So let me re-cap a little from the first part of “A Little Touch of Reality”: A 4.4-mile ambulance ride costs $1005; a day in a standard med/surg bed at Crouse Hospital costs $1639, and—what I forgot to mention—a day at Iroquois Nursing Home costs $315. Now, back to where I was trying to go before I lost focus.
My first two days at Crouse (this time) were deemed medically necessary so they were billed to Medicare/Medicaid, then I was put on ALC (too often confused with A1c, which is the three-month blood level of glucose; ALC is Alternate Level of Care), for which, in the words of a Crouse director, “We get paid nothing or very little.” Crouse told me and Stevie the Wonder POA that they no longer were getting paid BUT NOBODY TOLD THE JUDGE OR THE IROQUOIS LAWYER. Where, in the greater system of things, was it writ that the judge or lawyer should be notified?
So Crouse was providing total care and trying to find a safe, appropriate medical discharge, while the Iroquois was doing nothing. And nobody was paying either Crouse or the Iroquois for anything but Crouse kept feeding me—even gave me a credit card to use the cafeteria.
Then we had the second hearing, Annie vs. Iroquois, because Iroquois said (a) that I didn’t need skilled nursing and (b) they were sending me back to my apartment to live without any services in place—no aides, nurse, doctor, social worker or case manager—and I was appealing that.
The morning of the hearing, Crouse’s chief medical officer ordered all his people to stay away from the hearing, claiming that it was between me and the Iroquois. Only problem was that since May 24 I have been bouncing back and forth between Crouse and the Iroquois. When I am not living at Crouse then I am living at the Iroquois. The judge said he wanted to hear from my doctor; I have no doctor except the hospitalists at Crouse.
There were two reasons why Crouse personnel should have been at the hearing. First, because they were the only ones who could testify to my real and actual needs for care. Second, because they were picking up the bill. Wouldn’t any enlightened human being want to be present at the hearing in order to become informed about the circumstances of a patient he’s paying for? I would have thought so.
The chief medical officer never talked to me. If he had, I would have explained to him about the money but he never came anywhere near me. For several days, he and his staff had been talking about me and the hearing, but they never talked to me. Nobody ever said, “Hey, Anne, what do you think?” When you make decisions without talking to the end-point-user, you can count on getting it wrong every time.
So the hearing started at 10:30 and ran till 5:30 but I was too sick to stay up that late so I didn’t hear how the judge wound things up, but I was told that he decided (a) that I still was a resident of the Iroquois and (b) that the Iroquois had to come up with a discharge plan FOR HIM TO APPROVE. The Iroquois could not discharge me to any place they saw fit; it had to meet the judge’s approval. Meanwhile, I could stay at Crouse unless Crouse decided to kick me out.
Well, that was the Holy Terror for me: Crouse wasn’t getting paid, and how long would they carry me? I lived in a constant state of fear that Crouse would send me back to the Iroquois. Crouse is a caring hospital but it is also a corporate business that has to mind its financial manners. I kept trying to get Crouse and the judge to talk to each other but the judge wouldn’t do it. The judge had not issued an official decision but Crouse people were coming to me asking what his decision was. What should I say? What could I say? I didn’t know what to do.
The judge was reported to have told the Iroquois to come up with a discharge plan in two weeks. All the Iroquois did was try to bully and manipulate me into signing applications for extended care through TLS, Onondaga Case Management, and St. Joseph’s Behavioral Unit—all of which were psychiatric agencies. I have major medical problems and I will not agree to put those complicated and ultimately terminal illnesses under the control of a psychiatric case manager. I refused to sign the applications and told them to go see my Power of Attorney; they didn’t do it.
Meanwhile, I proposed to the Crouse social worker that we consider the NYS Dept. of Health’s Nursing Home Transition program—actually, reconsider it. Stevie and I had tried to get some action with Arise, which runs the only program in Onondaga County, and hadn’t responded in a timely manner when we applied in May. So I called Albany, talked to the boss lady of the Nursing Home Transition program, reported the unresponsiveness of Arise, and asked for her help. She said she’d call to have someone come see me promptly. That was two or three weeks ago and we still haven’t heard anything.
Then Crouse came up with PACE, “A Program of All-inclusive Care for the Elderly,” and I agreed to be interviewed by them. We’re still waiting.
Then my wheelchair broke down. I no longer can get out of my isolation cell. The repair company says they are not coming because no financial arrangements have been made. Medicare and Medicaid will not pay for it because they are paying for my hospitalization. No, I say, I’m on Alternate Level of Care and they are not paying. Oh well, Catch 22, says the repair company owner. When I ask for the contact information for Medicaid, she says she is not allowed to give it to me. When I ask for a denial notice so I can appeal it, she says there is no denial notice, only her saying no. When I say that I am a citizen and this is taxpayer business and I have a right to appeal, she does not answer me.