I have an aging parent in a nursing home. Dad left home 88 days ago for Methodist Hospital Emergency Room, because… he said: “I don’t feel well”.
Dad, 87 years old, needed prostate surgery. Once we identified the problem, we had direction. He needed to repair a hole in the bladder and rid him self of infection before the operation. After the operation, he would need time to repair from the operation, rebuild strength and then go home. All very simple.
How long could that take? Oh and by the way, the cost of all of this was never a factor.
Now don’t get me wrong. I never gave cost a second thought. When we first signed in at the hospital resignation desk, the Blue Cross Blue Shield insurance card was laid out on the table. She typed the numbers in to the computer and off we went to be fixed.
At some point I was introduced to the term “Medicare.” Now remember, I am a guy and I have not been sick. So, the word Medicare was not a word that meant much to me. I then began to slowly come to understand Medicare has something to do with Social Security or it is some how related to Social Security, I think. You know I am still not sure how it really works. Because Dad is 87 years old, I started to believe Medicare was paying all the bills. Keeping in mind, no one is telling me or Dad anything about what this process is costing. The doctor comes into the room and says to Dad and myself… “We need to do this procedure or that procedure.”
Excuse me Doctor, what is “this or that” going to cost? No… No… No… You sit around with Dad in his hospital room and talk about anything other than what it is costing. I mean let’s face it… you know it’s costing an arm and a leg, but hey, that woman downstairs typed in the Blue Cross Blue Shield insurance card number in to the computer, and between insurance and this Medicare thing, it’s covered.
Sixteen days at the hospital and Dad is now stable.
“You can’t stay at the hospital, any longer. You need to go away and then come back”
I now discover I need to move Dad to an Extended Care Facility so Dad can re-gain his strength and be ready for a prostate operation back at the hospital, a date to be determined at some point down the road. So, where do I take him? “What is an Extended Care Facility?”
Enter hospital social worker. Why we have all kind of options for you and your Dad. You can take him to Shady Trees Retirement Home or better yet what about Whispering Sheets Convenience Nursing and Health Care / Rehabilitation / Long Term Care Center… Tell you what honey, I will see if they have any room…
“I’ll put in a good word for you, (as she winks at me) maybe we can get your Dad in there… Oh, Steve, they are good people. And care about what they do. Your Dad will just love it there.”
I have but a few days to decide. There is no time for dilly dallying. I run here and I run there, trying to decide where to take Dad. They all ask the same question up front. The most important question of all… “Money.” They ask it in different ways. But they always ask…
“How old is your Dad? What type of insurance do you have?”
Loosely translated it means… do we have a blank check book? It became clear real quick, it did not matter where I took Dad, they all could smell Medicare, and Blue Cross and Blue Shield money. They know how to work the system and work it they will. So… I could take Dad to Down and Dirty or Lush and Plush and it didn’t matter, D&D or L&P were going to charge Medicare and Blue Cross and Blue Shield the same. So, I choose “Lush and Plush.”
I want Dad to stay in a nice place… Right? So I choose Marquette Manor. I was told up front, Marquette Manor had it all, and I want it all… for my Dad, and I want style too. TV in every room, great food in the dinning room.
“Steve, did you check out the stemmed glasses sitting on the white table clothes in the dinning room? Did you notice the number of pieces of silver wear we set out at each meal, the small vase of freshly picked flowers in the center of each table? Did you see the waiters and waitress in white shirts, black pants, all wearing a black bow tie? And our care givers are professional in every sense of the word. We here at Marquette Manor have a physical therapy area too, then at some point Steve, (His voice lowers and he becomes serious and very focused) we have an upstairs where we can move your Dad into “Long Term Care.”
The sales pitch was good. We here at Marquette Manor can do it all. I missed the emphasis on the “long term care” part and the de-emphasis on the physical therapy part. Here is another little rule I forgot that applies to life.
Let’s say you want to change your life style. What ever it is. Let’s say you want to stop smoking, or you want to loose weight. In order to adopt a new life style you have to change your habits for at least 21 days. You can change almost any life style, if you give it at least 21 days. 21 days is needed to adopt any new life style. Now let me say this about the 21 day thing, it works about 80% of the time. But, is the glass 80% full or 80% empty? It works for about 80% of the people who us it.
What I forgot was… it will also work in the health care industry. If you can get a guest in your nursing home to lay down in your bed, for at least 21 days or longer, you have a greater chance to keep that person “long term.” Remember Marquette Manor needs to fill beds and keep them full. They don’t make any money putting people in physical therapy or sending them home.
Now the sweet part of the health care industry. Medicare is going to be a partner and give the nursing home the opportunity to reprogram this patient. The nursing home gets 100 days to do it! The care giver, in this case, Marquette Manor, has 100 days of Medicare money to get my Dad reprogrammed and accustom to staying at Marquette Manor, long term, and Medicare picks up the tab for the re-programming.
The folks in physical therapy need to draw out the process. We can’t get our guests feeling to good to fast. The guest will want to go home. And if, like my Dad, the guest refuses therapy because it hurts or it is painful or causes discomfort… we at Marquette can justify in our report to Medicare and insurance why it’s taking additional time to rehabilitate. Life is beautiful, and the money keeps flowing.
Listen, I could be wrong about all this… But, I have been looking at the bills coming in and I can’t believe my eyes. When Dad went to Methodist Hospital, February 12, and was then released to Marquette Manor, Dad’s stay at the hospital the first time was sixteen days. The hospital invoice only, came to, one hundred sixteen thousand three hundred dollars.
I opened a bill from the company that transported Dad from Marquette Manor to Methodist Hospital for his surgery on April 16th. The vehicle was a wheel chair van and the cost to transport down to the hospital was, four hundred ninety seven dollars. By the way, the cost going back a week later was the same, four hundred ninety seven dollars.
Health Care is big business. And I am hopeful Dad will be one of the 20% that won’t reprogram into the system.
