Tag: mom

Coverage caps

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There’s a law in Florida called the Baker Act; a law which gives law enforcement and medical professionals the authority to hold people with mental illness – specifically those who show signs of being a danger to others or themselves.

There are few (if any) public facilities to provide this emergency care, so patients are cared for in private facilities… usually a floor set aside at the local hospital (the so called “psych ward”).

Since these institutions often are not publicly funded, “Baker Acted” patients are expected to pay for their care. Since most health insurance policies in the U.S. have unconscionable caps on the number of days covered in a 12 month period, and because mental illness can require extended periods of hospitalization, patients usually pay through the nose.

Because patients without coverage can not easily bargain as a group for the prices paid, patients without coverage usually pay more than insurance companies (for the same services). In fact, hospitals have been known to make up financial losses from insurance contracts with the fees charged to the uninsured.

As it happens, someone close to me is in the hospital, and she used up her hospitalization coverage (which only covered a percentage of the cost anyway) earlier this year. If I’m not mistaken, the bill submitted to insurance earlier this year was in excess of $60,000.

Imagine you had a really good job, with what was considered above average health benefits. Imagine what your finances would look like after paying 20% of a 60k hospital bill, plus 100% of what ever happens from here on out (which looks to be worse this time). Then ask yourself if you still like our health care system as it is.

With all the stress that undoubtedly accumulates in direct proportion to the accumulation of medical bills, it’s a wonder anyone recovers from a hospital stay.

Back in the ER again

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I’ve had a vested interest in the health care system this year, as some of you may know. Yesterday I got to live out the hospital admissions nightmare that some of you may have read about in the media. We went to the ER yesterday morning around 8 a.m. As of this writing, my mother is still waiting in the ER to be admitted. For those of you keeping score at home, that’s about thirty-one hours and counting.

It’s not just the one hospital that is full either. The ER staff called around – spanning five counties, and there are no beds open within about a 90 minute (drive), or 60 mile radius. And none of that is country driving either, so we’re not talking about 90 minutes of cows – where you wouldn’t expect to find any hospitals. We’re talking about 60 miles of freshly paved suburbia… just the place you’d expect to find a health care bounty.

Let’s hear it for the multiple payor system!

(To be fair, not ALL of the hospital beds are full… just kind my mom needs.)

Testing your imagination

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Imagine you grew up in a seemingly ideal home. Your dad worked Monday through Friday and was home for dinner and weekends. Your mom stayed home, cooked the meals, and handled the domestic duties… always there when you came home from school, or needed something to drink. Your dad was the king of the castle, but your mom was the queen of everyday needs. The only thing missing from Leave it to Beaver was Wally.

Imagine there was something abnormal about your childhood, slowly poking its way through the facade of utopia; something that made your childhood less than ideal: your mother was metally ill. Partially from the illness, and partially from her upbringing, your mother was emotionally fragile, childish, moody, and ill-prepared for any kind of change. Your mother couldn’t make phone calls, or handle anything but routine business without emotional upheaval. Your mother could be meek and timid one moment, then unexpectedly burst into a barely controlled rage at the slightest perceived slight by a clerk in a store… much to her children’s horror (and embarrassment). She was hospitalized after a breakdown when you were very young. Neighborhood kids would pick up on her being a little “different,” and pick on her as if she were just another neighborhood kid (and not in a jocular way). When you were in middle school a group of kids (your age) ran through the house, undaunted by your mother’s screams (which were equal parts fearful and angry), taunting her and the rest of your family (when your father was away, of course). She had to stop driving for a while when you were in high school because she was having paranoid hallucinations. She couldn’t attend your wedding reception because of a nervous breakdown at the wedding.

Imagine that after you and your siblings left home, she grew more dependent on your father, and could no longer handle some of the more mundane tasks in life without assistance… like grocery shoppping, gassing up the car, or making a deposit at the bank. She became a hermit, never venturing out unless absolutely necessary; or unless she had your father along as a chaperone.

Imagine that her condition rapidly deteriorated over these last six months, spending prolonged periods of time in the hospital, trying different medications, having multiple courses of ECT, and generally loosing what was left of her mind in the process.

Imagine that your mother is now mostly unresponsive. Questions go unanswered. Comments go unheeded. If she leaves her bed at all she walks around as if on a leash, following your father where ever he goes. For months the only words that came from her mouth were: “I’m not doing well,” or, “I can’t go on.” Now she just doesn’t talk, or if she does it’s seemingly the first thing that comes to mind. Language spills from her mouth, a veritable salad of words. Unprovoked she calls out… “compass, phone book, Grace Kelly, two fingers, red shorts, man.” You look around the room, startled, wondering what provoked this odd outburst; but find nothing but the crazed, glazed gaze of someone you have trouble recognizing.

Imagine that you’ve completely forgotten what your mother was like when she was happy. How would you keep from crying at the thought… that someone could be so unhappy for so long? Would you wonder if mental illness was the cruelest of all diseases? It never kills directly, but it seemingly can torture for a lifetime.

What would you do if confronted with this? If you were a religious person, how would you reconcile this with your belief in God? How would you respond to the common “truisms” offered by the pious as “reassurance?”

