This is a long story but I think I can get it into two parts. If you are a regular reader of this site, you might want to wait until Part 2 is posted and read them both in one sitting. I won't be offended. You will also understand why I am illustrating it with photos like this one of Phil Silvers in his iconic role of Master Sergeant Ernie Bilko…
A recurring theme in stories I write is that the hero outsmarts the villain. One reason I haven't done more in the super-hero vein is that I don't relate to victory through sheer brute force and power. I understand that that is often the denouement of conflicts in real life but not so much in my life. We who follow comics all have our Batmans. Mine is the one who out-thinks The Joker instead of out-crazying him or beating the crap outta him.
Outsmarting an opponent isn't possible all the time. It may not even be possible most of the time. But there are cases where the best resolution comes where you figure out how to "win" via strategy rather than by threatening and/or screaming and/or pounding on the desk or someone's face. That did not work when I had a problem with the kind of places that are called "skilled nursing facilities," regardless of how skilled the nurses there may be. And let me make it clear: Sometimes in my experiences, they were very skilled and very good at what they were supposed to do. But not always.
I first had this problem with my mother, who kept having attacks that put her into the hospital. My mother lived to the age of 90 and, given the number of cigarettes she went through for about 73 of those years, even she was amazed she lasted that long. But the last ten or so of those years, she became almost blind, almost unable to walk, unable to eat anything she liked, unable to stray too far from a bathroom, etc. Worst of all were the numerous times either paramedics or firemen or I had to take her into emergency rooms.
On the door to her home, there was a little lock box. In the lock box was a key to her door so that if I wasn't present, emergency personnel could get in and help her. Sometimes, I had to give them the combination over the phone. Sometimes, the private monitoring service to which I'd subscribed would notify the emergency personnel that she needed aid and they'd give it to rescuers. But the last few times when firemen came, they didn't need to be told the combination. They'd been there so often, they remembered it.
She received very good care at whatever hospital they took her to…and if it wasn't Kaiser Permanente, she would soon be transferred to the local Kaiser Hospital because that's the kind of insurance she had and Kaiser likes to treat its patients at their hospitals instead of paying the bills at other hospitals. Also, all her records were at Kaiser and she knew most of the doctors there and they knew her. I probably mentioned this before somewhere but because of her, I spent so much time at that Kaiser Hospital that when I went down to the cafeteria, the cashiers would automatically give me the employee discount. They saw me so often, they assumed I worked there.
Eventually, she would be released from the hospital. Sometimes, the doctor would okay her going home. Sometimes though, she would need additional care of the kind provided by a Skilled Nursing Facility, and I will henceforth abbreviate that term because I'll be using it a lot here. I don't know if it works the same way everywhere but here is how it worked with Kaiser…
Kaiser had (and I assume, still has) contracts with local S.N.F.s. These places are independently owned and managed but they agree to provide beds and care for Kaiser patients who are sent there upon discharge. They also provide space for Kaiser doctors to drop by each day and check on the Kaiser patients there. I would assume that because of volume, Kaiser pays a rate for this far less than you or I would pay if we just wanted to check someone in there or if they were referred by a doctor who wasn't part of a plan like this.
So let us say you're in the hospital and your doctor can't justify keeping you in the full-facility hospital and thinks you need to be in an S.N.F. for a while. A coordinator at the hospital makes up a page to send to all the local S.N.F.s with which they have deals. The page tells the S.N.F. who you are, what's wrong with you, what kind of treatment you will require there, how long you might be there, etc. When I dealt with these matters, these pages were faxed to all the S.N.F.s but I'll bet they're all e-mailed these days.
Someone in charge at each S.N.F. looks at the page and determines, first of all, if they have a bed for you and if they have whatever might be needed to do what the doctor says must be done for you. You might require certain equipment or physical training or you might have to be there a long time. In essence, they decide if they can take you or not and they so notify the hospital.
Under the terms of your insurance, once an S.N.F. has agreed to take you, you must leave the hospital. In some cases, you could elect to go home or to the home of a loved one who can care for you but often, that is not practical. It was not practical whenever my mother was discharged and it would not be practical a few years later when my friend Carolyn was discharged from the different hospital where she was being treated.
But in that situation, you have to leave. You cannot say, "I don't want to go to that S.N.F. I want to stay here in this hospital."
Well, you can say it but it generally doesn't do much good. Even if you have good insurance — and my mother and Carolyn both did — it's not going to pay to keep you in the hospital if your doctor says you should be in an S.N.F. and one is willing to take you. If no S.N.F. can take you, you remain in the hospital but only until some S.N.F. can and will accept you.
The first time my mother was to be released to an S.N.F., I insisted on going there first and checking the place out. It seemed acceptable…barely. But I didn't know what to look for, plus it was much better in the afternoon when I made my inspection than it was in the evening when I drove my mother there and checked her in. At night, other patients were screaming…about what, we never learned. And the nurse assigned to my mother was rude and negligent. At 7 AM the next morning, my mother phoned me and said, "Please…get me out of here!"
I hurriedly dressed and I did not go immediately to that S.N.F. Instead, I drove to Kaiser Hospital, parked my car and made my way to the employee parking lot where I located the empty parking space of one of my mother's doctors there. Fortunately, I knew his day off and it wasn't that day.
Fifteen minutes later, he pulled into his parking space to find…me. I explained to him what had happened and he said, "You go get her. I'll get the paperwork started." I sped to the S.N.F. and felt like The Prince rescuing someone from The Dragon as I packed my mother up and took her out of there. This was done over the objections of an S.N.F. staff member who insisted she could not be officially released until they'd received the proper orders from Kaiser. I was daring them to stop me as I loaded my mother into her wheelchair but then the paperwork arrived.
Thirty minutes later, she was back in a bed at Kaiser Hospital. She stayed there instead of going to another S.N.F. until it was decided she could go home.
A month or two later, she was back in Kaiser and about to be released…but not to go home. She was to be moved to a Skilled Nursing Facility (to unabbreviate for a moment). I told the lady in charge of such matters that the one she'd been in previously was unacceptable. She told me Kaiser no longer put patients in that S.N.F. They'd canceled the contract with them…the result of an investigation requested by my mother's doctor there, based on what she'd told him and what I'd told him. (That S.N.F. remained in business, by the way. I have no idea if it underwent improvement but someone was putting patients in there even if Kaiser wasn't.)
But now I had to deal with the question of what to do to prevent my mother winding up in a place equally as bad…or worse. And that, dear readers, is where we shall leave things until Part 2 of this story which will be here in a day or three.
Click here to jump directly to Part Two
