Posted 9/11/2015 9:46 PM (GMT 0)
So some of you may remember my long whiny post earlier in the summer. Don't read unless you want to. This is a much for me to let out all the bad feelings I have without my family having to listen to it.
So if you are interested, here's a recap. (Actually, now that I reread this I don't think I even know what I wrote before). On May 1st, my father went into the hospital for what was considered a "minor" procedure with an overnight observation. He has hardening of the arteries and has a stent in one groin area and another stent in the other leg. They ultrasounded everything and there was no blood flow in either leg.
So they brought him in and everything went wrong. They cleaned out the stent in the leg and then moved onto the groin. One look and they decided there was nothing they could do. They closed him up and called a vascular surgeon who eventually put in an artificial artery to bypass the stent.
In the meantime, my uncle who was the contact never got a call from the hospital. Around 10pm I called to find out what happened. My uncle said no one had called, but he called my niece Toni (who works at the hospital) and she told him that she couldn't tell him anything due to HIPAA rules.
So I called my niece and needless to say I was not pleased. She tried to pull the HIPAA crap on me and I let her have it with both barrels. She told me the same thing about HIPAA, but I ignored it and asked for the name and number of who called her. She hung up on me.
So I went in the other room, got out my husbands lap top and booked a flight and a car the next morning. I then called my uncle and my little sister to tell them when I'd be there. So a little background. I am the oldest.
The middle is sister is a drug addict and an alcohol who has done nothing but sponge off everyone. A few things she has done is stolen checks from my checking account from college. She cashed them at the grocery store I worked at part time. No atms back then. My parents had done business with the owner for many years and for part of that time my mother worked for the supplier that delivered most of the non-perishable items to the store. We went in looked at the check and my father asked what the fees were that they were charged for the bad check. He paid the face value and the fees and said it wouldn't happen again. It was my sister's handwriting. It bounced because I had just gotten home for summer break from college and had not made any money yet. She also stole my father's wedding ring and pawned it. He never got it back. Oh, I forgot to say she's a drug addict and an alcoholic.
My little sister, Tracy, is the hardest working person I know but has a little black rain cloud following her everywhere. Everytime she gets caught up on bills, something happens to put her behind again.
So back to the story. I was up there the next morning about 11am and my Dad looked like death. I actually traveled from my SIL's house because we had driven there for my husband's nephew's first communion. I only had two days worth of clothes, but luckily all my meds. My middle sister left me a voice mail while I was booking the flight. "How dare I yell at Toni. She didn't ask to be the contact. She has two little girls and they had a dance recital that night. Everyone needs to leave her alone" and the piece de Resistance ... "It's not like he could die from it." I truly do understand that she didn't mean that out of malice and she is just ignorant and uneducated, but I don't think I can ever forgive that. In addition, it was about 10:30pm so she was drunk and high at the time.
The blockages were in the main arteries so blood had pooled in the legs. I don't know how long this went on because I live in another state. He is my mother's primary care giver and was the person who was supposed to tell me when I needed to go to CT to visit when my mother reached the time when she is close to death. He "takes care" of everyone.
My mother has extremely severe COPD. It is just a matter of time before she passes on. A little more than a year ago, she moved into a skilled nursing facility because she needs round the clock care my father can't provide. The facility is the same place my grandmother lived in for her last years and my aunt was there as an Alzheimer patient. They were both private pay. My mother is on Medicaid. They segregate them by wing and the people on Medicaid get crappy treatment.
I am POA for both my parents. I am also healthcare proxy. So in addition to being sick in my own right, I have to take care of them and I have a 16 yr old at home and my husband travels for work 2 to 4 weeks a month. Right now he is in Paris and traveling home, but Sunday he goes to China for ten days. He was home for about a week 3 weeks ago, but before that had been in Japan. He also travels to California (where his employer is based) frequently since he works from home. He used to work for IBM and they put his old business unit it up for sale. It was purchased by his new company. He was involved in the negotiations and worked on all the planning for integration. He ended up as the head of the integration team when the sale went through. That means figuring out who would be best in which position. These were all people who he had worked with at IBM including his boss there. So for 18 months, he essentially worked 3 jobs. The good part is that he has been compensated well. This whole thing meant he worked hand in hand with the Chief Financial Officer of the company and had very high visibility to the CEO. That has it's good and bad. You do good you get rewarded. You screw up you get fired.
Back to my parents. There were problems at the hospital with the contact information. For some reason my niece was the only one who was getting any information. My father has something like 9 operations and spent time in ICU on at least 3 different occasions. I was working with the admitting physician to try and get it fixed. But during the month+ my father was there I only talked to one surgeon and that was after the very last surgery.
