NH is a character. Eighty years old and disabled from arthritis, you still see so much of what he was when in full force. He is funny, sure of himself and self-deprecating at the same time. He used to be rich, a millionaire he tells me (I think last of a couple generations of inherited wealth) until he finally lost the last meaningful bit at the casino. When he had money he used to give me gifts that I tried to refuse— a Swarovski crystal turtle, a wooden sculpture of a monkey scratching…..
He lives alone, no family to speak of to help him but with some kindly neighbors. Lately they have come around less because he smells bad. Too many accidents when he couldn’t get to the bathroom on time and the inadequacies of a sponge bath.
So last week after he fell while an occasional caretaker was giving him a shower and he couldn’t get up the paramedics brought him to the hospital. Nothing was broken. There was no fundamental change in his status but he was just too weak and in too much pain to get up.
After a few days in the hospital he could walk with some assistance and the wheels were in motion to discharge him. The hospital doctor said he didn't actually meet criteria for admission in the first place, anyway. But NH was worried so I contacted the hospital doctor and inquired—
I see that he is getting close to discharge but I don’t think he is likely to make it and will soon be back. Do you think you might be able to arrange a skilled nursing transfer for physical therapy?
The hospitalist responded right away, explaining that my patient met criteria neither for skilled nursing nor for hospital admission yet because he was unsafe for discharge he would be kept in the hospital for now. He quoted the case manager outlining this inane situation and concluded :
Yup, some disadvantages with insurance...
So here we are, 6 days into a hospital stay, certainly upwards of $10,000 spent because our system will put money into hospital care even when not meeting criteria and yet will not pay either for appropriate rehabilitation nor for the type of home care someone might need to stay safely, and less expensively, at home.
Just another day…..