Caregiving Chronicles: Medicare might give up on mom, but we certainly won't

raise the roofGuess who's going to rehab!?!? No, not your favorite celebrity starlet. Well, maybe.  But I'm talking about none other than my mom, Ardie Ho-Ho.

Get excited, G-dammit!

Since January, Ho-Ho hasn't walked much. We sherpa'd her to the bathroom enough times to realize that her MS was being a real bitch. Although she was hospitalized for two weeks, her admission status was in fact "under observation", not "in-patient". Big deal? YES, BIG EFFING DEAL!

Although her doctors and therapists recommended she be transfered to a skilled nursing facility for rehabilitation, she didn't qualify as she was never technically admitted and thus could not meet the "three consecutive midnight" requirement.

(Read Medicare guidelines for SNFs here)

WHAT? Yes. Medicare rules state that if hospitals keep patients listed as "under observation", Medicare can deny certain types of in-patient rehabilitation (coughbullshitcough).

Read more about this ridiculous guideline in the Washington Post. Seems like paying for rehab vis a vis SNFs could very well cost insurance companies less in the long term and even enable folks to get back on their feet and contribute to society (i.e., pay taxes). But what do I know?

Fast forward to March and, after a month of bi-weekly PT and OT sessions, little Ho-Ho still isn't walking. Her monthly home-care fees are jacked up to cover the costs of wheelchair transports, laundry and shower assists and she is turning into more of a recluse than I thought previously possible. What.the.hell? Especially confounding is the fact that medical professionals agree she requires a level of care that was ultimately denied due to an administrative decision.

I was informed that if she continues on this trajectory, the next step is a nursing home for this semi-independent 56 year-old-woman. As if that isn't depressing enough news, due to her dual diagnosis (medical and psych), most nursing homes won't consider her a candidate for residency.

Add that conundrum to a potential buyer withdrawing his offer on our currently "For Sale" condo, getting waitlisted for 20 (!!) Chicago Public Schools' kindergarten classes and five inches of snow, and get something I like to call YESTERDAY.

But here is the silver lining. After two hours spent in snowy traffic, we met with Dr. Silwa at the Rehabilitation Institute of Chicago - our last hope after I found a little Medicare loophole that allows coverage of Inpatient Rehab Facilities (more info here) without the the in-patient stay ridiculousness.

Arden did her best to convince Silwa that she didn't need rehab ("Oh yes, I get in an out of the shower independently! I can dress myself. The Vice President of the U.S. is Dick Cheney") and he still offered up intensive outpatient therapy. Apparently you get more bang for your buck that way.

I could hear my voice shaking when I asked the location of the facility and Sliwka informed us that RIC provides transportation and she will go three to five days per week for up to five hours a session.

Sweet mother of pearl! TRANSPORTATION, FOOLS! Cue BIG FAT UGLY CLAIRE DANES TEARS. All over the place.

It was glorious.

I'm not in denial about the progression of Ho-Ho's disease. She is transitioning to secondary-progressive MS and refuses to try all disease modifying drugs. I am certain her's will be an ugly and devastating decline. However, I also want need to feel certain that we did everything in our power to prolong her ability to live comfortably and maintain some autonomy before MS steals what little she has left.

Plus, I don't have time give her baths - I've got to figure how I can unload my kid onto a Chicago Public School!


Like this post? Check out my other caregiving stories

Caregiving Chronicles: Only quitters give up smoking

Caregiving Chronicles: Silver Linings

- Caregiving Chronicles: Why Can't Physicians Communicate?

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    Annie Swingen

    Chicago-based hyperbole enthusiast. Mom to a kid and sometimes my mom. Overboard (1987) obsessed weirdo. I like the funnies in life.

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