At one point, I figured out what was happening. My father went in for surgery and I knew it was going to happen because he told me. I contacted the admitting physician to find out why I wasn't called by the hospital. He didn't know that my Dad was going in for surgery. So after we talked, he went off to find the information and to talk to all the doctors involved to make sure that I was the person contacted.
Surgery time came and went. No phone call. Then I get a group text message saying "Grandpa is out of surgery and he did well". So I texted back and asked if she was at the hospital and she said no. So I asked who called her. No response, except for a message from my middle sister (her mother) yelling at me to leave her alone she was sleeping. Now it was about 90 second between the text from her saying no to the time my text asking who contacted her. If she can fall asleep that fast I want what she's taking because I lay in bed for hours. In reality, she overplayed her hand and figured that out to late.
So I went back to reread the entire message and something my niece said caught my eye. She said "I never called and asked them to change the information." My niece manipulates people very well and she tries to set things up so what she is saying is not an actual lie. I'm sure her mother (my sister) was the one that called. So I got on the phone and started calling the hospital. I found out that after hours the nurses actually answer the phone. I'm not bashing nurses. I understand that during the day they run non-stop. It's more frustration that I can't get any information if they don't pick up the phone.
So I talk to everyone involved including Post op, ICU and the regular floor nurse. I called and said my dad just got out of surgery. I want to make sure if anything happened and they needed to call that they had the right contact information. I went into the I am POA and all of my phone numbers have 919 area codes shpeel. One of the nurses said "oh, that's odd". In my father's chart there was a contact list and it had been written while I was there that first day after surgery. It had my name with my three phone numbers written. Below was my niece (we all thought she was trustworthy) and her phone number.
The nurse told me that there were four numbers. One was written in a different handwriting and was written across the top above the three 919 numbers. It was an 860 number and it was my niece's number. She said it looked like someone had called up and said there is a new number I can be reached at and it's the primary number.
I also found out that what they do for surgery patients is they fill out a pink post card with the contact name and phone number. It's attached to the front of the chart so the surgeon doesn't have to go looking through the chart to find the person to call. I think its a duplicate, but on my dad's chart the post card ripped and the piece still attached had the last four digits of the phone number still attached. They were the last four digits of my niece's phone number.
So I started writing texts to the group that we had created to make sure that everyone got all the info on my dad. I didn't accuse. I just stated that the surgeon had my name and her phone number so if this was a mistake made by the person filling out the card, then next time she should tell them they need to call me. She had my contact info.
So here is a sample of her response. I didn't change the info, grandpa must have done it and doesn't remember. Auntie Kim, you haven't seen me more than a few times since I was in elementary school. If you had you would never think I could do what you are saying. Stop telling evryone lies about me.
First, my father was on heavy pain meds and he was experiencing delirium that is common, especially in the elderly, with patients that have so much trauma. Multiple surgeries, in and out of ICU, etc. One day he actually dialed 911 and told them that the hospital was keeping him against his will. He also stated that he was going to sue everyone for all the damage they did to him. The surgeries included putting in the artificial artery, multiple incisions in thigh and lower legs to release the blood that pooled because of the blockage in the artery, going back in to cleanout infected tissue, an incision in his abdomen to pull a muscle down to the groin to allow the artificial artery to get a good blood supply and plastic surgery for all the wounds. Not to make them pretty, but just to allow them to close and heal.
Second, I don't have to tell lies. All I ever said, at the time, were the facts about what happened. No calls, her name on the chart, etc.
So after she woke up my niece started sending me text messages. Then finally said in a text "I'm not doing this via text. I'll call you". So at 8 am my phone started ringing. I am not a morning person. I generally wake between 4 and 6am, take my first set of pills and try to fall back asleep, so calling me at 8am to say I was a liar was the wrong thing to do. She called. I answered and then hung up. I texted her not to call me because I was furious and not in the mood to discuss it with her. But she kept calling and I kept hanging up.
See my nieces brand of manipulation doesn't work very well via text. She thought if she just talked with me over the phone she could convince me. It occurred to me later that she nevers shows any emotion. Not happiness, no joy, no anger, etc. So it dawned on me that both she and my sisters are sociopaths.
