Your Care Not Only Depends on Payor, It Is Payor and Only Payor (even if you have the money)

When my dad was admitted to the hospital on Friday afternoon after several hours in the ER, the nursing staff interviewed me about his medical history and such. I made it clear that my primary concerns were:

1. Figure out the level of care he needs and is likely to need in the near future (activities of daily living), and
2. Explore home and institutional settings.

I was assured that the doctors and the physical therapy team would evaluate him and a social worker would come in to talk to me about care.

What I got was a sales pitch from the medical group’s hospice branch.

It’s not that information about hospice, even their particular hospice company, is unwelcome. Hospice was fantastic for my mother when she got sick and died. It’s that hospice alone did not answer my main questions. Hospice does not set up any in-home or institutional care. In fact, to get any of that care coordinated, you absolutely need the hospital social worker to coordinate. They won’t just accept him into any of the living scenarios without contact with the social worker.

The other thing about the hospice sales pitch is that it was 95% about payment with very little information about the actual care provided. Most ironic, while they talk about Medicaid spenddown, they never actually tell anyone how much it costs per hour, per day or whatever. They never even ask if you’re going to need Medicaid in the first place. My dad will not.

I listened politely for several minutes but lost my patience as this lady went over Medicaid spenddown for the umpteenth time. I’m a lawyer who has practiced in that area. I know a lot more about that then she does. She finally switched to music therapy and still no information about maybe a CNA or RN or a care facility. After a while, I pitched a bit of a fit and demanded to talk to the doctors and the social worker. I wanted to talk to the doctors because we never heard any definitive information about his condition — information crucial to the type of housing and care he needs. He still hasn’t seen the physical therapy team.

The hospice sales person scurried out of the room. The doctor came in, and as it turns out, despite the earlier lecture to me about not demanding any more imaging, my dad did need another CT to determine whether or not he needs a procedure on his spine to decrease pain. (I knew it. You don’t need an MD. It’s common sense that if cancer has moved into a person’s spine and that person has already experienced excruciating pain in the area, something is going to have to be done or it will be very painful.) Eventually the social worker showed up with a list of nursing facilities. Not exactly great help, but at least I have a list to start making calls from.

When we finally get Medicare for All, we need to make it simple, cover everything, for everyone, so when your dad’s lying in bed dying from cancer, you’re not getting sales pitched or lectured about not demanding scarce hospital resources from one of the richest medical corporations in the country.