Learning Curve

If you read the post below this “A Holiday for Who??”….(or want to read it first, THEN come back here)

So not an hour after I finished my last post, I started wrapping SCORES of gifts and realized I would save my back, my shoulders and my sanity if I got the card table downstairs, instead of sitting on the floor pretending I’m a 10 year-old.

I actually tell myself, you should put shoes on….you KNOW what just happened…but I’m wiser now…I see the table neatly tucked in the corner, go confidently over there and smash the same foot on the same brick that I MOVED there so I wouldn’t do it again in front of the freezer.

Yup…really did that.

You just have to laugh……

 

 

 

 

 

 

A holiday for who????

In a sense, we mothers, never stop caregiving. And when you’re kids come home for Christmas from college and their ‘real lives’, you sort of begin all over again.  Which of course, we LOVE, right?

But then you can’t find your favorite pj’s or slippers. Or you are under constant demand to mate the sox that you let pile up in the ever-growing ‘volcano of  unmatched socks’ because your little darlings could only bring home so much stuff, and you haven’t replenished the unforgivable pile of stuff until Christmas  day. So c’mon, Mom get it together, we’re home now and you love us.

And I do, I really, really do like  you…so much so that Dad already knows he’s been relegated to the back seat of ‘attention’ and accepts his fate as driver, drink provider (now that all are over 21..YAY) and default errand runner for all things Christmas.

What turns us caregivers into “I-DON’T-CARE” givers? About ourselves, I mean. At the drop of a semester, and a holiday, we ramp up our to-do lists, our need to make magic for everyone, and our total and complete exhaustion all in the name of creating, “it’s a wonderful life”. If only George Bailey would have gone for a massage and a facial, had his nails done (including a peppermint pedi) and THEN came home and said:

“You know what,  you’re right. Life is pretty terrific with me in it! I feel refreshed, relaxed and well-groomed. Let’s eat!”

But noooo. Like George, we caregivers choose to take the hard road. Like today when my daughter asked for chicken. And like an idiot, in the middle of making bacon for my other daughter, I ran to the basement in my bare feet (cause’ chicken daughter absconded with my slippers when hers broke in the middle of the night), zoomed over to the freezer all the while, keeping a mental timer on that bacon so it didn’t get too crispy, didn’t bother to turn the light on, cause I KNOW where the freezer is in my basement, and promptly smashed my toes, likely breaking at least two of them, into a brick that was left lying in front of the freezer.

Yay caregivers the world over! Yay Christmas! Damn you George Bailey, you just couldn’t take care of yourself for once and be a lesson to us all?

Merry Christmas, caregivers…..cause

You just have to Laugh………………….

Cathy Sikorski

The most important meal of the day…..

I wanted to return to ‘my roots’ of why I started this blog. I believed (and still do) that there is a real honest place in caregiving for laughter. There’s no way you can do this day in and day out and not see the humor in all the craziness around you.

Today is an homage to my dear mother-in-law. She was known for her subtle sense of humor. She would laugh at whatever you tossed out there as funny and she could come up with a zinger or two herself when necessary. So I feel quite certain that given the time and the retrospective, she too, would see.

So once my 94 year-old mother-in-law moved into her assisted living facility, she was quite content. She adjusted quickly and enjoyed her feisty bingo games, where the winner got a quarter for each victory(I too became a little over zealous with “BINGO!” when helping her play…to WIN)She seemed to enjoy her table companions at breakfast, lunch and dinner, as well. The facility tried to keep the table companions constant so that they could get acquainted and hopefully, enjoy some conversation at mealtime.

Things were going swimmingly. But as time rolled on and Mom became more comfortable with her surroundings, she actually began to backslide into more childlike behavior. Eventually, she needed more help dressing, reminders to go to meals, and assistance to get ready for and go to bed. Otherwise she would never change her clothes, forget to go to meals, and stay up all night watching TV and dozing in her favorite chair. (This became such a pastime for her over the last 20 years, that I was tempted to put her in that chair for her viewing….most of us would have said “Oh she looks so natural.”)

Then her time clock began to get out of whack. She would put her pajamas on after breakfast, she would refuse to go to meals because she just ate, and she would wonder why no one was coming to get her for a meal, when she had just returned to her room from lunch.

