Caretaking 102 - The Aftermath

Thank you Cody.

I just got off the phone with a collection person trying to get payment on a bill from St Barnabas. The person's name was not given but could well have been Kafka. First she said that she could not speak with me at all because I was not Bernie. Then she said she could speak with me only if Bernie would get on the line and give verbal consent. When I told her Bernie was a patient in St. Barnabas, she was unfazed. Since she couldn't tell me anything about the "outstanding" bill - date the bill was drawn, amount billed, what portion of the hospital had sent the bill, what services were being billed, I don't know what she expected to get from me.

I kept the person on the phone, checked the pile of bills where he had placed them and found that a bill dated 9/14/2015 for what she reluctantly admitted was the amount on the bill she was trying to collect. Bernie went into Newark Beth Israel for his major surgery on 9/15/2015. Even if the bill had been mailed on the date it was issued, there was no way he could have received it before his surgery. Bernie went through his mail when he got home from the hospital on 9/21/2015 and according to the notation on the statement, paid a bill for the amount in question on 9/22/2015.

I asked the caller if she could note that the bill was paid. She said she couldn't do that because it could take six weeks for a payment to be posted to his account. Why then was she making a call demanding payment less than three weeks after the bill was drawn?

Ugh!

Joan, That call sounds quite suspicious. It is way to early to be getting any kind of collection calls and her dates don't appear to line up with the dates and locations where Bernie was treated. Hopefully you didn't give out any insurance information or data. If you get any more calls like that, get the name and number of the caller and tell them they will have to send you a duplicate bill for you to send to the insurance company. Don't give them any information about policy numbers, etc.

I know that you know to beware of scams, but you are still new to the intensity of dealing with a serious medical event and your guard may be down for the time being.

Hugs.

ETA: If you haven't done this in the past, you should make sure that your insurance company has you identified as a person that can speak for him. If not, when Bernie is feeling up to it, you can call the insurer, put Bernie on the line and give them his verbal permission for you to represent him.

You may also want to consider getting a springing power of attorney, so that you can handle all his business.

Bernie had an earlier medical procedure at St. Barnabas and the items on the statement I eventually identified match that admission.

I'm quite sure the call was from St. Barnabas, not the insurance company. There was a statement in his pile which corresponded with the date and amount that she reluctantly supplied. She said a duplicate bill would be sent to the house and that the October bill would include the outstanding amount from September. No personal or insurance information was requested or given. She didn't even ask my name and I didn't give it.

I have a power of attorney but did not want to fax it to the caller for reasons given by krnl.

Unforeseen Consequence: Woke up this morning to find that the house was colder than it has been. Checked the boiler to discover that it had been turned off. Had to call Bernie to find out how to turn it on since I was afraid to do anything that might damage the boiler. His response "Flip the switch at the side of the boiler. If that doesn't work, call the plumber."

One of the problems with splitting the household responsibilities is that the other person may not know what to do, even in simple situations like this. Thankfully, flipping the switch seems to have worked. Now to take a crash course in maintaining the boiler (bleeding water, etc.) until he is able to return home and talk me through things. Time for some cross training when he is able to come home.

joan_crystal said:
Unforeseen Consequence: Woke up this morning to find that the house was colder than it has been. Checked the boiler to discover that it had been turned off. Had to call Bernie to find out how to turn it on since I was afraid to do anything that might damage the boiler. His response "Flip the switch at the side of the boiler. If that doesn't work, call the plumber."
One of the problems with splitting the household responsibilities is that the other person may not know what to do, even in simple situations like this. Thankfully, flipping the switch seems to have worked. Now to take a crash course in maintaining the boiler (bleeding water, etc.) until he is able to return home and talk me through things. Time for some cross training when he is able to come home.

Excellent point on "cross-training". I allow myself to remain ignorant of a few household chores - must change this sooner rather than later.

Hospital just called. Arrangements have been made to move him to the nursing home between 3 and 4 pm today. He has no clothes at the hospital. I have to bring them to him.

In the meanwhile, I don't think the boiler is working. Flipping the switch and turning on the thermostat did not produce a pilot light. I can't call the plumber now because I won't be home when I get there. We may need to replace a part so calling a neighbor for help probably won't work. People I talk with wonder why I remain so stressed. Plan #1 is to call the plumber when I get back from the hospital. Plan #2 is to take a full course in boiler operation and maintenance.

Joan, a plumber you have worked with over time could very well be willing to try to get there before you have to leave, or come by after you get back, or work with you by phone/billing, if someone can let him/her in while you are away, esp. under the circumstances. Hang in there! Something will work out. Hugs from afar.

Or you could leave a key at the house or with a neighbor, if the plumber is someone you know and trust. Give a call, if time permits, and see what might be possible. Otherwise, it's double quilts tonight, and at least the pipes won't freeze.

I tried calling the plumber I usually use for heating issues. He if off until Monday. The person I spoke with on the phone said they can't send someone today because they are overbooked with emergencies and they are closed on the weekends until November. Need to get to the hospital is complicating matters. I will try calling plumbers I don't know and would appreciate any referrals. The plumber I have been using is Todd Williams.

"off until Monday": Oh crap, wouldn't that be the way!

Its just one thing after another and my doctor's office doesn't understand why I am putting off have a blood pressure test to see if my new medication is working.

Do you have a friend or neighbor who could stay at your house to wait for a plumber? I would call a few of the plumbers who frequent MOL and see if any of them can take the emergency call. But someone with more knowledge might be able to get it going without a plumber. Surely MOL has a savvy person who could take a preliminary look for you?

I'm so sorry about all the stress. At least the weather seems to be much less dreadful than we were all anticipating.

