My mother Marianne is 92. She’s lived in the United States for more than 60 years, having married an American engineer whose first job was with Combustion Engineering and later the Tennessee Valley Authority.
Marianne, about three weeks ago, fell and broke her hip. Today she is in Life Care Center of Hixson, which is part of a chain of nursing care and retirement care facilities run by multibillionaire Forrest Preston.
By David Tulis
What is in the best interests of the patient?
This is a difficult question because two parties have an interest in my mother’s care. Both parties are profit-seeking corporations.
On one side there is Life Care Centers of America based in Cleveland. It wants to have as many people in its rooms and as many people as it can muster right now.
Right now, the census at Life Care Center of Hixson is low, a staffer tells me. The dining hall is largely empty at lunch and dinner, at least partly because many people eat alone in their rooms.
Life Care Center of Hixson and its therapy staff want her to be a customer; they want to extend benefits to her as long as is possible under the rules would control her stay.
The rules controlling her stay are set by an insurance company which has a contract with the federal government and its Medicare division. BlueCross Blue Steel has in her case what’s called an Advantage plan.
The staffer at Life Care Center of Chattanooga says dealing with BlueCross Advantage is extremely tricky, difficult and unpleasant. Blue Cross because of its aggressive customs and manner, presumably saving the U.S. money in the leviathan gridwork of the code of federal regulations.
Tug of war
So we have these two entities tugging over the patient client. Perhaps the best interests of the patient are served in this conflict. Perhaps not.
We have a Life Care Center of Chattanooga on one hand wanting her stay to be as long as possible under insurance. On the other side we have Blue Cross Advantage which wants her to stay to be as short as possible if the patient is not showing measurable improvement. It doesn’t want here just to parked there for weeks.
What is the best thing for the patient? This question every relative or person with power of attorney of a senior citizen must answer.
Is it best to have her there, though she does not like to be there and would rather be at home? She gets therapy usually twice a day — physical therapy, occupational therapy and occasional interviews to test her cognitive ability.
The way of the Amish
The Amish are known for being outside the system. They work outside the system. They trade outside the system. They live outside the system. They’re not part of the tax structure of our country, though I think many voluntarily file tax returns though they are not liable to under the statute. They’re not part of the industrial economy. They avoid many of the expensive toys and worthless fads of modern American life.
They are Christians. They have a concern for their elderly and elder care is part of what every family does. No family anticipates a senior member being cast on the government dole in any way. Or the insurance dole upon which my family finds itself today.
The Amish care for their own. I’ve heard recently from a friend in Middle Tennessee who knows the Amish and area nursing homes. He never finds finds an Amish person in a nursing home or on Medicare or under Blue Cross Advantage.
Because Amish families identify with each member even the old members. Old people have a place in the Amish home. Even old people who need a great deal of attention and care.
The fear I have about the care for my mother is a fear about what I’m tempted to do. The temptation is as follows.
Let my Mother’s Day in Life Care Center of Hixson as long as insurance lasts. She’ll be able to get therapy and people will take her to the bathroom when she needs to go and I won’t be bothered. When insurance money runs out, we’ll take her home — yes, gladly.
But I’m wondering if that’s true. I’m wondering if I let her stay as long as insurance allows it if I’m being faithful in adhering to the principles of caring for our own people. Is letting her linger in a senior care center caring for her? Is wanting Blue Cross to last longer a godly want? Or is it letting others bear my responsibility? Am I depriving her of therapy benefits if I yank her out before the deadline tolls? Or am I being a faithful son, bringing an old dear closer into family life after he years of living alone in the house next to mine?
She has asked me repeatedly when she will depart. “Mom,” I reply. “I don’t have a plan.”
Paralysis afflicts me. I am of two minds.
If the senior family member were at my house, she would get exercise care from a grandson, on a schedule. Leg exercises. Lifts. Squeezing a ball between her knees. Pulling against a larger rubber hand by clutching at a handle.
Family members will take a lot of little walks when she is mobile again to get her out of her easy chair, her wheelchair or her bed.
“Mom, you rot to death in bed” is a statement I’ve made repeatedly, as a kind of warning.
She can be part of family life.
She can take part in family worship which I try to lead every day.
My mother has a thin Christianity fed mostly by potato chips of the morning devotional variety. She’s not a big reader of the Bible, and finds herself satisfied with summations and abstracts — Daily Bread sermonettes she reads in the morning.
If she were in my house she would be getting a little bit more nourishment spiritually.
What do you think?