One day I went to see her and she was sound asleep in her bed at 11 o’clock in the morning. This was extremely unusual for Mom. She has been an early riser since the dawn of time, and she NEVER would go back to bed for a nap or if she was sick. She would just get dressed, take to her beloved chair, and snore away the day resting comfortably…but NEVER napping. (I think that’s reserved for lazy people like me who try to nap every day, if possible).

I go to the nurse’s office to see if they know why Mom is in bed.

“Hey, ladies! Do you happen to know why my Mom is in bed at 11:00 in the morning?”

“Ummm, not really, maybe  her aide knows?”

I hunt down her aide, and this is the story:

“She got up around 1:00 AM. I saw that she was out of her pj’s and completely dressed for the day. So I said, ‘Hey M, where are you off to?’

“I’m going down for breakfast.”

“No, darlin’ it’s not time yet, let me help you back in bed. It won’t be for awhile, so you need to get some rest.”

“Ok,” she said.

The aide took her back to her room, put her back in her nightgown and tucked her in bed.

At 3:00 AM, the aide sees my mother-in-law down in the dining room.

“Hey M, what’s going on?”

“I’m here for my breakfast.”

“No, sweetie, it’s not time yet, let’s go rest for a bit and then we will come get you for breakfast.”

Back they go to her room, get her back in her pj’s and tuck her in.

At 5:00 AM, my mother-in-law enters the dining room, perfectly coiffed and ready for breakfast. It’s dark in there and no one is at her table.

“Good Morning, M. you’re down here a bit early,” says the aide.

“I’m here for breakfast.”

“Well, that ‘s not until 8 o’clock, how about I take you back to your room to watch TV until we come get you?”

“Ok.”

At a quarter to 8, the aide goes into Marie’s room. She has now changed herself BACK into her nightgown and is asleep in her bed, as the morning sun streams brightly into her room.

“C’mon, M, it’s time to get up and go to breakfast!” says the aide.

“Oh forget it,” says my mother-in-law, and turns over and goes back to sleep.

You just have to Laugh……

Cathy Sikorski

Just searching for approval….not PRE-approval

I have been so lucky with my brother-in-law, L this  past year. He has been pretty healthy for a guy with MS and relegated to a power wheel chair. The year before he was very sick off and on and required boat loads of my time. But this year, he has just been doing remarkably well, which led me into this complacent place of thinking all is well in the medical world….at least with L.

And actually, he’s fine–ish. But we are now in a push to get some testing and medical work done before the end of the year. And I just forgot how to do things, and how things would be done to me.

On Monday, L needs an ultrasound to check a worrisome kidney cyst. Okay,  I set up the test at the correct hospital and the correct facility of the hospital. His Medicare insurance requires him to go to certain facilities. Sometimes the ordering physician knows that and sometimes he doesn’t. But after 10 years, I KNOW it and so I set up as many of these tests without their “help”, so we don’t have insurance issues in the future.

I make sure the test is between his breakfast and his dinner, because even though he’s gained at least 40 pounds in the last three years, he gets really cranky if he misses a meal. I get that….it’s part social, part his inalienable right, and part “I’m hungry!!”. Okay, no sweat.

I call the ambulance transport and set up transport to the facility and the eventual doctor’s appointment to discuss the results of the test. And I even make sure the blood work is scheduled to be done at his apartment as a “home draw”, which requires a request to the lab directly from the doctor’s office, because I am not PERMITTED to ask the lab to come to his apartment, since  he is wheelchair bound and has no  transportation….ONLY the doctor can do that. (who of course, doesn’t ever remember that and so must be reminded by me, and then the lab calls me to make sure they can come at a convenient time…UGH does this really make ANY SENSE TO ANYONE????)

And then I realize, three days later, and three days before the test. Oh crap, I didn’t get PRE-CERTIFICATION for the ambulance, which must be a gurney and not a wheel chair transport  (which we will discuss another day) because he must be put on a table for an ultrasound and he cannot get out of the chair and onto a table by himself.

So…………….I call for the pre-certification:

“Hello, I’m calling for a pre-certification.” (This of course, after pushing 42 buttons and getting disconnected, and being asked at least four times: “are you calling for a pre-certification?)

