Friday, July 27, 2012

73 Days

“Seventy-three days per calendar year for developmentally disabled recipients” are what Robert gets when he lives in an Intermediate Care Facility for the Disabled (aka, New Home) in California. Robert’s home is reimbursed through the state Medicaid program (Medi-Cal) and they will lose funding for the days he is not at the home if he exceeds 73 overnight visits. 

This was unknown to me until after day 51 and New Home called to tell me we were on track to exceed the limit this year.  What?  There’s a limit? I was incensed but not surprised there would be such a rule.

Counting last weekend, we’re at 53 and it’s not yet August.  With holidays and doctor appointments (when I sometimes keep him overnight), we’re on track to be about 50 days short.

I was so disappointed when I learned of this and immediately worried about Robert’s reaction. Robert loves coming over!  I understand New Home has to get paid and understand there are very specific rules about Medi-Cal funding.  I'm still disappointed.

I don’t remember reading anything about a limit on the amount of overnight visits so double-checked the original “move-in” documents.  There’s a passing reference to overnight visits and checking how many days a client is allowed to have but nothing about a limit of 73 overnights (it is in the Medi-Cal regulations, however).

Again, this is another example of New Home not being used to family involvement.  They deserve credit for at least telling me about this rule before we hit 73 days in October (right before more doctor appointments and the holidays).

Yes, take note.  That’s me giving New Home credit for something.

This is disappointing but it isn’t something I can fix with conversations with varying levels of supervisors at New Home. Because I love to dissect rules to figure out where they originated, I have tried to figure out how the magic number 73 was decided.  The best I can guess is the people writing the regulations allowed one overnight per weekend, plus several days for holidays and a vacation and maybe a birthday. 

This year, Robert has spent Saturday and Sunday nights with my family and either my husband or I have dropped him off at Day Program Monday morning.  I love visiting with the Day Program staff on Monday mornings and getting updates on how Robert is doing. 

My husband, Robert and I have a great routine on Monday mornings (hubby makes coffee, breakfast and his lunch while I get Robert washed up and ready for the day) and although it’s taken months, we’ve been able to speed Robert up to a reasonable pace for a workday.

When dropping him off at Program, I remind Robert I will pick him up the following Saturday.  He still calls every Friday to ask if I’m going to pick him up the next day.  I don’t know if he’s actually forgotten or if he’s just worried about my memory and thinks I might forget him. 

Robert clearly enjoys coming over to our house even if nothing is planned although there’s usually some mix of a barbeque, a haircut, movie, card games, word search puzzles or just relaxing watching his favorite television shows. 

There’s always family around to talk to, dogs and cats to be amused by and Rocky Road ice cream to eat. 

The benefits of having Robert over for two nights (three, if it’s a holiday weekend) have been enormous.  Robert loves his weekends here (although I’m not above thinking he’s here just for the ice cream).

I will check to see if there’s a way to pay the per diem rate for any days we go over the allotted amount (it pays to re-read the original move-in documents) but, I suspect, we will be limited to the 73 day rule. 

I haven’t told Robert yet because I’d rather talk to him about it in person and want him to see it won’t be that much different.  We can still pick him up on Saturday and keep him through dinner on Sunday.  He can get ready for bed here and then be driven back to New Home in time for bedtime. 

We’re losing the weekly connection I have with Day Program on Monday mornings but they are so good about communicating that I’m not worried about my relationship with them.

We’re going to make the most of this 73 day limit as there’s still a lot that can be done in 73 days. 

We’re still getting six haircuts and mustache trims a year (well, Robert is; I don’t have a mustache in case you were wondering);

That still allows catching up on 260 episodes of Jeopardy (Robert doesn’t mind repeats);

That’s 73 chocolate shakes and cheeseburgers;

Three word search puzzle books;

At least 30 black, clicky pens;

Close to 292 times of petting Sassy, our Toy Pomeranian, and telling me how cute she is;

Most importantly, it’s 146 scoops of Rocky Road ice cream.

I think we can make this work.


Anonymous said...

Rules... and this is one of my least favorite. There are so many people in care facilities that don't have family that even come to visit! :( So sad! When we have family come in and want to take their loved ones home for a night or two, it makes me want to celebrate!!! I can't tell you how much it means to those residents. You can see it on their faces. 73 days... Doesn't seem long enough. I hope the adjustment is not too difficult for Robert and you.

All my best to the both of you.

Trish Hughes Kreis said...

KR, It's always great to get your perspective since you work in a care facility. I'm grateful for the 73 days (as I'm sure you know, regs for other facilities dictate fewer days). I took Robert back to his facility last night and it was odd waking up without him here.

Thanks again for everything you do to make your residents' lives a bit easier and happier. I know you do a lot!