I got an explanation iabout "Mr. Heart!" I'm 83, now they act like I can't possibly understand anything they are saying. One told me her grandmother had that problem--it only gets worse.
QOI docs' advisory for medicare receives my letters, and betters their recommendations: better mobile ultrasound, admitting physician/patient advocate communicating EVIDENDE at escalation via Infectious Disease...
Very good tip. Have used a “BFCC-QIO” (Beneficiary and Family Centered Care) organization when managing family care.
Okay, this might get a little long. Please ignore if not relevant to you. The BFCC-QIO I used in California is called Livanta (Livantaqio.com), and they are also the QIO (quality improvement organization) for many states. It was then, and I believe still is, our right (either as medicare recipients or being supporting family members or advocates for Medicare recipients) to use such organizations if we ever have quality concerns or would like a second opinion on medical or discharge decisions. The QIOs have a whole system for making this happen. They do this for care decisions and also for things like potentially premature hospital (of all kinds) discharge decisions, which can be very important to manage so that you aren’t booted out immediately to the worst possible nursing home or rehab, etc. (like for situations when the hospital doesn’t care what your ongoing needs are, nor when a bed will open up in your preferred rehab, nor when you can feasibly arrange home care—they just want your bed back). This is the kind of thing none of us are taught, but we learn over time and then want to tell everyone because its the kind of thing that should’ve been in the “life manual” that we don’t get. The woman that I spoke to from Livanta calmed me down when I was afraid of pissing off the doctor by filing an early dismissal appeal (which I filed at 2 out of 3 hospitals for one injury surgery and recovery). She said, “Honey, this is your Right, and your family member’s Right. People in the hospital know that. Don’t worry about what anybody thinks. You are not doing anything against the doctor, but in favor of your family’s care. Do you want to file this or not?”
Basically, it’s a form that the hospital must give you at the beginning within about 48 hours of you being there and they give it to you to show you what it looks like, so you can read it in advance. Then they give it to you, by law, 24 hours (I believe) before they want to discharge you. You or your family or representative need to watch for it, because if that 2nd one arrives and you didn’t know it, the 24 hours starts ticking anyway. They will often deliver it to the patient without telling the family member. Usually someone signs to acknowledge it, but its a good idea to ask the hospital how they do it. Usually a first one is included with intake paperwork—ask them if this is the only one you’ll acknowledge in writing or if a second one will be delivered and within what timeframe vis-a-vis discharge and what type of acknowledgment from you? Let them know clearly who can sign for the patient. Sometimes they will decide for themselves anyway, and have patient sign it, so you’ll need to search the room for the NOMNC (“Nom-Knock”).
Familiarize yourself with any new NOM-NC policies or procedures for the current year (google). This is the kind of thing the regime (via CMS) could get tricky about, in favor of the hospitals. Pretty sure I saw a notice of a change of some kind when googling to get the proper names above.
Not saying all this because it is necessarily relevant to Joyce, the author. But because Susanna C brought up QIO doctors (yes, the QIO actually employs doctors and specialists to improve procedures and review existing procedures or care) and these are things I learned managing multiple surgeries and rehabs for family members on Medicare. So I thought I’d pass this on. Maybe I’ll make an actual note out of it someday.
Lastly, another phrase to learn is to be able to speak the language of necessary or sufficient “level of care” because this is the legal language that the social workers and “hospitalist” Drs or nurses often speak (whose job it often is to help get you out of the hospital when they need a bed— even though you are paradoxically told that they are your advocate while you are in the hospital).
For instance, if you cannot provide the “necessary level of care“ at home following hospital treatment, then you need to repeat and defend that fact over and over and the hospital needs to not discharge the patient until an “appropriate level of care setting” is found/determined. Ideally, you’ll want to be in on that decision and its timing and not have it dictated by the hospital.
For example, you and your patient relative may want a good residential rehab at a CARF-accredited rehab (CARF is a grading system for rehabs), not a small rehab practice in what is otherwise a nursing home.