“Okay, can I have the name of the member, his ID number, his date of birth, his first born.”.(okay they didn’t ask for that, but they might as well have)

And after I get it all squared away, I think…

“Now, you will have to have the ambulance transport company call us to request that.”

“Well, I’ve tried that before. First of all, they won’t do that. Second, in order to request this you need the prescription, the diagnosis code and the physician’s name, am I correct?”

“Well, yes, so that we can approve that it is medically necessary for him to have transport.”

“Well, the ambulance company does not have the prescription, I do. And furthermore, I wouldn’t give it to them, nor do they want all this medical information on my brother-in-law. Not to mention that I’m pretty sure it would violate like 100 kinds of HIPPA laws to be passing around his diagnosis and doctor names and medical test information, don’t ya’ think?”

“Umm, well………Can you hold for just a second?” the nice lady at the insurance company says to me (the mean lady trying to get ambulance transport for the hundredth time with the same argument for the past three years)

“Okay,” she says as she comes back on the line, “can you give me all of that prescription information?”

“Of course,” I say. NOW, I hope against hope that we are really almost there.

“Well,” she says, “that will do it!” Very bright and chipper I might add!

“Oh, no, no, no,” says the voice of experience, “I need an authorization number,” knowing full well that the ambulance company won’t transport without it.

“Well, okay, I can give that to you, but this has to go to our medical team to determine if it’s approved. You will get a confirmation in 2 to 3 days.”

“Okay,” I say, “just give me the number.”

Because I know their dirty little secret. They will approve this BY MAIL in a week, if I’m lucky. But I will not cancel the test, because they will put on their approval that the transport is approved for the day of the test, effectively making it retroactive. But if  I wait for pre-approval, I will magically have to know when the approval will come in to schedule the test since they only approve a specific date. Don’t overthink it. It’s complicated and stupid. I’ve played this game so many times, I just know how to do it. Trust me.

 

You just have to Laugh……………………..

Cathy Sikorski

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A snapshot of Thanksgiving….no pictures exist

This Thanksgiving we were all reminded of days gone by…..and it turned from what to be thankful for, to who has ever had the worst Thanksgiving. Which is kinda of funny since, isn’t that the day we are supposed to look back and be….well…thankful?

So after a few “can you top this crappy Thanksgiving stories“, we all remembered with reverence and a few tears that this is Aunt J’s holiday to spend with us. Now if you remember, Aunt J couldn’t hear a lick, and because of macular degeneration, couldn’t see all that well either. In days gone by, Aunt J and my mother-in-law would be here for a day or two before Thanksgiving and be right in there helping with all the food prep and getting the house in order. Aunt J decided that her job would be chopping vegetables. Someone(probably me) got out the glass cutting board, because it’s big and two people could use it at one time. And the chopping began, onions, celery, parsley, potatoes. Ten pounds of potatoes requires a lot of peeling and chopping, as does the accompanying onions, celery and parsley to make three or four casseroles of Pennsylvania Dutch potato stuffing.

What none of us realized is that when one can’t see or hear very well, AND when one is hell-bent-for-election to get ten pounds of potatoes with all the accoutrements done in a timely manner….well, one Aunt J to be specific, turned that glass cutting board into a jackhammer. All of us in the kitchen, and there were close to 10 people in there slaving away, were standing there with eyes as wide as saucers looking at one another with alarm and an internal cry for help.

My mother-in-law went first:

“J, you’re doing that too hard, you’re gonna’ break the cutting board,” she said.

Aunt J just kept chop, chop, chopping away, in kind of a maniacal look if you want to know the truth.

Next up: my mom, in the loudest voice she could muster:

“J?…………….J?………………J!!!”

Miraculously, J looks up from her mission to crush, kill, destroy.

My mom takes her hand out of the pot she is stirring, and makes a gesture to slow down, kind of like they do when you’re driving through a construction area on a highway and they want everyone to SLOW THE HELL DOWN!

Aunt J shakes her head in the affirmative and ever so SLOWLY chops an onion in half, then in quarters, then starts to dice, and well, just can’t help herself. Apparently dicing is a gateway to methamphetamines and other dangerous things.

