Sunday, September 7, 2008

Medicare(less) Lessons 1 & 2

As is often the case, the government infrastucture is designed for acute issues and falls apart once the diagnosis changes to 'chronic'. We all see this in the news every day. Some of the stories hit home, others are at home.

We will be eternally grateful that Keith was accepted into the Medicare program on January 1, 2008. Knowing that the costs were covered took some of the stress out of the 3-1/2 month hospital stay. We are also grateful that we had some time in the hospital prior to returning home to train with the respiratory therapists so we could handle the new duties when Keith moved home with the ventilator and trache. We were fortunate that Walgreen's Home Healthcare is the provider contracted to take care of the post-hospital needs. So, without a doubt, the government-managed Medicare fulfilled its purpose in regard to the acute healthcare issues Keith has experienced this year. However, in this phase of healing, when Keith's health needs have been recategorized as chronic, Medicare has transformed into Medicare(less).

One of the most important parts of this healing process is getting Keith back into his pre-hospital life. In that life he engaged with the world daily, he did not hang out in bed for days at a time. Because Medicare will only cover a manual lift, he can only get out of bed when one of his male attendants is here. This is because the process of using the manual lift requires quite a bit of upper body strength, which is not something that most female attendants have. We have requested an electronic lift, which is easily managed by one person and is safer for both Keith and his attendants. Unfortunately, Medicare considers this an unnecessary expense and does not pay for the lift. This forces Keith to be confined to bed and allows him experience the world second hand through me, his caregivers, visitors, the internet and the television. So we have leveraged all of those elements to spread the word about Keith's progress and get the world engaged with him. Although his physical movement is still limited by the lack of an electronic lift, he has been able to reposition himself as an activist and is back to engaging with people near and far.

Lesson One: Insurance does the bare minimum to keep you alive, but does not allow you to truly live. If you want a full life, you have to fill it!

We were recently informed that Medicare had determined that the inner cannula on Keith's trache only needed to be changed every three days, rather than every day as we had been instructed to do at the hospital. (The inner cannula fits in the trache and is the is the first line of defense against infection.) We didn't find this out from Medicare, we found this out when our Walgreen's representative dropped off supplies last week and we only had one box of replacement cannulas instead of three. Naturally, it was disconcerting to discover that Medicare was reducing support for something that we had been told was vital to Keith's good health. After conferring with Keith's doctor, we decided on a workable compromise and the inner cannulas will be changed every other day. Medicare will cover one box and Walgreen's will sell us the 2nd box at their cost. It's an additional expense for us, but well worth it.

Lesson Two: Medicare does not service individuals, they serve groups. You have to do the work to make the plan work for you.

Okay, those are the lessons for tonight. No doubt there will be more, after all, tomorrow is Monday and government is back in session!

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