At that point, i got text messages in all caps from my sister saying why do you have to do this, you're breaking up the family, I'm not her sister anymore. Like all caps bother me and make me feel bad. NOT. So then they both blocked my phone number. Silence is golden. LOL
So it took another 2 weeks of calling the hospital 5 times a day to check on my father, check the contact info, and see if he was scheduled for more surgery, before a nurse finally said to me "Why don't you password protect his chart?" I didn't know I could do that. I put a password in place and after a few screwups on the hospital's part it worked wonderfully well. The first time I called the nurse gave me all the information about my Dad and I asked her wasn't she supposed to ask me for a password. She said "oh, sadiegirl or something like that?" I flipped my lid. She told me the password. Then later in the day I talked to an aide who didn't even know there was a password.
So then we have my Mom whose COPD is so severe that the hospital should have a revolving door. She ended up in the hospital at the same time my Dad was because the anxiety was so bad she couldn't breath. Magic word - Hospital. Too bad they cant do anything more for her there than the nursing home can be done.
I have spent the last few months being very demanding of the nursing home because they are not giving her proper care. No one ever had a discussion about end of life with her. Everytime she comes back from the hospital she is supposed to sign a new "document" regarding her code status. It's a sheet with 3 check boxes (A, B and C). A is do everything you possibly can. CPR, a ventilator, iv nutrition, whatever. Now my mother's disease is essentially that parts of her lungs are dying off. Each time she gets pneumonia more dies off. If she can't get enough oxygen, the organs also don't get enough oxygen. If her heart stops, its because it is being deprived of oxygen. CPR may start it temporarily but nothing can fix her lungs. If they put her on a ventilator, then she'll never come off. Quality of life which already sucks goes to zero, but the nursing home would be able to keep billing for her care.
Based on my mother's records, they don't have her sign when she gets back from the hospital. They have her sign while she is waiting for the ambulance. They told her that if they do CPR they might break a rib or two, but she'd still be alive. Wrong. If her heart stops, it due to her lungs. They can't fix her lungs.
So the last time she went to the hospital, when they called I said yes send her but make sure that all her docs are sent with her (living will, POA, healthcare proxy). She said oh, of course, she's code A we send everything. Well when she got to the hospital there was no paperwork. Nothing to identify her. If the hospital staff didn't already know her, she would have been a Jane Doe.
So needless to say, I lit into the nurse that told me she sent everything. I also found out that my mother's code was A and the form they normally send (which never made it to the hospital) is a discharge form. I was very unhappy. I made sure they knew it. So if she goes to the hospital, they get a kind of vacation. One less patient to care for.
So at the hospital, I tried to talk to my mother but she is almost completely deaf and phone communicate is impossible and frustrating for everyone. She handed the phone to the hospital aide and I explained to her that the code the nursing home sent with her is not what she wanted. It was the opposite of what she stipulated in her living will. But this discharge form apparently overrides the living will. The aide said she would contact the right people to talk to my mother.
I get a call from the patient advocate. She said the doctor spoke with my mother and actually knows her very well from previous trips to the hospital. I think she knows all the staff by name. So the doctor talked to my mother and decided that she was not capable of making the decision and didn't understand what she was being asked. So that means POA decides her status. Lucky me. No child no matter their age should have to say No Do not Resuscitate, Do not Intubate and no hospital. It really sucks.
So I get a call from the discharge nurse at the hospital. She tells me that with my mothers condition she will be bouncing back and forth between the snf and the hospital and had we thought about palliative care. I know for a fact that no one had to talked to either of my parents about it. Especially since the snf had her as a code A.
Other people are judgmental and think that I am depriving my mother of care that could help her. Hospital - the magic word. Except it really means adding the trauma of transporting her to the hospital. Them putting an IV into veins that are collapsed, drawing blood, waking her at all hours of the day and night, exposing her to staph infections that are antibiotic resistant then having to do blood cultures to figure out how to treat the infection she got in the hospital.
Luckily she had an appointment with her private lung doctor. I talked to him before she went and asked him to have the end of life talk with her. She thought that they would just sit there and watch her gasp to death. I knew they wouldn't. My husband and I had just been through this with my father-in-law. He did have the talk and when she came back she was much happier. She told everyone about it. I heard from at least 3 people before I ever got to call the doctor. I did call him back and talked to him about treatment. He said "I don't recommend this for many patients, but for your mother it is the appropriate treatment. Morphine will take away the suffocating feeling. It's not for pain. It slows everything down and makes breathing easier." I knew all that because that was my FIL's treatment.
So there was a big to do the next day and she got that gasping feeling. While I was on the phone with the nurse supervisor about the big to do, she was saying that my mother had calmed down and was fine. Then she says "hold on, oh, your mother is asking to go to the hospital." Right, so much for she's fine. My mother's code status states DNR/DNI and go to the hospital only after consultation with physician and family. I told them no. They couldn't send her to the hospital. I wanted them to talk to the doctor and get an order for the morphine. It was Friday after 5pm and therefore a big inconvenience. I said if the house doctor couldn't be reached they could call her private lung doctor. He felt that it was the proper treatment and I wanted them to try the morphine first.