Finally, I take all her toys away and just before she can shed a tear that’s not related to onion chopping, I replace the glass cutting board with a super heavy duty plastic one. The muffler of all cutting boards, even though we never knew we needed such a thing. Everyone grabbed their requisite wine glass that accompanies Thanksgiving day food prep (what? that’s not a thing????) and let the little chopping elf continue her important work.

That was years ago…. haven’t gotten that glass cutting board out since.

You just have to laugh……

Cathy Sikorski

When Sexy follows you wherever you go……

So if I made you sad, I’m here to make amends.

The other day I went to the gym to workout. I haven’t been going as much as I was, due to being at the hospital and funerals and what not, so I took myself to the gym for a good old-fashioned sweaty workout.

Laundry had also gone by the wayside. But I was feeling quite proud of myself as I had managed to get two or three loads of laundry squeezed in, mostly because my husband needed T-shirts and I needed gym clothes. Yes, you caught me. I wear gym clothes even when I’m not going to the gym. Sweats are the greatest invention for the stay-at-home anything. But I was going to put those sweats to their real use!

So this fine morning, I drink more coffee than I should to get motivated and I put on my freshly washed gym clothes and off to the YMCA I go. I am pumped. Well not yet, but I’m gonna’ be!

As I place my purse and jacket in my locker, I realize the coffee has made other demands. Darn, I have to go to the bathroom. UGH. I don’t have time for this, I have to workout. But as all middle-aged women know, when the bladder calls, it must be obeyed.

I begin my rush to the stalls, knowing this inconvenience will take precious minutes from my time on the elliptical. As I take the corner, I feel a weird sensation  in my pants and at my feet.

“Oh, no” I think, “now I am incontinent”.  “Really? I can’t be, I just took care of two other incontinents. I buy Men’s Depends for L. I really am not ready for this. Say it isn’t so, Lord!”

Weirdly, though, I don’t feel wet. I ever so slowly look down at my foot where I had the odd sensation, and there next to my shoe is a really cute and sexy pair of black silk panties…..that fell out of my workout pants.

So my first thought is, “Yay, no Depends for me….yet!”

And my next thought is, “Thank God that didn’t happen on the elliptical machine. Everyone in the gym would have thought I was truly working my ass off!” Or sending some other message that I dare not even think about.

I shove my black silk panties into my purse and hope I don’t take them out as I’m looking for my wallet when I go for coffee after my workout. Yup that’s EXACTLY what I do.

The good news is, you can blame grief on just about any crazy ass thing you do for at least one year. Yay me, I can be an idiot AND SEXY  and no one will blame me.

You just have to laugh…….

Cathy Sikorski

I apologize in advance…..

I went out to dinner with my husband last night. Just the two of us. I spent the entire day at home working on my marketing plan. I was tired and kind of cranky. And I was really bored with myself. So we went to one of our favorite places, and I drank Jameson and Ginger and started to feel, well not better, but not so dejected.

I was trying so hard to figure out why I was in such a funk…to which my husband said, “yeah, why are you in such a funk?” So, it was established. I was in a funk….for some days I think.

And so after those Jameson (yeah I had more than one….) and some teary chat over dinner with my husband, I realized, I think I’m just grieving. I’m sad.  Since this past spring, my darling, sweet mother-in-law and my sassy, Aussie aunt died within about six months of each other. And although one was 96 and the other 90, I’m sad. I’m not sad for them. Although one was ready to go and the other clearly NOT, which made it harder, they lived good long lives and lots of people loved them and they loved lots of people (which was evident by the throngs of people at both those nonagenarians’ funerals).

So I’m sad. It’s the start of the holidays and I’m sad. My dinner table guests are changing over time, and this year is just one more sad reminder. I don’t want to clean my house, or cook a turkey, or work on a marketing plan. I just want to be sad. It seems like that’s what I should be doing. Of course, I realize that the way to get OUT of a funk is to DO something.

Maybe sometimes we should just respect the sadness.

Cause sometimes, you just have to cry……..

Cathy Sikorski

Ambulance…”part trois”…..

Just a very brief update…..

