May 1, 2006

It costs $9,000

Hi Everybody,

Now that I’ve gotten my days right again (I get mixed up with I work a night), I’m ready for Monday – or is it still Sunday? I’m glowing a little because I got to chat with some of my favorite people over the weekend. Billy was in a bit of a hurry (understandably so - see Katy’s blog and Philip was taking a nap when I called. Denise and I caught up on baby news; and I chatted with good friends, Floyd and Tania.

Samantha is doing much better (again). She kept Jim up several times during the night wanting assistance from the bed to the dresser for food and water. He tried to move the kitty dishes closer but she still goes back to the old spot. Senile too, I guess. But, she seems happy and content. Not in any pain.

Work was busy. Some things I can't write about because of privacy issues. But, I can explain about the $9,000.

I was trying to get bedtime meds passed and it seemed that EVERYBODY wanted a bedtime pain pill. That means signing out the narcotic and recording it extra for every pill. It always takes more time to pass meds when they all want pain pills and/or sleeping pills. I had a couple patients who wanted sleeping pills at a certain time too, so I had to remember to go back.

Finally, I got to the 10:30 p.m. sleeping pill patient. I was mentally ticking off in my head how many more I needed to get done very soon before I would be out of compliance with med pass time. As I was turning to walk away, my patient said, “Do you have a minute to answer a question?”

Knowing that his roommate was restless for his meds, and the lady in the next room was expecting her pain pills now, I tried to sound sincere when I said, “Sure. How can I help you?”

“Well, they say I have two choices in the next few days. I can either go home or go to the other hall (long term care) because I’ve run out of days I can stay here. I was just wondering if I paid for it, can I stay here because I really like you guys and I don’t want to leave?”

I knew instantly what he was talking about. I work the skilled unit where most patients have 100 days for skilled care to be covered by Medicare. Most of the time, whatever therapy they need is successful and the patient is usually ready go home to family or spouse. But, occasionally a patient has no one else to take care of them, and they aren’t strong enough to live alone. It’s the ‘end-of-the-line' that we all think will not happen to us.
How do I tactfully explain to my patient that he can’t stay in this unit? He seems to honestly believe that it’s possible if he wants to stay there.

In this case, I remind him of all the nurses and other staff that he likes and explain that if he goes to the other hall, some of those same people will still take care of him because most of us work both halls.

But, he insists. “How much would I have to pay to stay here?”

“Honestly” I say with slow hesitation. “It would probably cost you about $300/day or about $9,000 a month to live on a skilled unit like this one. That’s why it wouldn’t be the best choice. I think you’ll like the other hall and I promise to come visit you over there.”

He still shakes his head no.

“I don’t ask for much. I've been in four different nursing homes in the last year. I have no one left. I'm afraid. Could I please just stay here where you are all so nice and I get such good care?”

I smiled and turned to his roommate.

There was nothing more I could say except, “I’ll see you on Monday where ever you are.”

It was difficult to fall asleep when I got home. I kept hearing his pleading voice asking,

"How much would it cost...?"

Take Care on Your Journey


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