Joan - I'm messaging my plumber to see if he might be able to come out for you. He's done a lot of work for me recently, so might ... If you want me to arrange it, let me know via text or phone or email.

Forgive me for butting in, however Harleyquinn's new service seems ready-made for this kind of home emergency. If no-one else were available for a future situation (I'm assuming it's under control by now), perhaps she might be able to help out?

I hope the transfer to rehab goes smoothly and convalescence proceeds uneventfully.

Thank you. For now things are under control.

Glad to hear it.

Advocate! Advocate! Advocate! I got to the nursing home around noon to find him still lying in bed. A few comments got him moved to a chair. Lunch came and the meal was not suitable for an insulin dependent diabetic. Spent about an hour talking with the head of the kitchen staff educating her on what a diabetic diet actually means. Watched him go through the end of his physical therapy session to see twhat they had him doing. Did not see him up and walking even though he has done this every day in the hospital. I am glad he is getting a period of time to get stronger before coming home. I just hope they do what he needs to get him there. Hoping to make it back tomorrow with the clothes he needs.

The kitchen doesn't know how to make a suitable meal for a type 1 diabetic? That is crazy and dangerous. Don't just talk to the kitchen, talk to someone in charge of the facility. The person you spoke with today may not be the same person making breakfast tomorrow, and so on.

What spontaneous said. Also, if he's on an IV, make sure it's a diabetic friendly one. My mother spent a month in the hospital and no joke, we had to ask every damn day if the IV was made for a diabetic since it had to be hand-mixed. They would just give her more insulin to counteract it.

That's a point. Despite explicit instructions for a saline or water drip, my insulin-injecting mum was given a glucose-based hydration drip for three weeks, told off for sneaking chocolates and sweets, and finally discharged on the verge of diabetic coma (she lived alone). Non-responsive to the phone or doorbell, she was finally found unconscious inside her home several hours after her return, and taken back to hospital by ambulance. The subsequent investigation into events led to staff retraining and demotions.

Horror stories aside, Joan's reminder that we should all advocate for our beloved patients is what's key. Medical staff need to listen to those who know the patient and know what's normal, what's not usual. If something isn't right it should be addressed straight away, calmly.

That is scary! they could kill him. Yes, I agree with everyone here, speak to the management about retraining on what a diabetic needs.

There was an information sheet in his room on what a diabetic diet should include (insert whichever emoticon is supposed to represent irony here). Comparing the information on that sheet with what was on his plate was what got me running to the nurse's station. They know what is needed. The head of the kitchen told me that she did not realize he was insulin dependent. She was thinking of her father whose diabetes was diet controlled. Ugh. I wasn't there when Bernie's dinner tray came up but he told me that it was much better than lunch.

In speaking calmly with the staff, stressing his therapeutic diet needs, translating from calories and exchanges to plain English, I think we have a plan but I will still watch closely to make sure his sugar level is being regulated.

Like with the IV drip example given above (he is no longer on an IV), there seems to be a strong desire to standardize care. Unless it is brought to management's attention that the standard approach, in this case meal composition, is detrimental to the patient's recovery, it may not occur to them to question. Preparing and keeping track of custom diets represent extra work and extra monitoring and could easily be avoided.

In summation, I am grateful that I was able to get to the facility today and note any problems there might be with his care. Thanks, to the volunteers of Helping Hands, I will be back today to follow through on yesterday's events.

Joan, at my mother's rehab (not the same one Bernie is at), we found that there could be a lack of communication between weekend and weekday personnel - so you may want to check on Monday to see if the person doing the dietary planning is the same person as the one you spoke to yesterday. If it is someone else, you may have to go through the explanation again. It may not be an issue for your husband, but I'm just mentioning what our experience was.

The diabetic issues continue. Bernie was very upset when I spoke with him this morning and a bit incoherent. He said something about the nursing home being concerned that he was losing weight and bringing him something in a bottle (I assume to fatten him up). I don't know what was in the bottle. He would not say but I assume it was laden with fat and/or sugar. You can't do that with an insulin dependent diabetic. Building up weight has to be a much slower, more deliberate process. I will deal with this when I go in later today since there is little I can do about it now from here when I have zero facts to go by.

While I am sure nursing homes have a valid use and may be necessary to Bernie's recovery, I can't help thinking we would do a much better job of managing his needs at home.

It may have been a dietary supplement like glucerna

Handling problems remotely is difficult when you have few facts to go by. Trying to handle them remotely on a Sunday when the person you need to speak with won't be in until Monday is next to impossible. it seems unlikely that a dietitian has been present at all since Bernie was admitted late Friday afternoon. The kitchen staff I have spoken with has been as helpful as they can be; but, I don't think they have the knowledge or expertise to understand the problem. It is highly unlikely they have an endocrinologist on call.

I was finally able to reach someone on the kitchen staff who told me that this mystery bottle would have come from the nursing staff not from the kitchen. He will find out what it was the nurse tried to give Bernie last night and has agreed to meet with both Bernie and me at 12:30 this afternoon in Bernie's room so Bernie can help fine tune what he needs to maintain his sugar level while trying to build up his weight. I also plan to follow up with the dietitian when that person is in on Monday. At least Bernie was somewhat calmer when I called him back to tell him all this.

mod: That is my thought as well. I'll report back if/when the mystery substance is identified. I may also reach out to Bernie's endocrinologist on Monday.

Joan, perhaps you should try to call a team meeting of all those involved in Bernie's care to coordinate a comprehensive care plan for him. This would include all the disciplines involved with his care, dietary, nursing, P.T. and O.T. if applicable. Good luck with your meeting today.