I am taking my cell phone with me absolutely EVERYWHERE. I am NOT going to miss the call again from the Medicare independent contractor, CMS. Because, as you know, if you miss the call, you can NEVER talk to anyone. Out of sheer exhaustion one afternoon this week, I go to lie down, just for 20 minutes or so, and put that cell phone under my pillow…like shotgun….I am NOT going to even think about RESTING without that ordnance by my side.

Lo and behold, that cell phone vibrates under my head like a 25 cent bed in a cheap motel. Of course, I’m in  a dead-to-the-world sleep, but, as a caregiver, I am so committed to alertness that any signal of distress, alarm, help, or hunger has me jumping up like a thoroughbred at a starting gate.

“Hello?  Hello?” I’m yelling into the phone like it’s a crank phone with a party line.

“Hello. may I speak to Cathy?” says the other line.

“Yes, this is me,”I say.

“This is Rebecca at CMS, the independent contractor for Medicare Appeals!” (you may wonder why I always put that in italics. It is because they use that phrase like it is a papal dispensation for everything that is about to follow)

So I carefully and slowly and without rancor(really I try as hard as I can to keep under control, “more flies with honey than with vinegar” theory) explain to Rebecca that I have sent them the necessary documents for my AUTHORITY for this appeal, three times.

( n.b.(which means ‘note well’) they readily admit they have all the documents for the ACTUAL appeal, they just claim to not possess the documents needed for ME to appeal. And you wonder why caregivers sometimes pretend to be 96 year-old men just to get something accomplished. I digress……)

To her credit, Rebecca stays on the line with me for 10 minutes or so and by listening to me  as I document every date and page I have sent them, and looking, really looking: EUREKA! She finds ‘my authority’!

“Ok, she says,” now I have to see if it was filed in a timely  manner.”

Since I KNOW it was filed in a timely  manner, I just sit on the other end of the phone with steam coming out of my ears waiting for her to confirm that.

As we wrap it up, she tells me:

“Okay you will get a confirming letter re-opening this appeal from it’s dismissal in about 2 to 3 weeks. Then we will review the appeal and send a notice of our decision.”

“So, just so I understand, since I have to report this to the collection agency,” I say through clenched teeth,”you will let me know you FOUND the paper work I’ve sent you three times and THEN weeks or months from now you will let me know your decision on the appeal?”

“Yes, ma’am, that’s correct.”

“Thanks, Rebecca,”I say as I reach  for the Pinot Grigio and go back to bed.

You just have to laugh……..

Cathy Sikorski

I knew there was a reason I didn’t go to nursing school

   Sometimes, I just feel compelled to tell a tale because you just want to share with the world the things you discuss on the phone, that you NEVER thought would be a part of your lexicon.

I have had a few difficult weeks, but during that time, brother-in-law, L, with multiple sclerosis has been magnificent. Last year was very difficult for him, he had a myriad of health issues and he was in a rehab center/nursing home for a few months. It was pretty awful. But we were able to get him back home. Get him on his feet (figuratively not literally) and through a lot of medical care, ultimately put him in a pretty good place. He has these AMAZING caregivers who come every day to get him up and dressed, in his wheelchair, and then at night get him ready for and into bed. His MS prevents him from walking or standing any more, but he gets around like a champ in his electric wheel chair, and goes to meals, plays poker and smokes a pack a day out in the beautiful sunshine every day.

He has been SO good for the last year…..that on some level, I’m just waiting for “the other shoe to drop”. But his attitude is positive (for a curmudgeon, which is what he’s ALWAYS been) and he is truly adored by his caregivers. He’s even gotten a fish tank from his son, and watches the fishees like they’re his new best friends.

I am so very, very grateful that he has been well and happy for the last year. And I pray every day  for just another ordinary day. So today my phone rings and it’s not a number I recognize. I always answer those numbers in case it’s about anyone I’m caring for. Most of the time, it’s a robocall. But this one went like this:

“Hello?”

“Hello, Cathy?”

“Yes, this is me.”

“This is Mrs. W, a nurse from the facility where your brother-in-law lives.”

NOOOOOOOOOOOOOOOOOOOOOOOO, I’m thinking.

“Uh-oh,” I say, “anything up?”

“Oh no, everything is fine, it’s really ok, no worries.”

YEAAAAAAAAAAAAAAAAAAAAA,I’m thinking, but I’m suspicious. Nurses don’t call for no reason.

