Getting back to normal (sort off)

CAREGIVING:  Yesterday Christina from Baystate VNA came for her weekly check on Kathy and to discharge her. Basically that means that Kathy’s condition after the hospital stay has stabilized. Her blood pressure and Oxygen levels are as good as new. I’m managing her feeding tube OK and keeping her throat free of mucus. Her diaper rash is getting better. And we have help now: enough for me to get out of the house for an hour or two at a time. The equipment and supplies we asked MassHealth and Medicare for months ago are finally drifting in. Apparently the fancy wheelchair we got excited about in April has  been approved. They are busy growing the rubber for the wheels and painting the chair purple in China.

But normal still feels scary. Even though the nursing visits were only once a week, it was good to have someone to validate how I was doing stuff. It was a visiting nurse who realized Kathy was in trouble and called an ambulance during one of her regular visits. I do have a call into Dr. Dorantes’ office to see what I should do when she has trouble again. Our nursing aides come every day and they help a lot with stuff. But they are not nurses.

I am also looking into a different health insurance program called Commonwealth Care Alliance (CCA). If I understand it correctly, CCA takes over the Medicare and Medicaid/MassHealth funds and administers them more efficiently. It is an HMO-like state program that eliminates the need for the Medicare Advantage Plan Kathy has. (sounds like the “public option”) The general feedback I have received from nurses and other therapists that have come by are that it would probably be a good fit for us. Getting things like supplies and equipment would be a lot easier. The key to me will be keeping Team Kathy together. I need to make sure that the health aides that I lean on will still be covered. So far it seems very likely. The only gripe I have is that CCA hasn’t returned my requests for info. Greater Springfield Seniors referred us originally. When i called to check on it they said Kathy was “put on hold in June for some reason.” I’m guessing that was because she was in the hospital. I told them in July she was out of the hospital. Last week I called to tell them she was still out of the hospital.

Another competing state insurance plan did contact me and they are persistent to the point of annoying. Summit Elder Care works on a different model called PACE. It is like CCA in that it combines your Medicare and MassHealth funds. Their services are based on the idea that the patient goes once a week or a few times a month to their daytime facility in Springfield. A one-stop-shop (like Kaiser Health when they were still in our area). Kathy could see the doctor there. Get physical therapy. Massages. They might give her a shower and even cut her hair if she wanted. Every member’s treatment plan is individualized. They would send nursing aides to the house. In Kathy’s case they were willing to do everything here: The intake and evaluation and then the nursing services because she is bed-bound now. My issue is that Kathy is very comfortable with the health aides we have and her doctors so it doesn’t make sense to have her go through that much change. I do think if I were in the same situation I would probably enjoy that outside stimulation. But Kathy was always happiest with just a few people at a time. Preferably one person at a time.

Coram feeding form
Form in duplicate from feeding supplies company, Coram.

We’ll see what happens. I seem to spend an incredible amount of time filling out forms for one thing or another. It is incredible how much paper is wasted. MassHealth sends every notice in duplicate just to make sure I guess. Every letter has an extra sheet of paper saying “This is important. Get it translated” in a bunch of languages. Everything is still regular snail mail: no eBills or eStatements. The picture above is a spliced panorama of a form from Coram/CVS, the company that provides our feeding supplies. This is how they get paid from the insurance company or MassHealth or Medicare. There are whole pages of the form that do not apply to Kathy but they print it out anyway. The form is just as large for one part that they overnighted to me. Another funny form came from a local medical supply company. When they delivered cartons of adult pull-up diapers (like depends) I had to sign a form that said acknowledged that they don’t do installation. I said, “Understood. I am the installer.”

The biggie lately was re-qualifying both of us for MassHealth under the Affordable Care Act. I had to update my information about my income and Kathy’s income from Social Security and lots of other stuff so she can continue to get help.  Lisa, the social worker from the VNA, came to help me fill out the forms because I was befuddled by some of the financial terminology. I’m still sure they will write back, in duplicate and ask for something else.