April 15, 2011

Homesick at Camp Medicare

Brad Stevens, 75, of Londonderry, shown with his wife, Doris, was told he had to stay
 at a skilled nursing facility to get the treatment he needed.
Union Leader Correspondent
Doris Stevens jotted down something
her husband said that resonated: "Bureaucrats
running an industry they know nothing about."
LONDONDERRY -- Brad Stevens says he is stuck in a hostage situation — forced to spend each night away from home so he can get the antibiotic treatment he needs to fight a dogged infection.
Each morning for the past two weeks, his wife, Doris, drives the 14 miles from their home on Stonehenge Road to Hackett Hill Healthcare Center in Manchester. She picks up her husband and takes him home, where he can relax, eat something, play with the dog, rake a few leaves, go for a walk, get on his computer.
By 8 p.m., however, Stevens must be back at the skilled nursing facility where he gets his nightly intravenous antibiotic. It takes about a half-hour. Then, he climbs in a bed and goes to sleep. In the morning he eats breakfast, gets another dose of antibiotics, and is free to leave the
building, until bedtime.
A nine-month ordeal

This is the arrangement made for Stevens before he was discharged from Massachusetts General Hospital, and the only way Medicare will pay for the treatment, says
 his wife. In total, it’s been a nine-month ordeal that has included five surgeries, most recently in March. That’s when doctors finally figured out that what was ailing him was an infection caused by the remnants of his outdated internal defibrillator. One of the leftover wires dangling from his heart was imbedded in his body. 

He was sent to Mass General from Catholic Medical Center, where a surgeon successfully removed the patch holding the wires attached to a thin wall of his heart. 
All that was left was to treat the infection in his belly. His surgeon initially told him he would be released to home, and a visiting nurse would handle the twice-daily IV set up, which would plug into the tube still protruding from his left arm. 
But before Stevens, 75, was discharged, he was told that he would instead have to reside at a skilled nursing facility for four weeks. If not, Medicare would not pay for the treatment. 
“It’s been a nightmare,” said his wife, Doris Stevens, who has been trying to make sense of their current situation. She’s spoken with two different Medicare representatives, and written to U.S. Sen. Jeanne Shaheen. 
A hostage of Medicare 
Nobody has explained why Stevens has to sleep away from home, or how that arrangement could be more conducive to his healing process. Stevens hates taking up valuable space at a residential center on the taxpayers’ dime when he could at home, healing in comfort with occasional visits from a home nurse. 
In printed material outlining benefits, Medicare specifies that it will pay for skilled nursing care for 20 days following a hospital stay, if it is “medically necessary.” Doris Stevens said they pay $600 for a supplemental insurance policy through Anthem, as required by Medicare. If Anthem were their primary insurer, there wouldn’t be a question of getting the care at home. 
“As far as I’m concerned, he’s a hostage of Medicare, and it shouldn’t happen to people. It would be one thing if he had something wrong with him. But this is a total waste of taxpayer money. I do know it would be less expensive to have a visiting nurse. But because of the way it has to be, we’re living like this,” Doris Stevens said. 
She was told the cost of the bed at Hackett Hill is about $147 per day. The cost of a home care nurse would be about $80. 
The principle of the thing 
Brad Stevens says it’s no wonder Medicare and Medicaid are at the center of this country’s budget woes. 
“Every time these politicians run for office they say how they want to eliminate waste and fraud. Well, if this isn’t waste and fraud, I don’t know what is,” said Stevens. 
Friends and family have offered to chip in for a home care nurse, but Stevens won’t consider it. 
“It’s the principle of the thing,” said Stevens. 
A representative contacted at Centers for Medicaid & Medicare Services in Washington, D.C., Thursday would not discuss Stevens’ situation due to confidentiality issues, but added that several calls had been made on Stevens’ behalf to Boston-region caseworkers. 
No one had contacted the Stevens directly as of Thursday. 
Steven Griffin of AARP New Hampshire said the Stevens’ situation is as disappointing as it is frustrating. 
“What’s coming with the baby boomers is this huge explosion in demographics, and not just the cost of care, but the cost of building nursing homes. We’re maxed out with beds, and if we don’t shift to home and community- based services, counties will have to incur the capital cost of building facilities for a population that doesn’t want to stay in these facilities,” Griffin said. “This story, and others like it, speak to the inefficiencies in the system,” Griffin said. 

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