“God doesn’t give you more than you can handle.”

“It’s all part of Gods plan.”

Could you hold your temper long enough to keep from swearing? Clearly, a person such as this (your mother) has way more than any person could handle. Mental illness doesn’t boil down to a deficit of faith. This may smack of heresy, but if bi-polar disorder, schizophrenia, or psychosis are part of the plan, then it’s crap.

You’ve been around. You read things. You know there are people out there like this: people with profound mental illness. You know that a few of them out there are mothers. Society is mostly bereft of answers; and their family… their kids, the children of the lost, are left with the hopeless task of caring for a shell who’s mind has fled.

What do you say to these children of the lost? Do you have any answers?

So this is what a social worker does

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There’s a widespread misconception about the role of social workers in America. Widely used reference materials aren’t helping matters either. Dictionary.com and Wikipedia both refer to “linking clients with agencies and programs that will meet their psychosocial needs,” when discussing the role of the modern social worker.

Now consider a recent conversation with a real world social worker, at a local hospital. The topic of this conversation was a patient who wasn’t really any better after a long stay.

Author’s note: this is the condensed version… the actual communication spanned several different conversations over the course of a day.

Social worker: “Well, we’re going to release (the patient) today.”

Family member: “Release… to where?”

Social worker: “Well, home… you can take (the patient) home.”

Family member: “Um… well, are you sure? That’s not what I thought the doctor said. I thought (the patient) was going to be placed in an assisted living facility – short term – for some kind of further treatment.”

Social worker: “I think you should bring (the patient) home and threaten more hospitalization if (the patient) doesn’t shape up.”

Family member: “But the doctor….”

Social worker: “Yeah, we discussed assisted living. I suppose you could take (the patient) to one after we release….”

Family member: “Anyplace in particular?”

Social worker: “There are a bunch up by where you live. Call around.”

—

Where do I begin?

A doctor makes a psychiatric/medical diagnosis, treats the illness with lots of medication and ECT, and a social worker decides the patient “just needs to shape up?” So we went through all this trouble and all that was really necessary was a good slap? Then when a social worker ceedes authority to the doctor, the best assistance she can come up with is “call around.” Is this what they meant by “linking clients with agencies and programs that will meet their psychosocial needs?”

If all you need to be a social worker is a nack for pop-psychology, a willingness to ignore medical advice, and a storehouse of useless information/advice… well heck, I’ve found my calling.

Don’t waste your time on me

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I’ve used this space to talk about someone close to me… someone who suffers from mental illness. I’ve alluded to hospitalization… and it’s been about 7 weeks now. They’ve tried medication, counseling, and until Friday – ECT (Electroconvulsive Therapy) as a kind of last – or next to last – resort. Since none of it has worked they’ve begun to look into some kind of longer term care (than the hospital can provide).

One thing that strikes me as particularly insidious about severe mental illness is the apparent uselessness of love. Maybe I’m making too much of things. I know I don’t have a lot of experience dealing with serious health issues, or crisis in general (thank goodness). I suppose people can tend to think of their own experience as wholly unique (when it usually shares a fair bit with other’s). All the same, it’s heart breaking feeling like you’re completely powerless to give any relief to the person that’s really suffering… that the sum of your experience suggests you have nothing to give worth receiving. Maybe mental illness isn’t unique in that way. Maybe “being there” has meant something.

Either way, it doesn’t seem like enough.

No, this isn’t the Holiday Inn

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Earlier this evening I was sitting in a room on a psychiatric ward during visiting hours, when a few other visitors arrived (to see another patient, assigned to the other bed in the room). A middle aged man looked into the room from the doorway, and at the person I was visiting. He said to his companion, “oh look, the wacko is in here.” His companion gave him a shush and shoved him out the door.

We decided to take our conversation elsewhere. As we were leaving the room (with the person we came to visit in tow), we passed the commenter. I looked at him and I was suddenly determined not to be the one who felt awkward. I looked him unwaveringly in the eye, like I was playing some kind of immaterial game of chicken. He said something to be friendly (“hey there,” or something like it), but I didn’t say anything back. When it became clear that I was not the awkward party in this brief encounter, it took some of my remaining reserve (from my otherwise shy, but weary soul) to keep from stopping, leaning in, and whispering, “oh look, the biggest fucking ignorant jackass I’ve seen all day is still here.”

I’ll have you know those were the exact words on the tip of my tongue. They are not particularly inspired words, but they fit my emotional state.

Dude, just where the hell did you think you were? Instead of banning cell phones on psych floors (regarding visitors and what they bring in on their visits), they ought to ban immaturity.

I don’t expect a whole lot of compassion from society at large when it comes to mental illness; but I’d expect a little more from a guy who obviously has some connection to it… why else would he be a fellow visitor on a psychiatric floor? Maybe I’m being a little too harsh. Maybe he’s a newbie. Maybe this was just his reaction to a horrible environment – a little defense mechanism in action.

Regardless, it was about as angry as I’ve been this month. I’m not sure wether my lack of response was a sign of maturity or fatigue.