Another thing to know: otherwise fancy/expensive private retirement places (even the life plan communities) often have good, modern rehab centers in their nursing care sections and they often have “Medicare beds” for rehab purposes=short to medium term, often 1-4 weeks, or whatever Medicare will reasonably cover. After that, they will want you out or paying private. Even though there is no such thing as a “Medicare bed” what they mean is that by law (at least in CA) they have to be willing and ready to take a certain number of Medicare patients if they have room. This is not for a permanent stay but for rehab only. A lot of people don’t know this and write them off as Medicare rehab possibilities, thinking they are private pay only. Sometimes these places will want you to go through some of the private pay rigmarole like you telling them about your (patient’s) finances and such so they can assess the extent to which you could be a private pay candidate. But they shouldn’t let that be a gating factor to admitting you for short-term rehab, as long as they are a Medicare provider who also serves some “community” Medicare patients.
I remember when I turned forty and everyone said it was the end of the world. What a joke. Forty is nothing. Forty is a blip. At forty, people still look at you. They still see you. They still listen when you talk.
At seventy-three, I've become invisible. Like you, Joyce, I walk into a doctor's office, and before I've even opened my mouth, I can feel it—that subtle dismissal, that mental categorization: elderly female, probably confused, definitely a complainer, possibly demented.
Did you know that if you're over seventy and you say you have pain, it's automatically considered less important than if you're thirty and say the exact same thing? I didn't make this up. There are studies.
The other day I was waiting to check out at Whole Foods, and the cashier kept looking past me to the young woman behind me, as if I might disappear if he ignored me long enough. I wanted to grab him by his organic cotton collar and say, "I've lived through eleven presidents! I marched on Washington! I've had more interesting conversations than you've had hot meals!"
But of course I didn't. I smiled. I was pleasant. Because that's what we do, my generation of women. We've been trained to be nice while being erased.
And this is how it happens—this is exactly how the sweet, hopeful woman of fifty-five transforms into the cranky old lady of seventy-three who seems perpetually annoyed. It's not age. It's accumulated indignities. It's death by a thousand cuts of condescension.
So now I understand my mother's generation and why they turned into such hardasses. They weren't born that way. They were made that way—by doctors who called them "dear," by mechanics who explained simple concepts to them very slowly, by a world that decided their expiration date had come and gone.
I've joined their tribe now. And here's what nobody tells you about this tribe: we remember everything. We're keeping score. And some of us still write.
So true. I had this discussion with one of my docs- I’m 75 and. Have been seeing her at least since 1998 because I have test results from her so then- and she agreed. She did say the even older men are not treated well, but women do get the brunt of it.
Ugh, too close to home. For me, at 76, it's aFib. The worst part is having to own a daily pill box to keep it all in order. "The 70's" doesn't mean what it once did.
Yay. I went back and re-read your post and saw that. If you need crowd sourced info after that and use Facebook, there is a great ‘Group’ called “Atrial Fibrillation Support Group” with 35,000 people. Lots of comparative knowledge and experience imparted for those early on the Afib learning curve. Best to you, Joyce!
I think Prada wil come out with adult diapers that you wear over your lulu lemon so don't fret my pretty. I hear you as my back is in rebellion again and now "back" at the doctor and PT. I hear you, it just sucks.
Looking on the bright side, your cholesterol levels are pristine. Your doctor probably figures that with those gorgeous uncluttered arteries, you're in for the long game.
Over dramatize a simple cardiac issue. "Terrorized" to try meds. Pls give me a break. You, my dear, are a crybaby
I got an explanation iabout "Mr. Heart!" I'm 83, now they act like I can't possibly understand anything they are saying. One told me her grandmother had that problem--it only gets worse.
What this country needs is a gale of laughter -- at Trump
QOI docs' advisory for medicare receives my letters, and betters their recommendations: better mobile ultrasound, admitting physician/patient advocate communicating EVIDENDE at escalation via Infectious Disease...
Very good tip. Have used a “BFCC-QIO” (Beneficiary and Family Centered Care) organization when managing family care.
