Here's a little crash course lesson in hospitals, diagnosis codes, reimbursement and such:
Acute Care Hospitals: UMC, Covenant, Northwest Texas, Baptist-St. Anthony's These are where you go when something happens to you. Example: You have a baby.
Long Term Acute Care (LTAC) hospital: Not available in every state, on almost every corner in Texas, to include hospitals such as Texas Specialty Hospital, Triumph Hospital, Cornerstone Hospital, Select Specialty Hospital You are admitted to these hospitals after a stay in an acute care hospital, for an acute condition that needs longer treatment than is provided in an acute care hospital. Example: You are admitted to General Hospital where you have your gall bladder removed. You contract a hospital-acquired infection. You will likely head to an LTAC where you will be for an extended amount of time for treatment of your hospital acquired infection with at least two IV antibiotics.
Rehab Hospital: Self explanatory, you go to these for Rehab. There are cardiac rehab hospitals, physical rehab hospitals, etc. Physical Rehab hospitals include: TIRR and Trustpoint To be admitted into a Rehab hospital you must be able to participate in at least 3 hours of intensive, physical therapy per day. Intensive, physical therapy is weight baring.
Nursing Home: Self explanatory, I believe.
Skilled Nursing Facility: A slight step above nursing home, although they are usually just a wing within a Nursing Home. Commonly referred to as SNF, pronounced SNIFF. Examples: The Plaza, Lakeside, etc. These provide higher care than a nursing home. They have LVN's on staff, rather than the typical aides in a nursing home. IV's and parenteral feeding are allowed, etc.
During the first week at UMC, before we were even out of the SICU, a social worker came by to discuss with Mom what the plan of action would be. By "Plan of Action" I mean, where Dad would go after being discharged from UMC. A rehab hospital would of course be in the plan. However, due to the extent of his injuries, he was not ready-and would not be immediately ready-for a rehab hospital. Since he would still be in need of medical care, they recommended a skilled nursing facility. I slapped on a smile, nodded at the social worker and accepted the list of SNF's.
The next day, as Dad stepped down from the SICU unit to 3 West, Mom and I set out on a field trip to perform our "due diligence" of scoping out our SNF options. Given Dad's age, mental capabilities and life at home to return to -- neither of us felt the SNF was a good option. Mom was a bit discouraged after what we saw in the SNF's. (Understatement.) We did not feel that he would receive the care he would need in order to make a full recovery. There would also be a premium fee of $'x'K for a private room and Mom would still need somewhere to stay while he was there. Furthermore, after witnessing Mom take care of our great-grandmother in a nursing home, I was worried about the toll on her.
The way I looked at it, we had two options: 1) Get him qualified for an LTAC to essentially buy him some inpatient healing time or 2) Essentially "piece together" the same care he would receive in a SNF and provide that in a private setting.
Long story short: I didn't think any of us were up for a battle with the invisible roommates such as
acinetobacter sp. and
pseudomonas that are common in an LTAC. This road will be long enough without having to battle a hospital-acquired infection. (Disclaimer: This was not a "slam" on LTACs, HAIs are just the nature of the beast.)
So, I spent the next morning on the phone with BC/BS of Texas. The representative who helped me was precious, delightful and so very helpful. I verified benefits for home-health nursing, aides, PT, OT, equipment and so on and so on. I wasn't quite sure how we were going to get "transportation" covered- ie to/from doctors appointments, etc--but, knew I could come up with something.
After I explained to Mom what would and would not be covered by BC/BS, I began looking for a handicap-accessible apartment. The very first place I contacted was Raider Ranch. They are a retirement community for 55 and older. They were fantastic from the very first phone call. An hour later, Mom and I embarked on another field trip--it had to be better than our first one.
Here are the highlights of our field trip:
Staff-delightful! Transportation via a wheelchair accessible van Tuesday through Thursday is included in the rent. Monday and Friday transportation is a small fee-and by small, I mean a prorated portion of $25.