So I got a lot of people mad at me because they had to go open up the emergency medicine cabinet. Only two people have the key and it is all the way across the building. Too bad, so sad, do your freaking job. They gave her the morphine and guess what? Her breathing got better. She relaxed and was ok. I actually talked to her on the phone for 3 hours that night. She had no trouble breathing. No hospital visit.
So then I tackled the normal day. With COPD, if you sleep in a regular bed you are prone and that is the hardest position to breath in. So she wakes up short of breath. Then they want her to get up, use the bathroom, wash up, and get dressed. All of those take lots of energy. Imagine trying to do all that with one of those vests the dentist puts on when you get x-rays. It takes effort to breath. This all sets my mother up for a terrible day.
So I had to demand they give her morphine first thing in the morning along with her breathing treatments, then wait for everything to kick in before getting her up. They don't like this because it messes with their schedule. But I was on them everyday. Did she ask for it? Did you give it to her? how was her day? I did this for a week until they finally figured out that if she started her day good then the rest of the day went well.
Then she got pneumonia. So they call me and tell me she has pneumonia. They had done an x-ray and it showed on the x-ray. Now my Mom gets pneumonia very frequently. She knows how it feels before it ever shows on an x-ray. She complains, they ignore her. Eventually, they would send her to the hospital for an x-ray. So why am I finding out now that they can take an x-ray? Because I said no hospital.
One of the nursing supervisors calls and says to me "are you sure that you don't want her to go to the hospital? what if it is a pulmonary embolism?" So I said, if she went to the hospital and found it was a pulmonary embolism, what could they do? Nothing. So why put her through that.
The week she had the pneumonia was hell on earth, especially since there was an issue with the doctor on call. There was literally no coverage and that resulted in her waiting like 12 hours for relief from the pain due to the pneumonia.
I got another call from a nurse supervisor because my mother has lumps in her breasts. They were there a year ago and the doctor wanted to wait 6 months to recheck them. For some reason, it never happened. So I finally got the snf to listen, but the woman says "you don't want her going to the hospital and that the only place the test can be done." I basically told her that I don't want them dumping her at the hospital when she has trouble breathing but that doesn't mean she can't go for testing. Then she says "well if it comes back as cancer what are you going to do?" I explained that if it were cancerous, there would be no treatment. I had already discussed it with my mother. She actually brought it up. However, the anxiety associated with not knowing was worse than the effort to have the testing done. Tests complete. Just fibrous tissue, same as she's had before. Worries all gone. Time to obsess about something else.
So a big problem is getting my parents together. My little sister works two jobs and it's physically difficult to take my mother anywhere. My Dad as yet can't get in and out of a car. So far we have amassed about $600 in transportation fees for him that are not covered by medicare because they were nonemergency visits to the surgeons.
Then last week my Dad had a visit with the plastic surgeon and we find out that he wants to take him back into surgery because he is not happy with the way one of the wounds is healing. I think he thinks he can fix it so that my father has better mobility. My Dad doesn't want my mother knowing because she will worry and work herself up. Possibly to the point that she won't be able to breath. Literally it could kill her. So we are keeping it a secret. Unfortunately, one of the people who know is a blabbermouth. But I think I took care of it by explaining that the anxiety my mother will feel will put her in a lot of jeopardy.
So, since my Dad was originally operated on we have done a new healthcare directive. In CT you can sign a healthcare directive in front of two witnesses, no notary, no lawyer. We did this for my Dad early on. You can appoint two people. One as primary and then a secondary in case the primary is unable to perform the necessary duties. I'm primary and then the secondary was my niece.
I was trying to make sure that everyone had the right directive. In the process, I found out that the surgeons have me as a contact using my maiden name and my niece's address. Oh and I was listed as "granddaughter".
The history with my niece is that from the very first day my niece (or her mother) changed the contact information so that she was the primary contact. The first day my uncle should have been contacted but never got a call to say that my father was out of surgery. It was supposed to be a simple procedure. It didn't go that way. They had to call in a vascular surgeon and he had to put in an artificial artery. It ended up being 9 operations and 5 weeks in the first hospital.
I kept being left out on the information. I was never contacted to be told he was going into surgery or when he came out of surgery. After quite a bit of investigative work, I found out that someone called in and told the nurses that I had a new phone number. The number written down just happened to be my niece's cell phone. She has no idea how that happened.
