Day 20 – Confusion

visitors around mom's bed at Park Regency Care Center in La Habra, CA

A Tale of Two Health Care Cities

Yesterday Gwendy & Licha accompanied mom on her visit to Dr. Shamlou, her Orthopedic Surgeon. Today Gwendy & I joined mom for a meeting with Park Regency case manager Kat. It was sort of a tale of two health care cities. Dr. Shamlou thinks mom will be at Park Regency for months at least; Kat estimates that CareMore will allow her to stay for weeks at most.

Perspective

Tomorrow is Day 21. The end of 3 full weeks since mom’s fall. The end of 21 days of lying immobile in bed. It’s just surreal to consider mom going across the street to St. Thomas Aquinas for mass, expecting to be home in an hour or so, and now not setting foot in the home she’s lived in for 60 years, for 21 days and counting.

Therapy

I just said immobile for 21 days. That’s mostly true. But the past few days they have been sitting her in a wheelchair for an hour or more after therapy. It’s very fatiguing for mom, but it’s a step. And fatiguing as it is, she’s also so glad to be in an different position.

Dr Shamlou Visit

Dr. Shamlou removed the stitches from both hip and shoulder and was pleased at how both surgical sites were progressing.

On the painful right foot, he was puzzled and ordered an x-ray. When she returned to Park Regency they took a foot x-ray which showed swelling, but no fracture. The foot pain and “drop foot” are both a mystery at the moment. Licha wondered if it might be a pinched nerve behind the knee?

I think a nerve conduction test was also discussed, but that can’t be done at Park Regency, mom would have to go back to PIH Whittier.

Outcomes

Dr. Shamlou estimated that mom’s hip might regain 75% range of motion, and her shoulder 50%.

Licha: how long will she be at Park Regency? 2-3 months?

Dr. Shamlou: oh, at least.

Next Orthopedic Surgeon Visit

  • Thursday, March 10 @2:30pm

I can’t be there on Thursday without missing class. It was great that Licha & Gwendy were able to go yesterday. I should call Dr. Shamlou and see if the next appointment can be moved to Wed or Fri.

Next Cardiologist Visit

  • No visit with Dr. Trinh currently scheduled

Meeting with Park Regency case manager Kat

  • Mom’s weight was 123# on Feb 4th
  • Mom’s weight was 123# on Feb 8th

Pain

Licha was concerned that mom was experiencing a lot of unnecessary pain. Dr. Shamlou said that given her age, the only appropriate pain mediation was Norco. But that it should be Norco and not Tylenol. It seems that Dr. Shamlou wrote a prescription for 2x/day and the CareMore doctor, Dr. Susan Keisner, wrote one for 4x/day. The problem with 4x/day is that they have to wake mom up to take it, which seems counterproductive. Especially since mom says she’s been sleeping really well the whole time. So we agreed on 3x/day, at 8am, 2pm & 8pm. Kat will contact Dr. Keisner to have this approved and have the prescription written.

Drugs

In addition to Norco, mom is also taking a couple of blood thinners, a blood pressure medication, diabetes medication, and a stool softener.

Physical Therapy

I learned today that “Physical Therapy” tends to mean lower body, and “Occupational Therapy” tends to mean upper body. So mom has “Physical Therapy” for her hip and “Occupational Therapy” for her shoulder.

The fact that she can’t put weight on her arm really limits her PT for her hip. Kat suggested that next time it would be better to only break one joint. Or, if it must be two, that it might be better to have the hip be the worse break and the shoulder less. Only one break is better – noted! 🙂

Dr. Shamlou cleared mom for Toe Touch Weight Bearing. Which, I believe, means not weight bearing. This creates two problems:

  1. Mom can’t do toe touch if she can’t support herself in something like a walker
  2. Mom can’t progress if she’s restricted to toe touch.

CareMore & Progress

Kat explained that CareMore will only pay for a Skilled Nursing Facility like Park Regency under 3 conditions:

  1. IV Treatment
  2. Wound Care
  3. Physical Therapy

In mom’s case, it’s Physical Therapy. But, in order to stay, mom must show “progress” every day. Kat said,

For example, if she takes 4 steps on Monday, 5 steps on Tuesday, 5 steps on Wednesday, and 5 steps on Thursday, that’s 3 days with “no progress” and CareMore would remove her from the Skilled Nursing Facility.

The problem is that Kat says it’s essentially impossible to show progress when you’re restricted to Toe Touch. It seems that Dr. Shamlou will need to change it to Weight Bearing before the March 10 appointment, or else CareMore is likely to remove her from Park Regency. Kat says CareMore would then send a therapist to the house, but that such therapy would only be to maintain whatever progress was gained at Park Regency, not to progress further as would be the goal at Park Regency.

Days of Skilled Nursing Facility

In any event, CareMore will only pay for a given number of days at a skilled nursing facility. Kat said that if, for example, you can’t make leg progress because your arm can’t bear weight, it might be better to go home, wait for some arm recovery, and then return when you can bear weight. Otherwise you’re using up your Skilled Nursing Facility days just to lay in bed and recover, but not to take advantage of Park Regency’s aggressive rehab.

Kat didn’t know what mom’s CareMore coverage would be, but she said just to make up random numbers, CareMore might pay 100% for 20 days, 80% for 21-50, 50% for 51-70, and 20% for days 71-100. Kat said a day at Park Regency was about US$300. We were all, mom especially, a little nervous about the financial implications of this.

Kat asked Rebecca from the Park Regency Business Office to find out what mom’s actual CareMore coverage is. We were all relieved to find out that her coverage is a lot better than Kat’s fictitious example.

  • Days 1-31 – 100%
  • Days 32-100 – $25 copay

Not surprisingly, mom is very eager to get home! But she also realizes that being at Park Regency might increase her eventual range of motion. Dr. Shamlou told Mom, Licha & Gwendy that he wouldn’t release her from Park Regency until she could get out of bed by herself. At the moment that seemed like a long journey to mom, but she too would like to have a bit of mobility when she gets home.

Mom lamented,

All my life I’ve never depended on anyone for anything. Suddenly I have to depend on everyone for everything.

Mom moved to Park Regency on Saturday Jan 30. Then on Monday Feb 1 atrial fibrillation took her to PIH Whittier. Rebecca said your departure day doesn’t count, so Saturday & Sunday count as 2 days. Mom returned to Park Regency on Thursday Feb 4th. That makes today, Friday the 12th, the 9th day of her 2nd stay at Park Regency, and the 11 day total.

Friday Feb 12
• Day 20 since falling
• Day 11 of Skilled Nursing Facility

Of course we all hope mom won’t need that many days, but it at least comforting that the copay for an extended stay would be relatively modest.

But again, this depends on CareMore letting her stay, which depends on mom making “progress” which is essentially impossible when restricted to “toe touch.” At the moment toe touch is all that’s realistic, but we might ask Dr. Shamlou before March 10 to change mom to Weight Bearing As Tolerated.

Occupational Therapy

Dr. Shamlu’s prescription for mom’s shoulder is currently Non Weight Bearing.

CareMore Plan

Mom’s CareMore plan is CareMore Reliance.

visitors around mom's bed at Park Regency Care Center in La Habra, CA

Just a minute after Gwendy, Mom & I finished meeting with Kat & Rebecca, Ryan came by with Austin & Ashley!

a blimp made out of yarn

Austin made a cool Valentine’s Blimp for mom!!

February 12th, 2016 by