Yes, she’s almost 91 and her time on earth is finite. But she’s also 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.
So this is part two of my rant about healthcare for elders when they need to be in hospital and rehab. In part one, I shared my feelings about fancy hospitals that do not have enough money left after decorating their lobbies to hire enough staff to care for the folks who are actually staying there. Now, let’s take a look at what happens to the elderly when it’s time to leave.
First, we play the Medicare Making Progress game. Mom is transferred to the hospital rehab floor where, according to the rules of this game, she has 7-10 days to make progress. You might wonder why 7-10 days? Good question. Well, this is rule #1. Medicare will not pay for more. Even though Mom was in too much pain to do much until days 8-10, the umpire declares, “Strike three,” and she’s out.
I already know how Sub-Acute Rehab Roulette, the next game, works. My father got to play it two years ago. Now Medicare will pay for 20 days in a rehab facility (AKA a nursing home), and maybe up to 99 days if Mom needs them, as long as she goes straight there from the hospital and makes progress.
So every week in her new location, we will have a “care conference” at which the physical therapist, occupational therapist, and social worker decide if there is 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’s Mom’s children (who aren’t so young themselves) 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 will eventually be a costly rehabilitation journey. But when they think the progress has stopped, we enter the final game, Go Somewhere Else. This is a very sad game. The powers that be declare there is no more progress, and she is out once again. Under the rules of this game, when Mom uses up all the money she has left for a caregiver and is forced to give up her apartment, she either moves in with one of her children if we are able to meet her needs or she is placed in a nursing home paid for by Medicaid.
Of course, this is not the ending she or any of us hope for. We hope she will be able to go back to her life as it was. We hope she will rejoin her friends at her senior living complex and continue to play penny poker and attend 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.
So we push our 91-year-old mother relentlessly. Eat. Work hard at therapy. Try to use your walker. Don’t lie in bed too much. Don’t get depressed. And she’s really trying. Her will is strong. Her spirits are generally good. Each night I pray, “Please, Mom. Please make progress.”
And I wonder if we, as a society, have made enough progress in how we treat the elderly. How should we address healthcare for elders? It's really complicated and I'll be the first to admit I don't have the answers. But as more and more Americans live to see their 9th and 10th decades, how do we meet their needs?
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