My father is 90 years old. He was diagnosed with PD late in life, fortunate for him. I am aware it is a degenerative disease, and what the future could hold, so I am not looking for sympathy or the litany about plan for the future. What I am concerned about is immediate treatment for a recent episode of rigidity, and the callousness of neurologists in regarding to treating it. Last Monday 11/22/10, I took my father to the ER at our local hospital because he complained that suddenly he had extreme difficulty walking.
For backgroud, a few weeks prior, my father developed symptoms of skin picking, nail biting, and tongue thrashing. I had taken him to an experienced Neurologist who ordered an EEG. She found what she called "short circuits" in the brain that are sending false signals that the skin may be itching. To address this symptom she prescribed a titration packet of Lamictal XR. Moreover, since my father was also complaining of morning stiffness, she upped his Sinemet ER to 50/200 from 25/100. Wouldn't you say that maybe these new meds had an effect on my father?
Anyway, back to the ER. While there, the Attending Doctors contacted this neurologist, and explained the situation. Her response was that my father suffered from weakness in the extremities, and needs exercise. I became infuriated by this answer. How could a doctor, who supposedly has my father as a patient, and knows what she gave him, trivialize the situation. Not satisfied with this non-answer, I called his PCP who agreed with me that this was a non-answer, and agreed to call in another Neurologist. Moreover, she decided to admit him to the hospital.
Three days later, on Wednesday, 11/24/10, I was informed by the Hospital Care Manager for his floor of bad news. They could not keep my father because under Medicare Guidelines, he was not being acutely treated but categorized under Observation status. I told her that he had received new meds, that he had extreme difficulty walking but while she understood under Medicare guidelines since they were not treating him with an IV or other acute treatment, he had to be discharged. The plan of the PCP was to ultimately admit my father into sub-acute rehab, however according to her, the hospital reversed the admittance staus that she prescribed from acute to observation. By so doing, according to Medicare guidelines, my father becomes ineligible for admission into the nursing home. Thus, his discharge would be imminent, and I would take him home with no resolution of the stiffness. The neurologist that the PCP consulted attributed my father's current condition to the disease, and just increased his Aricept to 10 mg, and recommended sub-acute rehab.
In a nutshell, the doctor blames the hospital for reversing her admittance status, the hospital blames Medicare, and nothing happens for my father. According to the PCP, the only way the status could change is if something acute is detected on a battery of tests that she will order such as MRI, Doppler, etc. Moreover, on Wednesday, I witnessed my father having some type of seizure while I accompanied him to the MRI. En route, he seemed to be in a very deep sleep, resulting in the MRI tech calling the hospital Rapid Response team to check my father out. Eventually, he snapped out of this state and the MRI proceeded. The MRI was done shortly after the seizure but yielded no results. The next day more tests were done. The nurse reported that he experienced an episode of extreme lethargy en route to these new tests, and she had to work to bring him out of it.
Yesterday, Saturday, the PCP called to inform me that an X-Ray revealed some pneumonia in a lung which she will treat acutely with an IV anti-biotic. In this case, this might change his admittance status to a 3 day acute which might now qualify my father for rehab at a home. In the meantime, everybody is afraid that they will be accused of committing Medicare fraud. I asked the PCP to change the Neurologist but she said it would make no difference to my father's status. I have posted this situation on several internet forums asking for intervention on my father's behalf by someone with medical experience with no luck. In other words, if there was an experienced Neurologist with vast experience in the area of PD, willing to look into this for my father or willing to consult with me, I would be very thankful. I am unemployed at the moment, my father has Medicare which is primary, and we are not rich. On top of all this my mother has Alzheimer's.
As an aside, by accident, I met the Medical Care Coordinator from the hospital who was directly involved in the input of my father's case into the Medicare eligibility work up. She explained that whatever admittance criteria is ordered by a physician, it is analyzed according to Medicare guidelines but that the hospital truly cares about my father. I said that what is abhorrent is that the doctor keeps blaming the hospital for reversing her, has placed doubt about the hospital in my mind, and no one from the hospital until now, and only by accident, offered to try to assist me. Yes, I did call Patient Relations, who quoted Medicare guidelines; yes, I did speak to a Hospital Administrator who quoted Medicare Guidelines; yes, I did speak directly to the Nursing Home, who quoted Medicare Guidelines, too. My position was that if my father did not meet the criteria for admission, he should have been turned away from the ER. These people had the audacity to say to me when I asked what are my options, we are sympathetic but you can do private pay, and get whatever you want,(where is my million dollars when I need it?) or apply for charity care. Keep in mind to plan for the future as PD is degenerative.
I even tried appealing to the QIO for Medicare to appeal the discharge. Under Medicare Guidelines, if you are admitted under Observation Status, you cannot appeal an pending discharge. Only in acute cases. Moreover, I fond out that in some hospitals, they do the admission status criteria analysis right at the ER level. Since, the hospital does not as of yet have such as system in place, the doctor should have been up to date on the new guidelines the hospital told me. I told the PCP what they said, and she went on about the problem being the hospital, and that she should not have to debate the admittance criteria while a decision has to be made in an ER.
What this experience has done for me is that now whenever I have to take my father, and/or mother to an ER, because they are not rich, and have Medicare, I unfairly have to be burdened to determine what status will they be admitted, whether the status will be reversed, and whether they will get paid, all at the expense of life saving minutes. It is no longer about preventative health or life saving health but dollars and cents.