We Will Worry About that Tomorrow

 Well, as the internet says "It's been a long month this week". When last we talked, my father-in-law was in the hospital with a broken back and other big health concerns.

I checked him into a nursing home yesterday, forever.  It played out exactly how we needed but so much quicker than we were prepared for.

The hospital kept him for five days: Friday Night to Wednesday afternoon, which includes Three Midnights. (this is important)  They stabilized him as best they can due to the health issues he has.  We were a little confused as to why they didn't keep him until they were resolved.  But we figured, it was a financial decision because our health care system is broken.

It was coordinated with the care facility where he was before and they arranged transportation.  All I had to do was show up to complete the intake. 

Having him in an adult care facility instead of a skilled nursing facility (referred to as SNF. "Sniff") when it was determined it was no longer medically necessary was our next option. He could not return home.  To do that,  I had to register him for Medicaid because he wouldn't be covered by Medicare after he was considered "healed and healthy".  This is a tedious process and takes a long time.  (please have Power of Attorney, Release to Share Medical Information, and access to accounts for your elderly parents. I beg you)

And it turns out that he is considered "over-income" for Medicaid because his social security benefit is on the high  end of the scale AND he has some savings.   We would have to "spend down" his savings and checking in a very limited way in order for him to qualify.  Essentially we would need to make him destitute.  HOWEVER, the fact that his social security benefit was "high" it made him "attractive" to more care facilities.  It's outrageous.

Meanwhile, the hospital changed his hospitalization status and he had to stay Three Midnights in order to transfer directly to a SNF and have Medicare pay for it.  They will pay for his care if he "medically qualifies" and that was achieved yesterday.  He was fast-tracked to a SNF.

During the intake, the twelve-year-old admissions person was going through insurance and supplemental plans and mentions "Oh, he's covered for 100 days and it will be easy after that..." and "Oh good, he has Medicare Plan G".  We were understanding that the first 20 days were paid and it was contingent on evaluations for the following 30 days then we would have to switch to Medicaid.

So, I asked "For clarification, what you're saying is Medicare will pay for this whole thing, until the...end?"  She said yes.  He medically qualifies for Medicare to cover his stay.  

I was relieved that we didn't have to spend all of his money and I didn't have to keep jumping through hoops AND that it was covered.  The end result and/or reason for this had not occurred to me yet.

Then I met the social worker assigned to Dad.  He is fabulous.  I loved him ON SIGHT.  I think Mom and her siblings conspired from the Great Beyond to send this man to us.  He's amazing.

We sat down to go over health issues and concerns and what landed him here in the first place.  We discussed what our expectations were "Safe, healthy and happy" and that we can no longer provide that for him.  He responded with "Of course you can't. It's too much"

Then he asked what Dad likes.  I had to think about it and said "Flirting. He will flirt with all the ladies" which they laughed and said would be fun. Then I said "Sugar.  He loves treats but he's diabetic."  Brandon said "Then we'll give him the treats.  Why not?"

And it was like a punch in the face.  Why not?  Because we're at the end.  Why are we worried about it at this point of life.  Give him the cookie.

Then he reviewed the orders from the hosptial and asked about any appointments.  I mentioned that the hospital advised that he have a follow-up appointment with his regular doctor in  two weeks.  I asked if they felt that was necessary.  Without a beat he said "No, because we got him."

Deep breaths.

Then he asked about a scheduled cardiac stress test and an evaluation for a surgical procedure that was scheduled prior to the accidents. I explained that it was because he was falling all the time and they were  trying to determine a) why and b) do a procedure so if he fell it wasn't a panic situation.  Brandon said "But why? to what end?  He's here now.  He's 85 and at the end of his life. Why would we put him through that?"

I was flooded with relief and with just abject sadness. Mix in a little validation as well.  Moreover, I didn't fully realize until I was walking out of the facility that This is It.  We're at The End.

This is why the hospital didn't keep him.  This is why the hospital didn't have a treatment plan for his blood pressure, fluid on his lungs, and edema.  There is no fixing him now.

I don't remember who it was now, there's been too many people.  They said "You did it. You kept him safe and healthy and home for as long as you could.  Now he'll be safe and happy here.  You did it, you're done now."

It has to be acknowledged that he can "rally" and yes, it's similar to the rally that happens during Hospice.  Even if he did, it would be short-lived.  It would not be enough for him to return home. Even if he suddenly became physically stronger, his mental status would not allow it.  

Because all of that wasn't enough from the Universe.  In the last two days, my father-in-law developed Hospital Delirium.  It's like dementia, caused by an underlying condition and/or trauma.  He has a myriad of underlying conditions - including dementia - and trauma so he is the poster child for this.

It includes memory loss, agitation, and hallucinations; all of which we've experienced with him. For him, it will most likely not resolve because at his age and advanced health and now in a SNF; it's unlikely.  Even if the Delirium resolves, he is not mentally capable enough.

That was the icing on  the cake for the Medically Necessary status determination.  

It also makes this easier because he's not fully cognizant of what's happening.  As far as he's aware, he's just there until "he gets stronger" and our scripted response to questions about the future is "We will worry about that tomorrow" until we run out of tomorrows.