Wednesday, November 23, 2011

What's wrong with Assisted Living?

And yet, the tales of bureaucratic ineptitude and exorbitant medical costs for my incapacitated 85-year-old mother's healthcare needs has not yet ended. This is another one on Medicare and on my mom's health service providers and her Assisted Living staff.

Ever since Mom's botched hip replacement in 2002 (which started her mental incapacity as well – had we known the extent of the problems then, we probably should have sued!), my mom has been unstable standing and walking. Once the post-surgery rehab was completed and she no longer needed to rely on the walker, Mom continued to be in pain (later revealed to be due to a protruding broken wire along with a mending broken bone), and she began to rely on a cane. Over the years, her dependence on the cane has increased.

When I visited early this fall, she seemed very frail and relied heavily not only on the cane but my arm and, wherever available in her Assisted Living facility, the wallrails. I requested her doctor to have her evaluated for physical therapy, and they determined she really needed a 4-wheel walker. After getting a loaner practice walker, Mom went to therapy twice and decided she'd had enough. So they just let her decline to attend. After a few weeks, Mom no longer recalled what the walker was for – she began using it as a clothes rack!

Meanwhile, oblivious to this turn of events, I was checking out walkers to purchase. Online, I found a perfect, barely used one for half the price of new. Since Mom has Medicare coverage, I called to find out what I needed for reimbursement. Well, you can't do that. I was told you can only purchase from a registered Medicare provider! And none of those seem to bother to offer used models or discounted prices. (Why should they when Medicare will pay for a full-price new one every five years?) How crazy is that? Once again: it is no wonder health care costs are breaking the budget.

The therapist Mom was refusing to see finally called to let me know she was concerned Mom could fall since she wasn't using the walker – or even going for therapy. So I got in touch with a Medicare supplier near the Assisted Living facility and motored on down to play the heavy and take the cane away.

When I arrived, despite numerous calls to the doctor requesting the required prescription, it hadn't been sent. For two days, I called the doctor's office. The phone either rang unanswered or put me directly in voicemail. I left messages whenever I could. Still, no prescription. Finally, midmorning on the second day, a real person answered – and explained she was a phone temp because they were short staffed. She took the message and passed it on (Later I learned the office was also moving its file room, so it must have been chaos.), but still, I got no call back and no prescription was sent. I was due to leave the next day.

I'd asked everyone I could around the Assisted Living facility for help, but only the doctor could write the prescription. Then, at 4pm I got word from the sitter we hired to help my mom when I'm not visiting: she'd spotted the doctor in the building! I enlisted everyone to track him down, and finally I spotted him myself! When I caught up with him, he claimed to have signed a prescription already, but I knew there was none where it needed to be, so I had him write a new one (fortunately, I knew what it was required to say because he didn't!). With it in my hand at 4:30, I raced to call before the supplier closed, gathered up my mom, and made it there at 5 before 5 – with a tornado warning bearing down.

Needless to say, the staff was anxious to get out and home before the storm hit, so they quickly filled out the paperwork (couldn't they have prepared it when they knew we were attempting to get the prescription?) and adjusted the walker for my mom's short height (too short it turned out) and off we went into the rainy, windy night.

Mom was remarkably compliant about using the walker that evening, but the next morning, she'd forgotten all about it and wanted her cane. I told her we traded it in on the walker. I stayed for the day to encourage her to use it and tried (futilely) to find the absent therapist to correctly size the handles. By the time I put Mom to bed, she was still grudgingly using the too-short walker.

I just hope the next morning, the Assisted Living staff didn't let her wander around without it! And that maybe someone even could have gotten the sizing right (as I requested they do). But I can only hope since no one has contacted me to let me know. You'd really think there would be more assisting going on there....
I wonder... what you think.

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