Priorities: Patient or Paperwork?

When I took Robert to a walk-in clinic on Monday, I knew it wouldn’t sit well with his Care Facility (otherwise known as “New Home”).  It had to be done, though.  Robert had a cough for several weeks which I asked to have checked out several times but the doctor Robert had seen at the Care Facility thought he was fine.  When he was at our house, he was running a fever and clearly not himself.

He was most certainly not fine.

A doctor’s visit was in order so I took him in and Robert was immediately put on antibiotics.  It was a strong prescription so had 10 days of medicine packed into five days.  Since he was staying with us for a few days, we gave him days one and two; New Home only needed to give him days three through five. 

New Home never likes when I get prescriptions for Robert without going through them (hey, I feel as if I tried. I told New Home Robert was sick and their doctor said he was “fine.”).  You missed your chance, New Home.

My mistake was in forgetting to get the discharge paperwork from the clinic that saw Robert.  I got the script, just not the discharge paperwork.

Boy do I regret that mistake.

After the appointment, I picked up the prescription.  I paid for the prescription.  I even emailed several members of the staff at New Home (which included House Manager, supervisor of House Manager and Nurse Ratchet) and explained why Robert needed the medications, where they were located in his bag and when he needed them. 

Of course, the directions were also listed on the label on the box of medication.

For those on pins and needles: I was even very nice about it (and refrained from addressing Nurse Ratchet by my pet name for her).

I know – I was surprised at how nice I was too.

The email I got back was from Nurse Ratchet was dripping with sweetness (hey, she stole my trick).  Bottom line: they can’t give him the meds without the discharge orders from the clinic.

Fine.  I call the clinic to get the discharge orders faxed to me but they can’t do that because I didn’t sign a form saying they had permission to fax me anything (the one form they didn’t have me fill out, apparently).  I would have to pick up the copies in person.  The clinic was nearer my home than my work and they closed at 5:00 p.m. so there was no way I would be able to do this without missing a chunk of work.  I’ve already missed work this week so chose to pick it up in the morning.  I understood their reason for not faxing the paperwork (confidentiality) but hoped this wouldn’t prevent Robert from getting his medication.

I personally would choose medication over the slight possibility of an infringement of confidentiality but the clinic does not.

I turned my attention back to New Home.  Can you please give Robert his medication tonight and I will fax the paperwork to you tomorrow?  No, they can’t (of course not).

I suggested I come over and administer the medication myself which I didn’t want to do because it would be an extra hour and half I didn’t plan on for the evening but I would if that was the only option.  Apparently, I actually couldn’t even do that because the medication was now in their possession.

Wow.  The screaming in my head couldn’t get any louder.

If Robert doesn’t get the antibiotic tonight, there is a risk his infection will return.  He’s on the mend and I’d really rather have him feeling well than back to coughing and feverish.

Call me crazy but it really doesn’t seem like too much to ask.

New Home’s solution was to copy the medication label (with all necessary “legal” information already on it!), fax it to the New Home doctor, have him write another prescription for the medication (the same medication now in their possession), have his office fax the script to New Home and then, if they get it in time, New Home will administer the medication tonight. 

Are you kidding me?  I’m surprised they didn’t have to actually pick up a new pack of pills.

If I had sent Robert back to New Home with a baggie full of unlabeled little red pills, I could understand the hesitancy to give him a pill.  I assure you, that didn’t happen!

I sent him with a brand new prescription, properly labeled, properly prescribed and he may not get it because they don’t have the “sufficient” paperwork. 

And in this case sufficient equals overkill.

I understand the facility has rules to follow and forms to complete in order to stay within the State’s regulations but when the paperwork becomes more important than the patient, there is a problem. 

The clinic, the care facility and the state (because of their rules and regulations), have lost sight of the priority: the patient.  

How has that happened?

It shouldn’t be this difficult to administer an antibiotic. 

Thankfully, at the end of the day, the New Home doctor faxed the prescription making Robert’s antibiotics “legit” and Robert was given his dose for the day. 

Maybe tomorrow everyone can work on their priorities. What form can I complete for that?

Making Sense of Healthcare Coverage

Let me start off by saying I am very grateful for the government healthcare assistance Robert receives. Really I am. Sometimes, though, I am left scratching my head about coverage decisions!

