Thursday, May 03, 2007

In Memphis

By the time we got to Memphis (Germantown) Daddy was back in the Canterbury Court wing and was docile and happy. A week or two ago, he was an inpatient for several days after we found a geriatric psychiatrist and Daddy was taken off most all the drugs he was on. At his worst, it was terrible. It is a big problem when older people get put on multiple drugs and then see other doctors to treat the side effects of the first drugs....pretty soon, no one is in charge and the drug-stew makes them crazy beyond belief or causes permanent physical damage as in the case of a friend of mine's Mom.

The wing Daddy is in has a max capacity of 8 residents. Only six live there currently. Daddy seems cintent to have his nice room and sleeps a lot. They are suppose to be able to basically dress themselves (Daddy can't), brush teeth, and sit at the dinging room table and eat like one would at a nice restaurant. The ladies wear suits w/ a broach on the shoulder and one man wears a coat and tie, nor sweater and tie each day. The other man usually wears a pastel cotton turtleneck w/ a light wool or cashmere looking v-neck crew sweater over it. Nothing about the Alzheimer's wing seems like a nursing home.

I have not been to the next level of care wing. I understand that there are two more, greater intensity wings for them as their living skills deteriorate.

One thing that is very frustrating is that it seems to me that these places order all this various 'therapy' that is paid for by the Federal they take advantage of it. Part of the problem is that they order 'therapy' to cover their asses but I think it is so they can bill the patient. I came to understand that even chats w/ the various people involved can count as 'patient family education therapy'. You have to be very pro-active and try to 'second guess' what is not being said and ask pointed questions and read everything as they will all agree to allow the family to sign waivers to by-pass certain things and then present you w/ paperwork at the signing meeting that says the opposite !!!

Momma and I ended up in a meeting w/ the head knocker, the Uber-Yankee Director of Nursing, the floor nurse (LPN) and maybe someone else--can't remember--but when we reviewed the printed , itemized bill that Momma brought, no one there even seemed to know what some of the therapies charged were for. They all said, Oh we have NOTHING to do with billing, that is not our dept...oh PLEASE !

Then, after much consultation, they said, 'no problem it is Plan B" They all smiled, Momma and I said What is Plan B...they said, Oh this is covered by Medicare, don't even worry about it !!!

....the hair on the back of my neck stood up. I boldly told them that I felt like there was a matter of honor and honesty here...that just because we CAN bill the Federal Gov't for something does not mean that we necessarily should.

I told them that I was a tax payer and considered it a personal issue to know that Daddy's bill had things that he might not have needed or benefited from. I went on to say that I couldn't speak for everyone in the room, but I imagined that they were honorable enuf people that even tho they could go out on that driveway and twist an ankle and apply for disability, that would not make it the right thing to do. I considered this Plan B stuff to be in the same boat. It is one thing to do certain therapeutic things to someone who has a chance of being rehabilitate to join the workforce, etc...but senseless in the case of a 85 yr old Alzheimer's patient.

The administration of the Village of Germantown uses all this mumbo-jumbo language to refer to simple things. One has to listen VERY carefully and then say back to them what you think you understood them to say and ask if that is correct. Something as simple as a feeding tube is called some convoluted name like 'alternate means of nutrition in the NPO phase' and a few other twisted things. Some ways they reference things were just undecipherable....I had to PRESS to get an explanation I could grasp.

Now, part of this I understand. Our family prefers plain, straight talk, while others might not react as positively to direct, blunt statements. It reminded me a whole lot of talking to funeral home salesmen.

There is also the matter of how much each daily rate occurred to me mid-meeting that there might be an underlying urgency to transfer the lower care Canterbury Court to the more Nursing Home wing (Dont know its name) as the facility makes more money. I brought that up.

I was hoping that Momma was not going to get upset w/ me for exploring all avenues that I thought of, but she seemed OK sitting next to her barracuda daughter and she definitely was not realizing all the little ins and outs possibly involved. There HAS to be a lot of reading between the lines and thinking and planning ahead to avoid unexpected things and crisis situations.

There are a ton of wonderful things about The Village of Germantown , I just think they are in biz to make a profit and not get sued they try to keep the eldery alive, no matter what the quality of life, as long as possible....and they operate under tons of regulations and paperwork, so they are all used to this 'shop talk' and we are not.

I got an email today that said Daddy's therapy has been cut back to one essential (they think) service.

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