Where to Begin – Part 1

This week has been a war of attrition. Back in April, my mom had a bad fall in her home. She ended up in the hospital for about a week and a half, and then was sent to a skilled  nursing facility for wound management and physical therapy. She has been there for about 4 weeks. The staff has said at this point she is not meeting their improvement standard; they want to discharge her to assisted living next, since she still cannot stand up without help and she lives alone.

I have asked her and my brother to fly her out here to live with me until she is strong enough to get up on her own. We don’t know if Medicare will cover her medical expenses if she comes here instead of going to assisted living, and she subsequently has something requiring medical services.

Yesterday I discovered a link that told me that it is against the Medicare Act to use “the improvement standard” as a standard for ejection from skilled nursing facilities.  http://www.medicareadvocacy.org/. It is a widely used standard, and has been used for decades. However, it is a misused standard.

My brother has filed an appeal to their decision. Hopefully we will win appeal. Medicare permits up to 100 days in a skilled nursing facility, and she has been there about 4 or 5 weeks. We believe that she might get strong enough with more weeks of physical therapy. Her first two weeks at the facility her wounds on her feet were still healing and her feet had huge bandages. thus she really has only had a couple of weeks of PT. Once she is standing, she can walk 75-100 feet, very slowly, using her walker, with someone at her side. Even if she is stronger, she should STiLL  probably be here……

As for the matter of me actually being able to give her proper care. I hope I/we can get her standing. There are 3 of us here (my husband and my 23 year old son). One of us will always have to be here, which is do-able—my tutoring has me in and out, and my son is still looking for work. My husband is away from the house on weekdays for 12-13 hours a day. His schedule isn’t flexible, but when he is here he can help. I pray that we can manage this, and keep her out of the hospital.

I cannot go to Ohio for weeks/months on end-my family needs me, my students need me, and we need my income to help  pay off the uncovered medical expenses from a number of years ago and other loans as a result of multiple job losses. If she is here, we keep our jobs and care for her.  My brother’s job is like my husbands—long and demanding. If he cuts his hours, he could lose his job–and of course then, there goes their home. If she is here, she won’t be shelling out $6,000 + per month for assisted living.

But of course, as medicare and medical facilities go, we will not know until the last minute what will happen. At that point, last minute plane reservations will need to be made, and I will need a hospital bed, a chair that goes over the toilet, and one of those belt things they use to help people stand up, and perhaps walkers and a wheel chair if she doesn’t want hers brought on the plane.

So that is where that stands. It would be good to have her here where she is loved, and we can try to help her. The getting from this point to that point is overwhelming. today we are going to have to move things out of the den and into other rooms and prepare for her potential arrival. She is overwhelmed beyond measure at the thought of the trek out here, and continuing to be away from her home.

So that is part 1 of the week. I am working on making lemonade for all of us.

About Kate Kresse

I love to write, I love to talk, I love to uplift people when I can. I am a woman in love with life. I am a wife, mom, tutor, writer, and I am a perennial optimist. (OK not every single minute but you get the point! :-)
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43 Responses to Where to Begin – Part 1

  1. Julie Church says:

    One of the things you can do while waiting, if you haven’t already is look into benefits available where you live. I live in Connecticut and both my mother (almost 90) and my niece (MS and 48) live in a nursing/rehab facility. They like it, but my niece has become an advocate for the patients who live there and as a result issues that come up get resolved. (Making lemonade out of lemons). Also, it’s said that patients who have a lot of visitors tend to do better, the way they are treated by staff and their well being in general is better. I hope it all works out for your mother.

    • Kate Kresse says:

      Julie—how do i find that out? She is on Anthem Senior Advantage back in OH. Do I start by calling them or start by calling m\Medicare? The actual facility she is at is terrific. She is well treated, and getting healthier. I have no complaints about them except that they want her to leave d/t their improvement standard. thank you for your feedback, and if you have further advice/guidance i would appreciate it.

      • Julie Church says:

        I will ask my sister, she is the one who would know, I think. Your brother appealing it is a good step and I will see my sister tomorrow (we always go to Starbucks after church for sister time) I will ask her and get back to you.

