One Day Last Month

IMG_0896My father is 94. Although  deaf and partially blind, his overall health has been good. For the past four years, he has lived at home receiving help from paid caregivers, until one day last month.

Dad had a very bad urinary tract infection that would not go away. It had begun to travel to his kidneys. He could not sleep because he constantly had to go. He didn’t want to wear diapers; it hurt his dignity. So, he struggled dozens of times to the bathroom about 10 steps from his bed. His caregivers and his family all worried that he would fall. Again.

My brother, who oversees his care day to day, told me he had to be hospitalized and that his caregiving team was very worried. But my brother had just moved into a new house, had a new job, and was finding it difficult to manage it all.

So, I flew to Colorado to help. Dad had only recently been approved for VA health benefits and was admitted to the Denver Veterans Administration hospital. His condition was “touch and go.” The young physician I first spoke to was at first puzzled, but said he and his team were hopeful. I was worried that he might be receiving substandard care, but I shouldn’t have been.

I was by Dad’s bedside for two days and I don’t recall there ever being a time when a nurse, nurse assistant or doctor wasn’t visiting. At one point, a team of physicians including the head resident stood in the room and explained in plain language just what was going on.

During one of those team consults, I told them that I had transcribed Dad’s South Pacific diary and it could be read online. Every single physician read it overnight. I recall that a few of the nurses did too. In other words, they took extra time to get to know my Dad; he was not just another number on a chart.

My brother, who has visited Dad in other nearby not-for-profit and for-profit hospitals over the past several years, said this was the most positive hospital experience he could recall. Rarely have doctors elsewhere spent the kind of time these folks had. Rarely has a team of nurses and nurse assistants been so attentive to his needs.

Dad began to recover; the doctors finally figured it out. However, since he would need a permanent catheter and round the clock care, the verdict was in. He would need long-term care in a facility; he could not return home. I was given a list of the homes the VA contracted with. Naturally, I expected the worst. But, once again, I was wrong.

With a few clicks of the mouse, I found not only an Eden Alternative home but one with stellar Nursing Home Compare ratings. It was 10 minutes from the VA hospital on a quiet city street adjacent to the city park. My brothers and I checked it out and Dad subsequently moved in.

Dad now eats with others in a common area, not alone in his apartment. He is able to walk the halls with his walker and an aide; at home, he rarely went for walks. His caregivers were concerned about his falling and their inability to pick him up. He is receiving speech therapy now, something he had trouble accessing at home through Medicare. His ex-wife and their dog can visit anytime.

So far so good. Dad seemed content the day before I had to return to Northern Virginia. He described his room, which is filled with sunlight most of the day and accommodates his furniture, artwork and family photos, as like a stateroom. This US Navy veteran of years at sea should know.

My father passed away in July 2016. 

 

 

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Cut Medicare? Cut Medicaid? Why?

kbmgmedicareterms.jpgIn the 1980s, I worked for a health economist named Carl Schramm. His mantra was that the real problem was health care costs, not the cost of insurance. This message landed him a great job with the health insurance industry and he played it forward while leading its lobbying group in the prelude to the Clinton’s health reform efforts.

While I get that health insurers would rather blame providers (hospitals and doctors at that time more than pharmaceutical companies) rather than shoulder the blame for ever-increasing costs, policymakers might want to think about what Schramm was trying to get across nearly 25 years ago.

Here’s my favorite example. In 2006, a Republican-led effort added a prescription drug benefit to  Medicare. The law specifically states that Medicare could not negotiate prices (it was reasoned the market will do that and how is that working exactly?).

Before tearing up the social contract with older Americans and throwing in the towel, let’s empower Medicare and Medicaid to negotiate health care costs across the board. Giving them more control over costs might, just might save these crucial programs for future generations.