Okay, this might get a little long. Please ignore if not relevant to you. The BFCC-QIO I used in California is called Livanta (Livantaqio.com), and they are also the QIO (quality improvement organization) for many states. It was then, and I believe still is, our right (either as medicare recipients or being supporting family members or advocates for Medicare recipients) to use such organizations if we ever have quality concerns or would like a second opinion on medical or discharge decisions. The QIOs have a whole system for making this happen. They do this for care decisions and also for things like potentially premature hospital (of all kinds) discharge decisions, which can be very important to manage so that you aren’t booted out immediately to the worst possible nursing home or rehab, etc. (like for situations when the hospital doesn’t care what your ongoing needs are, nor when a bed will open up in your preferred rehab, nor when you can feasibly arrange home care—they just want your bed back). This is the kind of thing none of us are taught, but we learn over time and then want to tell everyone because its the kind of thing that should’ve been in the “life manual” that we don’t get. The woman that I spoke to from Livanta calmed me down when I was afraid of pissing off the doctor by filing an early dismissal appeal (which I filed at 2 out of 3 hospitals for one injury surgery and recovery). She said, “Honey, this is your Right, and your family member’s Right. People in the hospital know that. Don’t worry about what anybody thinks. You are not doing anything against the doctor, but in favor of your family’s care. Do you want to file this or not?”
One additional tip: learn what a “nom-nc” is (Notice of Medicare Non Coverage). This explains: https://medicareadvocacy.org/self-help-packet-for-expedited-skilled-nursing-facility-appeals-including-improvement-standard-denials/
Basically, it’s a form that the hospital must give you at the beginning within about 48 hours of you being there and they give it to you to show you what it looks like, so you can read it in advance. Then they give it to you, by law, 24 hours (I believe) before they want to discharge you. You or your family or representative need to watch for it, because if that 2nd one arrives and you didn’t know it, the 24 hours starts ticking anyway. They will often deliver it to the patient without telling the family member. Usually someone signs to acknowledge it, but its a good idea to ask the hospital how they do it. Usually a first one is included with intake paperwork—ask them if this is the only one you’ll acknowledge in writing or if a second one will be delivered and within what timeframe vis-a-vis discharge and what type of acknowledgment from you? Let them know clearly who can sign for the patient. Sometimes they will decide for themselves anyway, and have patient sign it, so you’ll need to search the room for the NOMNC (“Nom-Knock”).
Familiarize yourself with any new NOM-NC policies or procedures for the current year (google). This is the kind of thing the regime (via CMS) could get tricky about, in favor of the hospitals. Pretty sure I saw a notice of a change of some kind when googling to get the proper names above.
Not saying all this because it is necessarily relevant to Joyce, the author. But because Susanna C brought up QIO doctors (yes, the QIO actually employs doctors and specialists to improve procedures and review existing procedures or care) and these are things I learned managing multiple surgeries and rehabs for family members on Medicare. So I thought I’d pass this on. Maybe I’ll make an actual note out of it someday.
Lastly, another phrase to learn is to be able to speak the language of necessary or sufficient “level of care” because this is the legal language that the social workers and “hospitalist” Drs or nurses often speak (whose job it often is to help get you out of the hospital when they need a bed— even though you are paradoxically told that they are your advocate while you are in the hospital).
For instance, if you cannot provide the “necessary level of care“ at home following hospital treatment, then you need to repeat and defend that fact over and over and the hospital needs to not discharge the patient until an “appropriate level of care setting” is found/determined. Ideally, you’ll want to be in on that decision and its timing and not have it dictated by the hospital.
For example, you and your patient relative may want a good residential rehab at a CARF-accredited rehab (CARF is a grading system for rehabs), not a small rehab practice in what is otherwise a nursing home.