The number was written into the chart in such a way that it would be the first number called. It also is the number that was given to the surgeon to call after surgery.
Amazingly my niece said all the doctors told her they had already spoken to me. When I talked to the doctors they say they only called one number. Obviously, there is a conspiracy to make my niece look bad. I later found out that I could password protect the chart so the contact information could only be changed if you had the password. I also found out that my niece had been talking to the discharge nurse and contradicting things I was telling her. The discharge nurse was under the impression that my niece had authority to make decisions.
My niece told me "grandpa said to give me his debit card" and "grandpa told me to get the keys to his car." Her explanation was that if my dad needed something she needed money to get it and when he was released from the hospital they needed the car to take him home because he wouldn't be able to get in their cars. Yeah, right. The extent of what my niece "bought" him was a couple of newspapers and a few breakfasts sandwiches from McDonalds. She "paid a lot of money out of her own pocket." Nothing close to the $900 I spent to buy clothing for my mother and other things she needed. I also found out that my niece's husband's car was in the shop. My Dad's car isn't even paid for.
So I started looking into the finances and found that my niece was gauging my parents on the cell phone bill. They were paying $80 for two flip phones that my father paid out of pocket for. No data. In march he "had to" replace one of the phones. She signed him up for a two year plan instead of paying outright $192 for the phone. My father paid $149.99 and she agreed to a 2 year contract but he could have paid the $192 to purchase the phone with no contract. I just found paper work for a rebate. It never came in the mail or it was intercepted. My niece had the mail key for about 2 weeks during the time period the rebate would have been in the mail. She has done this before to someone else.
My father was moving to a new cheaper apartment. Luckily I was able to cancel the new apartment. But that $80 a month was enough to break him.
So Medicaid pays for my mother's long term care, but it has to be reviewed every year. That fell into my lap. On Medicaid she gets to keep $60 a month from her social security. She can only have $1600 in assets. Since she and my father have a joint checking account his SocSec and pension count against her assets. Since he's had no rent to pay the money has piled up. They could make me spend down the account. That means paying her bill until it's under $1600.
So I had to remove her from the joint account, then open a new account for her so their money isn't mixed. Her money goes into her account. His goes into his.
Also, the cash value of a whole life insurance policy counts as an assest. To get rid of it, I had to make an irrevocable contract with the funeral home. I had to sign the policy over to them. They became the owner and the beneficiary. I have to pay the premiums. The only good news is that every member of my family has been buried by the same funeral home for like 80 years. I know they will still be there. The burial plot is in my name not my parents so it's my asset. There i also a nursing home rider on the policy so if I have the right paperwork they will wave the premiums for my mother. The bad news the face value of the life insurance doesn't even cover the basics like opening/closing the grave, the funeral home services with one wake, the car/limo. But I've always known that I would be be covering the expenses.
I think my middle sister thinks that she is in line for a third of the life insurance. Bad news for her. Especially since I was the only beneficiary to begin with. The purpose for the insurance was to cover as much of the funeral costs as possible.
Don't spend the money on a whole life policy. Yes you can get a loan but you'd be better off going to a payday lender. So the way they calculate your premium is they take the face value and divide it by 12 months times 20 years. The policy states that after 20 years you stop paying premiums. Insurance companies don't gamble they know exactly how long the average person will live. They always make money.
So since I've had to explain why I'm paranoid about the Advance Directive, there have been lots of questions. Oh I forgot my niece works for the hospital and this violates HIPAA practices. It also leaves the hospital open to a lawsuit. I haven't reported her but I think this time around she's out of luck.
But some good news. Today they installed a close caption phone for my mother. She is no longer isolated. She was able to "talk" to my Dad today. She gets both the audio and the text to read. No more frustration on both ends. She can't understand what is being said and we can't get her to understand what we are trying to say.
Did I forget to say she is almost completely deaf and we can't talk on the phone without and aide or nurse relaying our message.
So, in general today was a good day. I only got one call from each of the nursing home. I only spent about an hour and a half on the phone with my little sister trying to get things done.
I still have 3 weeks to file for Medicaid for my father. The PT guy said after the surgery they can start working on getting in and out of a car so my Dad can go visit my Mom. I'm also going on vacation in two weeks and will be able to see my daughter for the first time since January. Although I haven't started treatment for the Lyme, I'm feeling ok.
I really do feel better than I did when I started the post. Of course, that was at around 9am. So I have spent 9 hours writing this in between juggling my parents, two snfs, at least one doctors office, my Dad, my uncle, my sister, and the close caption phone guy.