CAREGIVING: This week a bunch of changes occur. First of all I’ve decided to change Kathy’s insurance from Health New England as her Medicare Advantage Plan to a plan called NaviCare. It is one of the state Senior Care Options (SCO) plans authorized by Medicare and the state. I had written before about wanting to move her into a different SCO called Commonwealth Care Alliance. I called and called and told them I wanted to sign her up. I even filled out the form. But it turned out they don’t service our “zip code”. Translation: Hampden is a Podunk town,I guess.
An SCO is a state plan that combines your Medicare and MassHealth (Medicaid) funds into one comprehensive plan. She will get all of her care from NaviCare with no other insurance premiums or co-pays. I keep on getting these little bills from Kathy’s visit to the hospital. She will have to switch to a new doctor in their network. I don’t think that should be a problem. The important thing is that her aides will continue to be provided by the same agency. There are changes on that front too but I’ll know more tomorrow.
The new plan goes into effect on October 1st so I only have a few weeks to make sure everything flows uninterrupted. For example, they said I need to make sure I have 60 days worth of all of her meds in case there is a “screw up”. That is according to NaviCare. I don’t know if Kathy’s new doctor will want Kathy brought in to her office so she can examine her. That will mean an ambulance trip to and from. They did check on her meds and they cover all of those. I forgot to ask them about her feeding tube supplies from Coram/CVS. And then there are the supplies I am getting from Agawam Medical like her briefs, bed pads and other supplies. There are co-pays for the new wheelchair, hospital bed and hoyer lift I think. I don’t know what happens to old charges. It is a maze of info that I am hoping will be more straightforward with a SCO.
A week or so ago, Kathy was having a decent day, sitting in her chair. But in the afternoon she started regurgitating her feeding formula. It was scary for both of us. I used the same syringe that I give her meds and water to draw out as much food as a could out of her stomach. I think I pulled out almost 50 cc. Normally when I test to see if she is digesting it I get next to nothing in the syringe. 5 cc. at the most. I used the suction machine to get the extra food out of her mouth and off of her clothes. Of course the suctioning caused her to gag and more came up but that might have been a good thing as long as it doesn’t go down her wind pipe. I shut the food pump down and lifter her into her bed so I could clean her up. Later on, I did get her meds into her and that night I started up the pump but lowered the feeding rate down to 45 for the night.
When she came home from the hospital with the PEG tube, the instructions were for feeding her at 55 ml / hour. That’s about a quarter of a cup of food every hour. And she was to get 5 1/2 containers of the food per day. Then the nutritionist at Coram suggested that I increase it slightly to 75 ml / hour. I was having trouble because I would need to start a new bag or refill it in the middle of the night. So, the reasoning was that this higher rate would mean that she could be disconnected for an hour or more during the day and still get the nutrition and calories she needed.
This rate worked fine for a few months until this episode. The next morning I raised it to the old rate of 55 and that worked fine. By now she was behind on her nutrition. Between throwing out food that wasn’t getting into her and me forgetting to turn the damn thing on I felt I needed to get her back up to speed. I increased it next to 65 ml/hour. Unfortunately a few hours later there was a small bubbling up of stuff while I was suctioning her for regular lung gunk. I called her doctor to report. The nurse took the info and they referred us back to the VNA. So they will be doing visits again at least until October 1. The main purpose for the VNA is so that they will send a nutritionist to see if Kathy needs some dietary adjustments to her feeding schedule or a different formula. So that will happen this week too.
The other thing that happened is that the aide that was coming on Thursday went back to nursing school. The agency had lined up a replacement that was going to start a few weeks later. That day came and no one showed up. I called the agency and found out that person went back to school too “at the last-minute.” “And your case manager was supposed to call you about it.”
I waited for that call from Greater Springfield Seniors (GSSSI). Finally a few days later I called and found out that the agency was having too much trouble finding people to work in Hampden (see Podunk reference above). They wanted GSSSI to find someone else. This was for the best though. Now all of our aides will come from Medical Resources and Whitney will add the time on to her Thursday and Friday mornings. It will be easier to coordinate stuff.
But wait that wasn’t the end of my scheduling woes. It turned out Hope hurt her back again and can’t work with us. So they are sending someone new tomorrow for the companion care day (my shopping day). Hope was great so we’ll have to see.
I guess I better get to bed so I’m ready to train (if and when someone comes to help).
Somewhat confused,