My mother had a massive stroke in November. In the four months since, my father has been in an almost constant battle with the medical professionals working with her. It began when in ICU, when they wanted to move her to a regular room. Then once she was in another part of the hospital, the personnel there wanted to move her to a nursing home. Now that she’s in skilled nursing, we’re fighting to have physical therapy given to her, in addition to their wanting to get her moved to long term nursing.
In order to save her life, the doctors in ICU threw the kitchen sink at her with the nurses telling us that they had never seen doctors do these things together before. One drug was so regulated that the pharmacist had to bring the drug to the room and give it to her himself. All of this effort finally stopped the bleeding into the brain, which was at that time a massive amount of blood. She didn’t lose consciousness and had good mental acuity throughout the process. Her hearing was exceptionally good, so we had to warn people about whispering around her. However, she did lose all ability on her left side (arms, legs, and vision). Once it was determined that she was no longer at further risk of additional bleeding, our battles with the medical professionals began.
The main driver appears to be the strict regulations that Medicare places upon payments for services. (Medicare has basically taken over healthcare for seniors, my parents being no exception.) So even though my mother was unable to stay conscious and had significant brain swelling and blood in the brain, once she was stable, hospitals want to move you out of ICU. The decision was made by the hospital regardless of the desires of the family or patient. Fortunately, my father was able to delay this decision for a few days.
In her second room, the same scenario developed. Once she was in this room, they were telling my father that he had to be prepared to move her to a skilled nursing home. Again, the decision of when she’d be released from the hospital was their decision, irrespective of patient or family wished. Father was again able to delay this move for about a week, but finally, the hospital told us we had to move her.
All of this results in my mother moving to skilled nursing before she had recovered sufficiently from the stroke to benefit from skilled nursing. The nursing home then discontinued therapy (first swallowing, then physical and occupational) after a month because she had plateaued. (Plateauing is not a reason for discontinuing therapy as per Jimmo vs. Sebellius court decision. NY Time article here.) The nursing home would not allow us to pay for therapy out of our own pockets (citing a violation of their ethics since if they believed it was worthwhile, they would be able to bill Medicare for it).
Living a long distance from my parents, I visit once a month for about a week. I just returned from a trip there and noticed many improvements in her situation. Granted improvements are slow, but she does have strength and some control of her left leg, and there is tension in her left arm upon command. More important is that her mental condition is much better. In February, she would simply lie in bed however, this month, she was fidgeting in bed and moving herself around. Were she to arrive at skilled nursing today, I believe that she would be able to perform the activities the therapists require and would be on an improvement path.
My conclusions are that the medical professionals were unable to see my mother in any prism except the constraints of Medicare. These one-size-fits-all approach causes the medical professionals to be the enforcers of Medicare policy and thus in conflict with the patients and families whom they are serving. With the prospect of the federal government prosecuting and fining the medical personnel and facilities, as well as refusing payment, it’s easy to see why they would rather fault on the side of Medicare than on the side of the patient.