They were completely willing to accomodate us, even though they knew this would be "short term." Their minimum lease agreement is usually one-year. Even though she is too young to live there, they will allow Mom to live there since Dad will be there. Their handicap-accessible apartment is fantastic. And since it's their own apartment, friends and family may visit as they wish.
They have a full-time physical therapist on staff who serves as the Fitness Director. Their fitness classes and equipment are diverse. Mom will be able to use the facilities, train with the trainer, etc. In addition, when she isn't with other clients or teaching classes, their Fitness Director can work with Dad to supplement the physical therapy and occupational therapy he is receiving.
They receive a dining allowance for each of them--so, when Mom needs a break from cooking, they can head to the Dining Room. Their dining allowances may also be used at the Starbucks or spa. (No, I'm not kidding.)
They have an Assisted Living complex as well. In the event that we needed those facilities, they would let us transfer. (That is not in the plan.)
Cable, internet and phone services are all included. They have a 'Guest Suite' that is for rent in the event that family or friends want to come.
They have a social calendar that rivals that of a certain island I know--complete with Oktoberfest, fashion shows, concerts, games and so on. They are even pet-friendly! Kitty can come to Raider Ranch!
We left there with the greatest sense of relief. We headed back to the hospital and began pulling together the referrals we would need for services. Mom and Cash headed out that afternoon to rent furniture and a washer and dryer for the apartment. Our goal was to have all of this in place so that it would be a smooth transition when they did decide to discharge him.
Mission accomplished! Raider Ranch met Mom at the hospital with their nifty wheelchair accessible van and they headed to their new "home" at Raider Ranch. Ralph and Rebecca helped Mom transport everything between the hospital and Raider Ranch and then headed to Target to pick up a few things for Mom. From what I understand, they even brought Mom a Keurig. Thank you both for bringing them into the year of 2010 with that fabulous invention! Ralph even hooked up the dryer for Mom. They spent their first night in their "home away from home" and settled in.
Several visitors have kept them company, laughing and entertained! Caleb, Alisa and Addison visited for Halloween weekend. The Bennetts drove down from Amarillo with their hysterical terrior, Dexter, and Larkin treated everyone to some amazing cupcakes. Chuck and Maria have continued to help Mom tremendously.
Dad is still having quite a bit of trouble swallowing, therefore, eating is very challenging. Ever the creative one, Mom has managed to pack 800 calories into a shake in order to keep his intake up. The home health agency came to complete their assessment and have now started their services. PT and OT have been coming to work with him and Mom reports that they are "just fabulous!" The current plan is to stay at Raider Ranch until it is time to begin rehab. At that point, they will either continue to stay at Raider Ranch and participate in intensive, outpatient Rehab, or he will go to Rehab at an inpatient Rehab hospital such as Trustpoint there in Lubbock.
We cannot say enough great things about Raider Ranch! They have truly welcomed us with open-arms and been understanding and accomodating of our situation.
Their address at Raider Ranch is: 6548 43rd, #3201, Lubbock, TX 79407
Several have asked why they can't just go home to Wellington. From the outside, it might seem that if one could go to a retirement community, you could just go home. However, there are several factors that individually seem small. But, combined together, just make things far too difficult. His doctors and therapists are in Lubbock. The variety of services he needs and will need are offered there in Lubbock. Our house is far, far, far from handicap accessible. Dad had a brief idea that Mom could just "set him up in the front room." However, once he realized the front room did not have a toilet, roll-in shower or handicap-accessible sink among other things, he took that back. He is not able to ride in a car seat. He must be in a wheelchair for now, therefore, necessary transportation and relative ease of that transportation must be considered. Pelvic fractures can prove to be fairly complicated, which means being in close proximity to major medical facilities in necessary. While these are just a small sampling of reasons they need to stay in Lubbock for now, the bottom line is that they will eventually be returning to Wellington upon a full-recovery!
More to come later,
Dan's Dozen
