This should be a cautionary tale to all of you.  What I describe could, and may, happen to you, your parents or someone close to you.

The scene: two large southern cities in the year 2009.  Main character: 86 year old lady.  Supporting characters: son and daughter-in-law in another city, the chaotic medical community.

My 86 year old mother-in-law has lived alone since her husband passed away in 1977.  She lived in a nice condo in a very good part of town, had sufficient means for a decent lifestyle, had a good circle of friends, drove her Honda Accord all over town and was in pretty good health.  She took no prescription meds and her doctor was generally amazed with her overall health.  Her well-ordered and active life came to a screeching halt in January of this year.

Her son received a call from one of her friends that his mother had injured her leg and needed emergency medical help.  Two days before this call, a friend had taken her to the doctor because of a swollen ankle, but the doctor could find no cause and sent her home with pain killers. Why no xray?  Medicare.  Now, the swelling was cutting off circulation and her leg was turning black.  She was sent to the emergency room of a nearby hospital.  Thus begins the story of the downward spiral toward death of a sweet little lady who depended on and trusted the medical community.

She was hospitalized for 5 days.  Diagnosis was a fractured ankle.  While there, she was administered Oxycontin and a variety of other medications for pain and anxiety. These drugs caused severe disorientation and nausea and propelled her into a downward spiral. The drug literature for Oxycontin states it should be administered with extreme care to the elderly, if at all.  She was discharged to a nursing home for recuperation because she could not put weight on her injured ankle and was diagnosed with dementia.  She had no dementia prior to admission, so this was drug-induced.

The first nursing home was the pits of hell and she suffered indignity after indignity.  She dropped ten pounds in the first three weeks, became incontinent, became addicted to Oxycontin and delirious from the drugs. Daily racking nausea, a reaction to the drugs, weakened her severely.  We knew we had to get her out of there, but she did not want to leave her community of friends to come live with us in another state.  We were on the waiting list for a room at a decent nursing home in the area, her son was traveling back and forth the 450 mile round trip between cities several times a week, with other family members checking on her daily and I was in another city with a commitment for two months and could not leave to assist.  This was not enough to insure her care.  By the time the transfer became available, she was addicted to Ocycontin and so weakened that her life was in danger.

Although the new nursing home was light years better, the prevailing attitude was minimal care, drugs rather than diagnosis, and get her off Medicare.  Medical decisions were regimented and minimalist while Medicare was paying the bills, and we were still out of town during a large part of the week. We knew if we didn’t move her closer, she would die.  She reluctantly agreed that moving to a place near us was the best solution, and after a very careful process, we moved her to a facility near our home so we could be with her on a daily basis to help her bounce back.

We chose a facility with the best reputation in our community.  Her Medicare days were exhausted, so she was now completely private pay.  Her Medicare Advantage plan only paid when Medicare paid. So it paid nothing.  When Part D Drug benefit was implemented, her private company dropped her and she was never enrolled in Part D, so all of her medications were private pay also.  She did not know this. She had a long-term care policy that cost her $200 per month, and it paid $100 per day. We moved here here in May.  The cost for her care for the month of July was over $400 per day ($12,400) , all but $100 per day paid out of her own pocket.  But I digress.

We moved her here May 15. They didn’t have a private room, so they moved her into a room with a dying woman.  Unknown to us, the dying woman also had one of the deadly community diseases, c. difficile. Highly contagious and often deadly in the elderly.  According to all literature, this should never be done.  Residents with this infection are supposed to be isolated so they can’t transmit the infection.  We did not know this and were not told the woman had the infection.  Big problem. Another problem, my mother-in-law was left in the bed for two days while we waited for a wheel chair.  She developed blood clots.  Three days after arrival, she was rushed to the hospital for pulmonary embolism.  Discharged after two days, she was sent back to the new nursing home, where we found out that she had contracted c. difficile.  They pointed fingers at the hospital and tried to cover up the fact they placed her in a room with a resident with the infection when she first arrived.

Thus begins the end game for my mother-in-law.  She would be dead if I did not watch and review every move made by her caregivers in the nursing home.  They were not up on the latest treatments, kept saying “Medicare won’t pay for that” when she was private pay while I am  insisting on more aggressive treatment, using the cheapest least effective drugs and making mistake after mistake in her care.

For $400 per day, my mother-in-law gets blood clots, bedsores, drug overdoses, bladder infections, bronchial infections, c. difficile and largely incompetent care.  And this is a good nursing home.  I have had to nearly become a physician and challenge every step of her care.  Without my intervention, she would be dead.  Medicated to death in a drug stupor while she dies of treatable, if not curable, diseases.  They would rather treat her pain with morphine than cure a bladder infection with antibiotic.  I even had to demand a urinalysis for this simple problem.

We are at the point of no return with her now.  She is dying. She is too weak to do the tests that should have been done in the first hospital, but were not done because of prevailing attitude and Medicare pressure.  Yes, at 86  she was in the end years anyway, but I wanted some good time with her.  I didn’t want this.  Her treatment in the medical community, largely because of the attitude toward the elderly created by Medicare, has hastened her death.  There is much more to this tale, but you get the idea.

And we ain’t seen nothin’ yet.