  2. niasunset says:

    Oh dear Kate, I hope and wish everything to go fine and your mother get well soon. Love, nia

  3. Oh, Kate, this was the post I’ve been waiting for. NOW I know why you’ve been gone and that, besides frightfully busy and in need of prayer, you are basically doing okay. Such good news!
    So, don’t feel you need to encourage us, so much! Let us encourage you for a change! And tend to your mama. Whatever, wherever that turns out to be, I know you know we will be right there with you, sharing the burden as best we can.
    Much love and PRAYERS!

    • Kate Kresse says:

      Arghhhhhhhhhhh thanks so much!!!!!!!!! thanks for the prayers; i pray that everyone does the right things. she is frightfully thin—weighs only 82 pounds; and is about 5’5 or 5’6″ (used to be 5’6″ but has shrunk some). She was never heavy—usually weighed about 110. but has been extremely emaciated—she just doesn’t have much appetite these past few years. She does drink those nutritional drinks (forgot the name)—for protein and nutrients.

  4. AlohaKarina says:

    Fight them. Even the “good” skilled nursing facility here was a joke. We were constantly on their case about things, and even then they managed to screw up my Mom-in-law’s medication for the full time she was there. And this was the “highly recommended” place. You can file a complaint with the Better Business Bureau as well, I bet, and perhaps even move her to a different facility.

    Just because she’s there doesn’t mean she can’t go somewhere else. A care facility here told me that–they were the hospital-based one so they knew what they were talking about.

    FIGHT. Good luck. We’ve got your back with prayers and good thoughts! Good luck!

    • Kate Kresse says:

      The facility is terrific. the problem is she hasn’t improved sufficiently in the last 2 weeks to meet their improvement standard. Their stance is that Medicare won’t cover it then. My research has shown otherwise. The improvement standard is NOT required by Medicare, by facilities often use the standard to boot the patients out—hence we have filed the appeal. we are very happy with the facility. but she cannot afford to go to another place and have to pay for it—that would cost in excess of $6,000/month. Neither she nor we can afford that for any sizable length of time. We are fighting–and thank you so much for your support, feedback, prayers, good thoughts, etc.

      • AlohaKarina says:

        The hospital told my mom-in-law and me that she could move, and medicare would still pay for it. It’s something to consider. Good luck with the appeal. And don’t be afraid to appeal the appeal if need be. Be the squeaky wheel that gets the oil. Meanwhile, take care of you and BREATHE! 🙂

  5. misswhiplash says:

    and I thought my week was bad enough! My prayers and thoughts are with you and your family and I wish your Mother a very speedy recovery

    • Kate Kresse says:

      thank you so very much. been thinking about you lately—it must be because the Queen’s jubilee is coming up….was thinking about you in your days gone by living in her kingdom. prayers and hugs to you.

  6. Kate, since I’m a Canadian nurse working in community, I obviously am unfamiliar with the American system of home healthcare. However, is there a possibility of hiring someone privately to help you at home? You, your husband and son are going to be doing some tricky balancing if you have your mom with you. Hiring a private support worker (not a nurse – you don’t need a nurse for basic care) will be cheaper than an agency support worker and more flexible in terms of hours.

    • Kate Kresse says:

      i may be able to hire someone part time—i hadn’t considered that. i had only thought about private nurse–and that is more than we could afford. i will have to see about a private support worker. thanks for the idea..

      • When we needed someone just to check in on our mom and help her in and out of the bathtub, we found a very jolly nursing STUDENT who wanted a part time summer job. The price was right and everyone was so happy with that arrangement. I had completely forgotten about that, and all these wonderful comments, here, reminded me. This is such a great group — they really have you completely backed up!
        And I love the comparison to algebra! You can plug any variable into a formula and just run with it, girl, and I know you will.
        Well, you may have to throw in some of that bleepin’ new math! 😀
        Grace to you, and peace, from our Father. 🙂

  7. Sweetie, contact your local county Senior Services Division. It may be called something a bit different but you should have one that is county funded and run. They will be able to help you in ways that will surprise you I pray.