Another thing to know: otherwise fancy/expensive private retirement places (even the life plan communities) often have good, modern rehab centers in their nursing care sections and they often have “Medicare beds” for rehab purposes=short to medium term, often 1-4 weeks, or whatever Medicare will reasonably cover. After that, they will want you out or paying private. Even though there is no such thing as a “Medicare bed” what they mean is that by law (at least in CA) they have to be willing and ready to take a certain number of Medicare patients if they have room. This is not for a permanent stay but for rehab only. A lot of people don’t know this and write them off as Medicare rehab possibilities, thinking they are private pay only. Sometimes these places will want you to go through some of the private pay rigmarole like you telling them about your (patient’s) finances and such so they can assess the extent to which you could be a private pay candidate. But they shouldn’t let that be a gating factor to admitting you for short-term rehab, as long as they are a Medicare provider who also serves some “community” Medicare patients.
Thank you. Begin with complaint on Medicare's own form.
Reassuring to receive reply from QIO that Medicare forwarded.
“Your semi-blocked arteries are normal for a woman your age who eats Kettle Chips.” I want to send them all to charm school.
YOu can't beat cardiac arrest humor. Go for it, Joyce Wadler. I've decided to live forever.
Will you sign my copy of your book, perhaps over dinner at t
the Knick?
"Normal for a person of your age." Most ominous words ever uttered.
I remember when I turned forty and everyone said it was the end of the world. What a joke. Forty is nothing. Forty is a blip. At forty, people still look at you. They still see you. They still listen when you talk.
At seventy-three, I've become invisible. Like you, Joyce, I walk into a doctor's office, and before I've even opened my mouth, I can feel it—that subtle dismissal, that mental categorization: elderly female, probably confused, definitely a complainer, possibly demented.
Did you know that if you're over seventy and you say you have pain, it's automatically considered less important than if you're thirty and say the exact same thing? I didn't make this up. There are studies.
The other day I was waiting to check out at Whole Foods, and the cashier kept looking past me to the young woman behind me, as if I might disappear if he ignored me long enough. I wanted to grab him by his organic cotton collar and say, "I've lived through eleven presidents! I marched on Washington! I've had more interesting conversations than you've had hot meals!"
But of course I didn't. I smiled. I was pleasant. Because that's what we do, my generation of women. We've been trained to be nice while being erased.
And this is how it happens—this is exactly how the sweet, hopeful woman of fifty-five transforms into the cranky old lady of seventy-three who seems perpetually annoyed. It's not age. It's accumulated indignities. It's death by a thousand cuts of condescension.
So now I understand my mother's generation and why they turned into such hardasses. They weren't born that way. They were made that way—by doctors who called them "dear," by mechanics who explained simple concepts to them very slowly, by a world that decided their expiration date had come and gone.
I've joined their tribe now. And here's what nobody tells you about this tribe: we remember everything. We're keeping score. And some of us still write.
So true. I had this discussion with one of my docs- I’m 75 and. Have been seeing her at least since 1998 because I have test results from her so then- and she agreed. She did say the even older men are not treated well, but women do get the brunt of it.
Happy to read you again. Missed you. Reader since NYT daze. Always screamingly funny especially in the face of doom. Love you.
Ugh, too close to home. For me, at 76, it's aFib. The worst part is having to own a daily pill box to keep it all in order. "The 70's" doesn't mean what it once did.
Make sure you see an electrophysiologist. Cardiologists do plumbing, EP’s do electrical. Learned the hard way. 😘 Now all good.
I have an appointment with one this Friday
Yay. I went back and re-read your post and saw that. If you need crowd sourced info after that and use Facebook, there is a great ‘Group’ called “Atrial Fibrillation Support Group” with 35,000 people. Lots of comparative knowledge and experience imparted for those early on the Afib learning curve. Best to you, Joyce!
Just pre-ordered your book! Can’t wait. The catskills hotels were a big part of my family history.
I think Prada wil come out with adult diapers that you wear over your lulu lemon so don't fret my pretty. I hear you as my back is in rebellion again and now "back" at the doctor and PT. I hear you, it just sucks.
Looking on the bright side, your cholesterol levels are pristine. Your doctor probably figures that with those gorgeous uncluttered arteries, you're in for the long game.
Wonderful!