1. Vision care. When Robert first moved to a care facility in Sacramento, he needed a primary doctor and I also thought it would be a great idea to get his eyes checked and for him to see a dentist. I was fairly confident he hadn’t seen either in quite some time so wanted to take care of this for him. The primary doctor was priority number one so arranged that using the doctor affiliated with his first care facility (he now has a new doctor that is affiliated with New Home and will have yet another one once he moves in with me). Eyes and teeth were next but before the eye appointment, I bought Robert reading glasses because he was squinting while working on his word search puzzles. Can’t have that! Sat him down on the seat of his walker at CVS, gave him several pairs to try on to find the right magnification as well as a style he actually liked. Hours later, he was able to read his puzzle book without squinting! The vision appointment was made but then something happened and I needed to change it to the following month.

Well, vision coverage wasn’t covered the next month (it must have been a new budget year). Ugh. So much for that idea! At least Robert had the reading glasses and was able to do his puzzles. Once Robert moved to New Home, vision coverage was restored and his eyes were checked (and the doctor confirmed the reading glasses we bought were sufficient). When Robert moves in with me, vision check ups are back to not being covered. Even though, it would seem, the state is saving money by having Robert live with a family member.

Can someone explain the logic of this to me, please?

Tools for Your Caregiving Tool Belt – Navigating Government Programs

We’ve added Education and Navigating Care Facilities & In Home Care to your caregiving tool belt (again, thanks to Denise Brown who gives many caregivers plenty of tools for their caregiving tool belt and is the kind soul behind caregiving.com – a wonderful online support community).

At some point in the caregiving experience, you will most likely need to step into a government office. Before doing so, take a deep breath (or a few) and throw all expectations of common sense out the window.

This is not said out of mean-spiritedness or because I am perpetuating stereotypes without basis. There are many, many helpful people who work at the various government agencies who I cannot blame for the difficulty in navigating these agencies. It is my personal experience that the policies and procedures are so convoluted that two people from the same agency, working in the same office may give you two different answers to the same question!

I’m not here to change the government (although it is on my to-do list) but will help you navigate through a few government agencies as painlessly as possible. (If you’d like to read an admittedly long, yet honest personal experience of dealing with a government agency, my first ever blog post details it here).

The reason contacting a government agency may be necessary is for help in covering the extraordinary expense of caregiving. Depending on personal circumstances, this may or may not be necessary and your loved one may not qualify but it is worth looking into. Caregiving is expensive!

Common Sense

common sense 

–noun

sound practical judgment that is independent of specialized knowledge, training, or the like; normal native intelligence.

There must be some odd phenomenon within an organization that does not allow for common sense. I didn’t study organizational psychology when I got my degree in psych but the psychology of a business has always fascinated me. It seems as if individuals can have common sense (not all, of course) but organizations or large collectives of people usually cannot (such as care facilities, to name just one example).

As you may have gathered from my previous post, I was a bit upset with New Home recently. They wanted to take Robert to an ER for a non-emergency x-ray and urinalysis. He has been experiencing some back pain, which I suspect is from sore muscles from his recent falls. I suggested he be seen by the New Home doctor and since his monthly check-up was just around the corner, agreed to wait for that.

The New Home doctor examined Robert and thought the pain was caused by sore muscles but suggested an x-ray and urinalysis to rule out anything more serious. New Home then told me Robert had to go the ER for an x-ray and lab work. I was told the reason was that the doctor affiliated with New Home didn’t have a lab or imaging center he was affiliated with and this somehow was related to Medi-Cal not reimbursing doctors as much as they used to. This didn’t make any sense to me. Unless they picked up the guy on the freeway off-ramp holding a sign, “Will work for food,” slapped a lab coat on him and called him doctor, I’m pretty sure the doctor can write an order which you can then take to a lab or imaging center. I did not see any reason to sit in an ER for non-emergency lab work and x-rays.

Yesterday, I pressed the issue further and higher up the chain of command. This time, I was told the reason Robert had to go to the ER (not for bashing his head this time, remember, but for an x-ray and pee test) was because New Home assumed he couldn’t pee in a cup and he would have to be catheterized.

Oh my god. Are you kidding me? Really?