For one day, let go of your assumptions that someone should just

• Smile more
• Try harder
• Stop attention seeking
• Stop drug seeking
• Take more pills
• Appreciate life more

1. Under Wisconsin law, someone with a developmental disability cannot be admitted to a nursing home without a need for skilled nursing care, which he has so

2. He needs a pre-admission screening to prove he needs the nursing home level of care but

3. Since he won’t need to be at a nursing home for 30 days or longer and he would be discharged to the nursing home from the hospital he’s exempt from this screening, however

4. Now the nursing homes we were looking at are refusing to admit him under this exemption because, let’s be honest, a lot of group homes have a tendency to give a 30-day notice to residents once they go to a nursing home, and the nursing home, rightly, doesn’t want to be stuck with a new resident, so

5. His group home manager is calling the intake coordinator at the nursing home to assure them that my member will be returning home once his IV Antibiotics are finished.

Meanwhile he’s still in the hospital. By the time this is all sorted out, he can probably just go home.

This could have all been avoided if Medicare would just cover the goddamn outpatient IV Antibiotics.

After several back and forth phone calls on Friday with the Aurora St. Luke’s Medical Center’s Social Worker and Nurse regarding discharge plans, I was kind of expecting at least a voice mail letting me know when my client was discharged.

Especially since we hadn’t actually established which services he’d be needing in the community. The only voice mail I have today was left by a provider needing authorization for services they started providing on Saturday.

Because I didn’t specifically tell the Social Worker we need to know exactly what my client would need upon discharge and we would need to authorize it prior to him being discharged and, because he is consistently non-compliant with medical advice, I would need to be directly involved in discharge planning to help make sure he is getting the best services for him to ensure recovery in the community, and prevent readmission.

Apparently the needs of the hospital to get the patient out of the hospital before the weekend trumps the actual needs of the patient.

I spent the past few days arranging the discharge of a client from the hospital. He needs to have IV Antibiotics for 2 weeks, and would need a home health agency to do some cares for him outside of a hospital. No problem. He was all set to go back to his group home, which made special arrangements with the staffing schedule so he would be able to stay home during the day (the home generally isn’t staffed from 8am-3pm because all the residents go to a day program). The social worker at the hospital was going to make arrangements with a home health agency to go to the group home every day for skilled nursing cares. Everything was going to be just fine.

Until today. I get a call from the home owner saying the hospital can’t find a provider for home health care. Ok. There are like 6 gazillion companies that do this. That makes no sense. I called the social worker at the hospital, who redirected me to the intake coordinator for one of the providers where I found out…

Medicare won’t cover outpatient IV antibiotics so, instead of going home with a home care agency in place to manage the PICC line, my client has to go to a nursing home for 2 weeks for absolutely no reason. Thousands of dollars difference in cost for care, in addition to an increased risk of infection, wounds, communicable diseases, and readmission to the hospital. Nursing homes are just lovely. You’re welcome, taxpayers.

If you want to know why health care isn’t affordable, it’s because shit like this, and completely not like this but just as stupid, happens every day. More than once. One bill isn’t going to fix that. It’s not even going to scratch the surface. But, hey. At least everyone can at least be financially covered while some politicians pretend they’re going to do something to fix things. Don’t get me wrong. I think it’s great that everyone gets health insurance. I’m just not going to sit here and pretend that makes health care more affordable or fixes anything wrong with the quality of care. Or the lack of emphasis on prevention, education, and community health. Or the way things are billed. Or the way records are kept. Or the lobbyists that influence every single decision made by politicians. Or even the overall uneducated and/or non-compliant American population. Seriously. Do you know how much Type 2 Diabetes and its complications cost to manage and treat every year? A lot. Type 2 Diabetes and its complications are almost 100% preventable. Twenty per cent of antibiotics prescribed every year are completely useless.

America’s got work to do and no one willing to do it.

So, I guess we took a tiny step in the right direction. Great. That’s enough. The bigger issues are all the way over there. But at least we made a little progress.