do not have the acute crisis that you had with your son’s death twenty years ago; that must have been terrible, I don’t even want to imagine.</p>
<p>But I do urge you to find a professional therapist you think you can work with. And don’t be afraid of tears. Therapists have big boxes of kleenex in their offices for a reason. It would be normal and expected for you to cry at some point during your work with a therapist.</p>
<p>Good luck tomorrow at the hospital. Don’t neglect to talk to the discharge planner about discharge, as LasMa recommended.</p>
<p>Dharma dear, you have so much going on. Try to reschedule that visit with your priest. I’ve no doubt he would want you to see him as a resource for your troubles. </p>
<p>DW- be sure to find out if your mother’s hospitalization is considered a Medicare approved admission to the hospital that would qualify her for rehab if indicated. It is possible to be in the hospital overnights, but not have it be Medicare certified. Then you can find out if there are additional Medicare days available for rehab. Speak with aftercare or discharge coordinator. As others have said, understand the nature of her wounds, which actually might be contributing to her upset behavior. Many elders have wounds that need much watching, cleaning, and bandage changing to allow healing. Ask about her prognosis. The three day a week visiting nurse in AL needs to be assessed by hospital staff to determine if it is optimal. Once you sort out her present status and needs, try to think about her health and how it has changed since the summer. It may help you put together the best way forward for her over time.</p>
<p>Now about canceling a counselng appointment because the priest has an impossible job. It is important not to let assumptions about others determine your fate. Counselors schedule as works for them, you schedule as works for you. It really is that simple. Counselors can not only bear upset and tears, but also help people get to the other side of them. Your decision is whether or not to take the journey. I hope you can feel worthy of the opportunity or decide to go, even if you don’t yet. It gets better. Hang in there! </p>
<p>And nothing could be more normal than shedding tears when talking to a counselor. It would not be unexpected, not a “show-stopper”, not disastrous.</p>
<p>If you want an exercise in frustration, call Medicare. Otherwise, seriously, do not bother. There is zero need for that. Agree that at the hospital be sure she is considered admitted and not just there for observation. You want the 3 day admission if she has to go back to rehab and have PT to get she strength back to walk without falling. </p>
<p>If she is eligible for rehab, the business or billing office at the one selected will likely obtain verification of her available benefits with Medicare and be able to inform you. Obviously should be done prior to transfer. Agree that calling Medicare is not the shortest distance between 2 points. </p>
<p>In case my tongue in cheek comment was not clear, there is NO reason to call Medicare. The hospital handles the Insu verification. Not your problem. They can’t bill your mom for covered services if denied by Medicare. Do not look for trouble. </p>
<p>That said, you NEED to go to the hospital to see what their plans are and check on her care. You may have to sign forms if you are healthcare proxy and not going for several days of her hospitalization could look like neglect to the staff, because “abandonment” is considered elder abuse. . You don’t need some overzealous staff person to contact the nys dept of aging and file a report. Unlikely to occur but you don’t need that. Hospital staff will wonder why family hasn’t come in. Especially if you are POA and healthcare proxy. </p>
<p>Here’s how the Medicare situation was explained to me:</p>
<p>The previous 3-night hospital stay opened the SNF claim. It was for 100 days. When she was discharged from SNF, that claim was closed.</p>
<p>Here’s where it can get sticky: In order to open a new SNF claim, she must:
a) Be out of the hospital for 60 days, FOLLOWED BY
b) Another 3-night hospital stay.</p>
<p>PLEASE NOTE: I am not an expert on this. Do not take what I have written as definitive. This is how it was explained to me by SNF billing staff when we were facing a somewhat similar situation. But Dharma, you will definitely want to discuss this with the hospital case manager ASAP.</p>
<p>Does she have any secondary insurance?</p>
<p>OK, here is a correction to what I posted above:</p>
<p>
</p>
<p>It doesn’t say what happens if the break lasts for less than 30 days, so it sounds like the claim would still be open? If so, Dharma’s mom should have 100 days minus the days already spent at the SNF.</p>
<p><a href=“SNF Care Coverage”>http://www.medicare.gov/coverage/skilled-nursing-facility-care.html</a></p>
<p>This is OT, but seriously … these last few posts are an excellent illustration of what is so crazy about healthcare. Why does it require an elder to have a person who is able to devote almost full time status to managing all these paperwork issues??</p>
<p>And what happens to elders who don’t have children who can devote, well, it’s not full time but it’s certainly a significant amount of time, to straightening out their health care issues?</p>