This is a true story, albeit one that is nearly a year old. I share it here, not so much on it’s own merit but so that I can link to it as a background item for a future post. The names of the medical providers have been changed mostly for my amusement.
For those who don’t know, I am the caregiver for my father. He is in the late stages of prostate cancer, and the middle stages of Alzheimer’s Disease. I moved in with him in December of 2005 to help him enjoy his life to the fullest in whatever time remains.
About a year ago, I had reached the end of my rope. Dad had progressed to the point where he could no longer be left alone at all. So I was “on duty” 24 x 7 x 365. And it had gotten to be too much for me.
Dad has a wonderful primary care physician, we’ll call him Dr. Primary. Dr. Primary has done a fantastic job with Dad, working to make life as good for Dad as possible. Dr. Primary is amazing, but he works out of a practice operated by Dr. Asshat. From the name I’ve chosen to use for him, you can imagine what I think of Dr. Asshat.
In an apparent effort to offset the awesomeness of Dr. Primary, Dr. Asshat has chosen to staff the office largely with a group of the most incompetent, unpleasant, uncaring, unprofessional women I have ever had the displeasure of knowing. I refer to them collectively as the Useless Cs – since they simply aren’t worth the effort required to name them individually. There are some exceptions, particularly Dr. Asshat’s Scheduler, Miss Useful.
When I reached the end of my rope, I called the office and asked to speak with Miss Useful. I had to go through three of the Useless Cs before I could speak to Miss Useful, so it was less onerous than usual. I explained my predicament to Miss Useful. She said that she knew exactly what we needed – some in-home care from LTN Co. She offered to send somebody from LTN Co. to our home to make arrangements to help me care for Dad.
At 30 minutes past the appointed hour, a woman that I’ll refer to as Nurse Ratched arrived. Now I must apologize to the the more famous fictional Nurse Ratched, who by comparison is a wonderful, warm, caring, health care professional.
I explained the situation to Nurse Ratched. She explained that she didn’t think that they could do a whole lot for us. She also explained that whatever they could do for us, we would have to arrange for the dogs to be outside the entire time, as none of their staff would put up with dogs. I explained that since I was looking for some way to get 3 or 4 hours away from caring for Dad at a time, that putting the dogs outside (especially in the midst of a Michigan winter) was not an option. I was ready to dismiss Nurse Ratched and LTN Co. at that point. But Nurse Ratched insisted that since she was there she would have to physically examine Dad for her report. So we agreed that she could examine Dad, but of course before she could do that, she needed to see Dad’s insurance cards.
Now Dad had put in a long career as a teacher and one of the benefits of a career teaching in the State of Michigan is an exceptionally comprehensive medical plan – even in retirement. She took one look at his insurance cards and her eyes lit up! “Oh, we can ‘skill him up,’ we can do PT, OT, we’ll get him a bath aide, we’ll have the social worker stop by,…” she exclaimed as she ticked off every single item on her checklist of services that they could provide. Of course the one thing that she didn’t mention was some respite for me!
But she was on a roll now! She actually threw out the calendar page that I had printed out for her showing all of Dad’s appointments, my appointments, etc. She started making out her own calendar for us, showing what days that Dad would be receiving physical therapy, occupational therapy, visits from the social worker, bath days, and of course “skilled nursing” visits.
Now at this point Dad did not need “skilled nursing.” And he still doesn’t need it today. He has some balance issues, so he needs help pulling his pants up; he uses a walker to get around so he needs help getting a glass of water to put by his chair; and his medications & chemotherapy were causing violent bouts of diarrhea – which at a minimum caused him to need help pulling his pants back up. None of which requires “skilled nursing.”
But Nurse Ratched was not interested in what Dad needed. She was solely interested in maximizing what LTN Co. could bill Dad’s insurance. So the parade began.
PT came in to evaluate him, OT came in to evaluate him, the “skilled nurse” (Nurse Ratched herself) came in. All of which tired Dad out and provided no benefit to either of us.
The saddest and most comical of them all was Shower Girl. On her first visit she laid out for me the list of things that I needed to have ready for her when she arrived to give Dad a shower. Towels, washcloths, soap, shampoo, etc, etc. I also had to have Dad undressed and ready for the shower when she arrived.
Now we have a walk in shower for Dad and he is perfectly capable of showering himself. Because of his balance issues he likes to have somebody around while he takes a shower, just in case he should slip in the shower. I highly doubted that 90 lbs. of Shower Girl would help, but at this point we were clueless and just went along with the program.
