I'm a senior trying to care for an even more senior parent. There are lots of us. We are grandparents who are struggling through our "golden years," some of us still working far beyond age 65. Many of us are trying to be good "children" for our parents at the same time we are trying to be present in the lives of our grandkids. It's a tough, multi-generational balancing act.
So this post has nothing to do with Obamacare or Medicare or death panels or any other health care policy. It's a personal story about my 91-year-old mother's recovery from a broken hip, and my limited ability (as her out-of-town almost 69-year-old daughter) to keep her safe and reasonably healthy.
I understand my mother is lucky to have lived 91 years and that her time on earth is finite. But she's still a mother of three, grandmother of eight, and great-grandmother of almost nine. She's a person who was managing independently until she fell and broke her hip. She plays bridge on the Internet, loves to go on shopping trips and to movies, and can still carry on an intelligent conversation about politics or her beloved Detroit Tigers. Most importantly, she's my mom.
Mom fell Memorial Day weekend and broke her hip. The first step on the road to recovery from the broken hip was the hospital. Mom's was pretty fancy. Like many modern hospitals, it had a huge atrium filled with cafes, Starbucks, gift shops, and all kinds of special stuff.
Let's skip the whining about the endless hours mom spent in the ER after she pushed her alarm button and was transported by the nice paramedics. My brothers live near her and met her at the ER, where she languished in a hallway waiting for care. I guess that's understandable. Apparently lots of folks decide to have emergencies on a holiday weekend.
The surgeon was skillful and Medicare was happy to pay mucho dollars to fix mom's hip. She came through the surgery and we all breathed a sigh of relief. So far, so good. So now she was in hospital, dazed, confused, and totally helpless. I tried to stay in touch with the nurses and social workers, but they changed every day. I'm lucky I have my brothers there, as it isn't easy to talk to anyone official when you live in a different city.
My husband and I drove there, leaving at 6 a.m. on a Saturday. My bad -- it was now the weekend. While it was great to see mom and help by cleaning up her apartment and getting her some stuff she needed, it seemed the fancy hospital didn't want to pay weekend rates to anyone other than a few RNs and nursing assistants.
Sunday was really special. There was one very nice and dedicated nurse running from room to room putting out fires. The consults we needed about diet and therapy didn't work weekends. Neither did the social worker, who was the care manager. And there was a different care manager on Monday. And another one on Tuesday, when Mom was moved again to the rehab unit.
Now, let's take a look at what happened to the Mom when it was time to begin the rehab process:
First, we played the Medicare-making-progress game. Mom was transferred to the hospital rehab floor where, according to the rules of this game, she had 7-10 days to make progress. You might wonder why 7-10 days? Good question. Well, this is rule number one. Medicare will not pay for more. Even though Mom was in too much pain to do much until days 8-10, the umpire declared, "Strike three," and she was out.
Now a rant about care managers. This person's job is to help with discharge planning. It might make sense for the person to be consistent but that's not how a modern hospital operates. On day 10, the manager-of-the-day told us Mom would have to leave that hospital pronto. By pronto, she meant now. By 4 p.m..
Her "kids," who are seniors (or close to that for one of us), now had to scramble to figure out the next step. We knew the drill from when dad went through this two years ago before he died. There would be no help or extra time to figure out where she should go. Luckily, the only place we had agreed upon for rehab at that point had a bed for her. One more day would have really helped mom's senior kids get their act together. But we moved on.
I already knew how sub-acute rehab roulette, the next game, worked. My father got to play it two years ago. Now Medicare would pay for 20 days in a rehab facility (aka a nursing home), and maybe up to 99 days if mom needed them, as long as she went straight there from the hospital and made progress.
So every week in her new location, we had a "care conference" at which the physical therapist, occupational therapist, and social worker decided if there was enough progress to continue mom's rehab. Think of this as a geriatric version of the Individualized Education Plan (IEP) meetings for children with special needs. Instead of parents coming to advocate for their kids, it was mom's senior kids pleading with the care team to deem her worthy of another week of rehab.
Don't get me wrong. I am grateful we have Medicare to help defray what ended up being a costly rehabilitation journey. But when the sub-acute rehab thought the progress had stopped, we entered the final game: go-somewhere-else. This is a very sad game. The powers that be, declared there was no more progress, and mom was out once again.
Under the rules of go-somewhere-else, mom got to use up a large chunk of the money she had (and yes, I know she is lucky to have some money) for a caregiver. Happily in our case, she did recover enough to stay in her senior housing and get around on her walker. She was not forced to give up her apartment and move in with one of her children if we are able to meet her needs, or to be placed in a nursing home paid for by Medicaid when her funds were depleted.
Of course, the last option is not the ending she or any of us hope for. We hope she will continue to enjoy her friends at her senior living complex, playing penny poker, and attending social gatherings there. We hope she will live out her days feeling happy and independent. We even hope, as mom has told me many times, that one day she simply doesn't wake up, and her life ends peacefully.
But I am cynical enough to know there is a darker path that is also possible. My father took it two years ago and lived his last six months in a nursing home, totally dependent on others and unable to eat or stay awake for more than short stretches of time.
And I worry if mom's senior kids, my brothers and I, are up to the challenges ahead.