Has anyone had any experience with appealing to Medicare under the provision allowing such an appeal when the patient or authorized party disagrees with a doctor's decision to discharge?
The PCP has decided to discharge my father tomorrow even though he (a) can't stand (b) has heart rate, BP, and SAT rate that are higher than normal, (c) lives alone (d) won't get any home care until the day following discharge?
I intend to call the Medicare specified contractor tomorrow to appeal the decision, but honestly expect a runaround or support of the doctor's irresponsible decision.
Anyone have any experience with this short term rapid appeal process?
It was explained by one of the chemo nurses that even a small amount of bacteria that can get in the system during the flush rushes through the body and causes the reaction.
Those bacteria are bad bugs!
I can imagine the discomfort of the bi-pap; my father was on a vent mask and he hated it. I remember when I wore a respirator while doing some sanding and then painting, and I felt so confined, so trapped, and almost disoriented.
Thanks so much for sharing your experience. If Dad gets a chest tap and something happens very quickly in his breathing, I'll understand and not panic.
We were instructed to bring her back to the pulmonologist for followup and a possible outpatient tap (really?), but when I called actual doctor, who is the head of the pulmonology service at the hospital, he said "stop poking holes in your mom. Let this progress at it's own rate and make sure to sign her up for hospice when the time comes. They'll be able to use morphine to ease her breathing and to keep her from feeling like she's drowning". (She's got congestive heart failure). I know that we're losing her; I just don't want it to be awful for her. I hope some of this helps.
My mother was very firm about not ever being intubated, and we intend to honor that, unless it's a temporary situation like surgery. When she was on the bi-pap, she looked so panicked, we just kept telling her that it wasn't a tube, just a "breathing thing " just like Mike ( my husband has a c-pap) has"
Were your mother's breathing difficulties specifically from the chest tap, or complications from something else? Do you know how it caused the difficulties?
If the former, I'll be on the lookout for that so it won't be unexpected, but, gee, they've already got him up to 5 liters and if he has more respiratory difficulties, they might also talk about intubating.
Thanks for the heads up. Now I can be prepared for what might happen tomorrow. And I'll ask for a bi-pap to be tried first. They've been using a vent mask; maybe they could use that.
The pulmonary doctor said yesterday that the pleural effusion is what's necessitating the high oxygen level, so depending on whether they administered Lasix or Bumex today, there should have been some change.
My nurse relative told me Bumex is 40x stronger than Lasix, so the fluid should have been rushing like Niagara to leave his body if that's what they gave him this morning, although yesterday we discussed use of Lasix.
I'm trying to contact the oxygen supplier to see if they even have portable concentrators that we could use if the need is 5.0 or above - otherwise, I'll have the back seat of my car filled with oxygen tanks!
I''m really starting to get worried now.
Thanks for your advice and comforting words.
Re pleural effusions, my mom has had her chest tapped several times. Last time they did it, she had some terrible breathing difficulties and the ER personnel wanted to intubate. We said no (she's got a dnr/dni), so they used a bi-pap and that worked.
I thought this was a simple pneumonia but it's gotten complicated.
I'm going to need all the chocolate energy you can send!
GA, hoping you are coping ok today, and that there are improvements for your Dad.
But a B-29? Who is going to sue? Boeing? I admire that bakery's integrity, but I think they don't have a good grasp of intellectual property laws. I guess their motto must be "better safe than sorry."
Getting a bakery to do an airfield and placing a model plane or a plane-style pencil sharpener or a toy, etc. is a good alternative. I've known many home-based cake decorators who will do a lovely beach scene with seashells and big rock and then the mother takes it home and places a Little Mermaid doll on the big rock. I once did a lovely park scene, and placed a hinged porcelain box of Madeline on it.
You may or may not be able to find someone to print a B-29 on rice or frosting paper for a cake, depending on the picture. No one wants to get into trouble with copyright infringement! But there must be thousands of photos of that plane that are in public domain and you can use Bing to find them. Just limit your search to "public domain" on the license drop-down list.
(I once took an invitation I had designed into a nice copy place for many copies. The clerk told me he could not put that photo on the invitation, because of copyright concern. I asked for the manager. I said, "This is a picture of MY son. I took it with MY camera, in a public place. I OWN the copyright. And I want copies!" I got them.)
You can't blame businesses for being careful, but there are ways to get what you want on a cake, without necessarily becoming a cake decorator. :)
A cousin's nephew was a submariner cook; I may contact him to see if he has any military patterns. Guess I'll have to learn how to decorate cakes and be forced to eat all those tempting samples and experiments.
On the issue of the discharge, it's now been resolved, but in retrospect, I am so glad I replaced the PCP with a hospitalist. It was shocking though how unprofessional the PCP became in his comments about other medical specialities.
Checking on options for the B-29 cake....wish I'd thought of it sooner.
I do like the idea of an airfield on the cake though.
I'm so glad you're making progress. The dire communications gremlin strikes again, what a hideous couple of days it managed to create for you. Chocolatey hugs
I've encountered the "family do it all" attitude, found it insulting and irresponsible. I guess working for attorneys for years made me a tough old bird, although sometimes I'm actually a softie.
We made a lot of progress yesterday, I'm switching focus today to planning a small birthday celebration tomorrow, but will have my guard up for those voracious discharge planners who want to gobble up my energy and resistance.
I'm also moving past the "who said, who did or didn't do what" issue with regard to the discharge. There were clearly some issues, but I'm going to step out and leave that to the hospital staff to deal with.
PCP - lots to say about that but I'll hold my wicked tongue until it's been tempered by some chocolate, which I ran out of last night in my frustration.
This is my dilemma for today - how to get a bakery to make a birthday cake with a model of a B-29 when they won't deal with making designs from any copyrighted material. That's a new one on me.
Thanks, everyone. I really appreciate the support and suggestions.
It was one of the few times I lost my patience. I asked if she thought I really had all this time on my hands, running to hospitals, losing work days, not caring for my husband with serious cardiac issues. I told her we had to get the problem FIXED so that she could get back to leading a semi normal life.
She never complained about my handling of her medical issues after that. Sometimes you have to stand up for YOU as well as for the patient.
I dug to the bottom of the issues and discovered what appear to be conflicting stories, but I did make a lot of progress this morning. The alleged discharge order was never written or signed. There's some confusion but I'm going to take a "between the horns of the bull" position and write a letter to someone in admin suggesting that it would be helpful if discharge plans be clarified in the charts before advising patient's families. This seems to be the crux of the issue.
I don't intend to start or get involved in personnel feuds, so I want to take the position that as a patient's relative, I see some areas in which improvement could be made to enhance the already excellent care provided to patients.
At this time there are still some issues with the vitals but I understand more (from a relative in medicine) how they interrelate. Discharge date is only being now discussed as "when" it happens.
I'll write more later when I get caught up on my sanity and sleep.
And I really, really do appreciate the concern of each of you as well as your suggestions and support.