When Shower Girl returned several days later for Dad’s first shower, I had everything ready as specified. I had Dad undressed and sitting just outside the bathroom covered in a blanket to keep him warm. When she finally arrived 45 minutes after the scheduled time, she proceeded to bitch me out about not having everything laid out for her in the bathroom. I let her bitch and then told her that when she was done, I would appreciate it if she would walk the four steps from the bathroom and drop the towels and washcloths in the open washing machine. She actually said to me “We’ll see if I have time for that!” Which of course she didn’t.
Before Dad’s insurance began paying for the assistance of Shower Girl, it took me half an hour to get Dad undressed, into the shower, cleaned up, out of the shower, dried off, dressed, and the towels & washcloths into the washing machine – at Dad’s convience. With the benefit of Shower Girl, I still spent 15 minutes getting Dad ready, 45 minutes waiting around for her to arrive, and another 15 minutes cleaning up after her. What a deal!
The first big club over my head clue came one Tuesday morning. On Tuesday mornings, Miss Tidy comes in to do laundry, dishes, and some light housekeeping. Dad found her through the local Council On Aging. Miss Tidy came in for about 3 hours each Tuesday morning and accomplished these tasks in a cheerful manner and Dad always enjoyed her coming. On this particular Tuesday Nurse Ratched also arrived to “skill ‘im up.” I decided that while Nurse Ratched was there to provide skilled nursing care, and Miss Tidy was there to show Nurse Ratched where things were located – I could get away for a quick errand. I was gone for a grand total of 15 minutes. When I returned home, Nurse Ratched was standing alone in the living room, on her cell phone, bitching at somebody because “he had an accident and blew my whole schedule. I’ll have to reschedule his ‘skill’ because I can’t just stand around wasting time on him.” Meanwhile Miss Tidy was in the bathroom helping Dad get cleaned up after his accident. This is NOT Miss Tidy’s job. It IS Nurse Ratched’s job. Miss Tidy earns $10 per hour. Dad’s insurance was being billed $55 per hour for Nurse Ratched’s “skill.” I’ll bet that Nurse Ratched makes more than Miss Tidy’s $10 per hour out of the deal. Yet Miss Tidy is actually HELPING Dad, while Nurse Ratched is bitching about her time being wasted. I think I just bought a vowel.
The only useful service provided by LTN Co. was the social worker Davey. Davey actually took the time to speak with Dad. I explained to Davey that we really didn’t want all of this nonsensical “care” tiring Dad out and adding no benefit – all we were really looking for was somebody to provide some basic assistance so that I could get out of the house for a bit. Davey told us that LTN Co. could provide that service at a cost of $25 per hour and that they would not bill Dad’s insurance for it. Instead, Davey suggested that we should call the local Council On Aging. There we could get the same “aid” to come in for $10/hour – and the aid would keep all of the $10. If we went through LTN Co. the aid would get $9/hour while LTN Co. pocketed $16.
So now I felt like a real chump. I had made Dad’s life miserable for nothing. We called the Council on Aging and made arrangements for an aid – who would actually do what we wanted & needed at a bargain rate. I made the call to Nurse Ratched and let her know that we were stopping EVERYTHING with LTN Co. immediately. She started to go down the list with me. The conversation went like this:
Nurse Ratched: PT?
Me: Cancel it!
Nurse Ratched: I’m sorry we can’t, Doctor ordered it. OT?
Me: Cancel it!
Nurse Ratched: I’m sorry we can’t, Doctor ordered it. Shower Girl?
and so on through every service on her list. She finished the conversation by telling me that she would “have to confer with Doctor.”
The next time somebody from LTN Co. showed up at the door, I told them to go away and shut the door. Within minutes I received a phone call from Dr. Asshat. He was very upset that we were “non-compliant” with the therapies that he ordered. Hold On – THE THERAPIES THAT HE ORDERED?!?!?! WTF?
As Dr. Asshat had never actually seen or spoken to either Dad or I, I asked him on what basis he ordered anything? And had he ever actually dealt with the slimy disgusting creatures at LTN Co? He explained to me that he had ordered all of this crap in his role as the Medical Director of LTN Co. based on Nurse Ratched’s “work up.” Yes, you read that correctly. Dr. Asshat’s clinic recommended LTN Co. LTN Co. couldn’t “do anything for us” until after they found out that Dad had Cadillac insurance. Then magically Dr. Asshat “ordered” a bunch of therapies and skilled nursing that Dad neither wanted or needed – and that actually reduced his quality of life! And then Dr. Asshat had the audacity to bitch me out for being “non-compliant!”
At least we got an education about how the medical racket works. This education would become very important later when Dr. Primary recommended that it was time for Dad to enroll in Hospice – which he ordered from LTH Co. (where Dr. Asshat is also the Medical Director). But that’s a post for another day.
Oh, and LTN Co? Where did I come up with that name for the Lying Thieving Nursing Company? Gee – I don’t know.