    Also there should be a social worker either in the hospital that she was released from, or someone from where she is at now who can reccomend. Another wonderful resource if you have not thought of them is.AARP. I know it sounds cliches but they have been around so long for good reasons.
    They are maybe the largest and most credible advocacy group with amazing lobbying powers that can help you navigate this.’
    I also liked this site when I was caring for D.s mom.

    You are a woman of deep faith and can do anything with His Grace. I have no doubt this will be trying, and I hope you continue to share. it has to be about taking care of you too. I am sending you gentle hugs filled with strength and courage you had forgotten you have. My love to you Kate!

    • Kate Kresse says:

      Double B–thank you for the wonderful advice and suggestions. It seems selfish of me to say it will be trying—but it will be; largely because these are all uncharted waters and i am going to have to extremely adaptive. perhaps my secure feeling about some things being predictable has something to do with the rationale for loving algebra. i am an odd mix–spontaneous and just being on the go etc–which is fun, but if i have to spontaneously react, find solutions etc in brand new areas—well that is scary and intimidating. i am going to START with the support group!! thanks so much sweetie!

  8. Anne says:

    Kate, God Bless you, your mother and family during this time of transition. I will pray that all goes smoothly for all of you. I know how you feel, I was at the same place with my mom 5 years ago.
    I’m sending lots of love and good thoughts for her recovery.
    Love Anne

  9. dorannrule says:

    Kate, I can only imagine what you and your family are going through about now. The decisions are the hard part, and then coping with all the changes. I so hope your Mom improves dramatically quickly. We may not know each other, but there is another soul out here who is rooting for you.

  10. Susan Michaels says:

    The Lord uplift in His arms every care and every burden…and make it light. Prayers, Susan

  11. Gilly Gee says:

    Oh Kate I feel for all of you, what tough times ahead either way.But I’m sure there will be a way. Bless you all and take care.

  12. Kathy says:

    I feel your pain and understand your struggle. Good Luck!

  13. I really will pray for you and your family, Kate. This is a very difficult situation and one that many of my friends are facing these days. And finding clear information is indeed hard. My dad just got out of the hospital and there were concerns he’d need assisted living, but my mom has been able to arrange a visiting home nurse to come in at least a few times a week. That is all they need right now, but I think more would be available. Medicare is paying for it at least at this point. My understanding was that a doctor had to order it. So perhaps you can talk to her doctors and get pointed in the right direction. I think some of the issue is she lives in another state…each state has it’s own particulars. Let’s pray that God reveal exactly what is best for you all, and then pave the way for it to happen. I’m sure you are frustrated wanting to care for her! oxo Debra

    • Kate Kresse says:

      yes, part of the issue is she is in another state, so we are trying to handle some of it from here. my brother is there. at this point the doc will not authorize her being at home with home health care. My brother says that they can’t arrange that for(or won’t pay for) every day, and she needs help throughout each day, bt lives alone. I agree with you that we need God to clearly reveal what is best for all of us. Thanks for your lovely words of support and prayers. I hope your dad improves quickly!

  14. Caddo Veil says:

    Bless your heart, Kate! Am stepping up my prayers for everyone to have strength and joy, and peace–as you make the lemonade. God bless y’all–love, sis Caddo

  15. auntyuta says:

    I’m very touched by your writing.The way you write about your mom and consider all the possibilities how to help her best – this is so very touching. Your heart will always tell you, what you should do. And then you’ll find a way to make it possible.
    Working on making lemonade and praying, praying, praying, this should get you where you want to be. It’s good to see how you have such a loving family and how you love your mom so very much and want to do for her whatever is possible to do.

  16. jelillie says:

    I am praying for you Kate!

  17. Maria Tatham says:

    Dear ‘Trooper’,
    As you know, every inconvenience and sacrifice is worth it.

  18. eof737 says:

    Sorry to read about your mom. I hope it all gets sorted out soon and sending your family prayers and virtual hugs.

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