Friday, September 13, 2013

CORPORAL WORK OF MERCY or Mission Impossible?

My poor mother was diagnosed with shingles last night at the skilled nursing home where she is getting sub acute rehab for several weeks before going back to her apartment in assisted living. The Doctor who works at the nursing home told her last night after she cried hearing the news she has shingles, that she could take a week off from rehab to rest.  She just spent 15 whole days in the hospital (five of which were due to insurance red tape) after having internal bleeding requiring a transfusion of two units of blood.

Today, the nurse said she could NOT rest and that she HAD to go to rehab despite the doctor's orders. That is because her insurance would not cover a brief break in rehab. The poor woman is EXHAUSTED. She can barely stand on her own.  She needs therapy but she also needs rest to recuperate from the shingles. She has aortic stenosis and has a bad heart valve as well as having three blocked arteries. She is not eligible for open heart to have the necessary double by-pass surgery. Hence, she needs to beef up with therapy so as to get a transcatheter aortic valve replacement (TAVR) procedure in the near future.

MEDICARE refused to pay for her current skilled nursing rehab as she exhausted 100 days this past Spring in Erie (Feb-May).  Medicare does not reset until 60 days passes without any skilled nursing or  hospital stays. Medicare ended on May 20. I got a phone call while on pilgrimage to the shrine of Saint Pio of Pietrelcina on May 19 telling me my mom would be discharged on May 20. I said I would not be back in the US until May 28. The nursing home kept her for a few extra weeks but charged my mom FULL COST (over $300/day)

After returning to the US, I had to find an Assisted Living facility as my mom was too weak to live alone but Medicare said she had to leave the skilled nursing facility.

June 12 I found and brought her to assisted living in Harrisburg.  Just ten miles from my rectory.

Then, on July 22, mom suffers a mini-stroke (TIA) that lands her in hospital for ten days. A month later, she has internal bleeding and needs 2 pints of blood.

Medicare said that 60 days did not occur between her nursing care in Erie and her hospitalization for mini-stroke in Harrisburg.  I count 62 days from when Medicare STOPPED PAYMENT and when the meter started running on my mom's checkbook to the day she had her TIA. Medicare counts the extra days after she was dropped by them as non eligible counting days. Therefore, they refuse to pay.

My mom is being PUNISHED for getting sick in less time than the government allows. Why penalize the sick and elderly? Why not penalize those who ABUSE the system and use food-stamps to buy cigarettes, booze, lobster and crab legs? If Medicare STOPS on May 20, then I count May 21-June 12 as much as I count June 13-July 21 in ascertaining 60 days before resetting. The government is saying NO. They refused to cover her for those days but they will not allow us to count them either. DOUBLE-JEOPARDY. This is a gross miscarriage of justice. A law abiding taxpayer is suffering legitimate ailments and she must pay out of pocket merely because a bureaucrat has a bizarre calendar.

Now, my mom who has nearly collapsed from exhaustion and almost is over the edge, is told she cannot rest even though the nursing home physician said she could lest her supplemental insurance refuse to pay the portion of the sub acute rehab.  She is being charged $2,000 a month as it is PLUS she is paying $3,000 a month to keep her room at the assisted living center. She only gets $2,000 a month in social security and pension. Hence, my brother and I make up the difference as she has NO MORE ASSETS. Medicaid says she makes $20 more a month than is allowed to be covered by Medicaid. Medicare has draconian regulations that no one can understand. Meanwhile, my 79 year old mother is treated as if she were living in some socialist government where the state counts more than the citizen.

Caring for the poor is a corporal work of mercy but doctors, nurses, aides, and caretakers are restricted by regulations and bureaucracy that defy reason. Helping people get better and stay healthy would help the common good. The elderly and the infirm still have much to contribute to society in terms of their wisdom, experience and presence. They are one of our treasures just as are our youth and children. If we discard them or allow them to be ignored, abused and exploited, guess what? We are next. I am 51. Does not look as if things are getting better. Science and technology advance but medicine is less an art and more a business today. Health insurance companies are buying and owning hospitals. CONFLICT OF INTEREST !!!  Number crunchers and bean counters, bureaucrats and managers reign supreme while doctors and nurses are controlled by arcane regulations.

I realize health care has a cost. It cannot be totally free. But ACCESS to medical treatment is a fundamental RIGHT of every human being.  Access is denied when it is too expensive or when only the rich and only the poor are served while the middle-class SUFFER. Justice demands we do something to FIX things rather than allow the current crisis to worsen. Socializing medicine is not the answer. More bureaucracy and more regulations from state and federal authorities is not good medicine. INSURANCE COMPANIES have too much control. They determine what the doctor can do, what procedures and what equipment. That is not medicine, it is business. People are not a commodity. What we fail to resolve now will haunt us later and become a sheer nightmare.


Bill Rushmore said...

"What we fail to resolve now will haunt us later and become a sheer nightmare."

It sounds like to me from what your mother is experiencing it has already become a nightmare!

We will keep praying for your mother.

Anonymous said...

Father Trigilio, I remember that you asked us to pray to Our Lady of Sorrows and today is the Memorial. I am grateful that your mother has you as her advocate. You are a good son. And to think your mother was a nurse herself! This situation is unbelievable. Our society should bend over backwards to assist the sick, especially the elderly.

Have you thought about making an appointment to see your congressman? It would be worth the effort to send copies of this well-written "blog" as a formal letter to your congressman, two senators and the Medicare administrator, Marilyn Tavenner. Your federal representatives probably have contacts at the Medicare office who can cut through the red tape. I encourage you to follow through on these options to try to help your mom. Thank you for keeping us informed. Prayers will be offered for the Lord to bring comfort to your mom and to solve these problems.

Anonymous said...

Very sorry to hear this Father. My parents died suddenly several years ago so I have never dealt with this.I absolutely agree with You that the middle class is being left to flounder. My husband and I have eight children. Thankfully my husband has a good job, but medical expenses are killing us financially. It will only get worse for us under the new healthcare act. The children and I will pray for your mom. I hope she can rest and recuperate.

Anonymous said...

Dear Father:

Please give your Mom a big hug (carefully with the shingles) and let her know she is being sent good thoughts and prayers from one of your blog readers. Shingles pain is so difficult, my heart goes out to her and to you.

God Bless you for being such a wonderful son.

Thank you for sharing this and thank you to your mom for raising such a wonderful priest.

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