“I just wanted you to know that we were called by the caregivers because L had an open sore and they wanted us to look at it and treat it if necessary.”

“Oh, yes,” I say relieved, “I know about that, they asked me to get some derma-patches for the area. Are they not working?”

“Well, the patches he had were not staying on, but I got some ‘industrial strength’ ones and they seem to be staying on, so we will probably be able to get this sore to heal. We don’t want it to get too bad, or then he would need to go to the doctor or hospital.”

“Oh yes, of course, ” I say. And now I am almost giddy with relief that it is not anything serious and these great people are on top of it.

“So, just so you know, the area is a bit pink with a little clear injury showing. It is located between his anus and his scrotum, so it’s hard to keep the patch there, and we may have to work on keeping that there without peeling off, just to make sure we have significant healing time.

I’m now thinking…..well, I don’t have a scrotum, but ‘industrial strength’ patches  there probably really hurts.

I say:

“Ummmm, okay. Well is there anything else I need to know or do?” (Please God, say ‘no’)

“Oh, no just keep an eye on it and I think he’ll be fine,” says this fantastic nurse.”

“Ummm, okay,” I say. But I’m thinking…yeah I’m not keeping an eye on that….ever.

You just have to laugh………

Cathy Sikorski

Never call an ambulance if you’re old…..Part 2

I think I have spent about $5,000  ( at least in legal time and photocopying) trying  NOT to pay an ambulance bill. I began this tale as one of my first blogs, Do you really need an Ambulance? I think not. I related that my dear 95 year-old mother-in-law was found in pain in her assisted living facility, and the staff correctly called an ambulance. Her pain was evident, so even though she suffered from dementia, which was documented, the ambulance drivers decided to take her to the hospital.

For over a year now, I have been fighting with Medicare to pay this bill. I have told the Ambulance Company, I will not pay this bill, as there is no way my mother-in-law could have made the decision to go to the hospital, let alone  CALL for an ambulance. I do not wish to leave these hard working emergency first responders without pay. However, there has to be some manner in which they can support the patient when the first responders make a medical call, that requires an ambulance.

My mother-in-law does not drive. She has never driven. She has never had a car. In an assisted living facility, she has no transportation to go anywhere without it being directed by someone else. The facility is also doing the right thing by calling for an ambulance for a client who seems to need medical help.

Okay, so we’ve established that everyone who actually PARTICIPATED in this trip to the hospital made a rational and correct decision. The only people who don’t agree with this is Medicare and it’s not even Medicare. It’s a company called CMS, an independent contractor, who assesses whether the claim should be paid. So I send 22 pages of documentation with a letter of explanation telling this independent contractor why they should pay this bill.

The first denial is because this darling old lady really didn’t need to go to the hospital. They found nothing wrong with her and sent her home. Yep…..that’s absolutely true. But, I persist with an appeal.

The SECOND DENIAL is because I have NO AUTHORITY to appeal. I call to clarify this.

” If you would like to leave a message, please leave the appeal number, the claimant’s social security number, the date of service and the provider for which you are appealing. Please leave a phone number and we will return your call.”

YOU CANNOT TALK TO ANYONE…..EVER.

They do call me back, and I explain that I am holding in my hand the appointment of representative form that gives me authority to talk to them AND to APPEAL.

“O well, sometimes Medicare doesn’t send us all the paper work in the file so you need to send it to us again.”

I grind my teeth. Call the ambulance company AGAIN to reply to the bill they have sent ME again, and tell them I am still appealing.

The THIRD DENIAL comes because they still didn’t get my paper work. I call them again and they say….”oops”….and ask me to send it again. I ask the representative to explain to me how I will know if they get it…she says:

“Well you might get a notice that we received it…..wait, no, no I don’t think you will.”

Yesterday, I got the ambulance collection agency notice. They are going to sue my mother-in-law, which I kind of want to let them, because she died.

But I leave a message for the independent contractor, who calls me when I am in a meeting and can’t answer the phone. AND THE MESSAGE IS:

“This appeal was dismissed twice for failure to have the proper paper work to authorize you to appeal.”

I am not fing kidding. I’m not.

I was just going to pay the $797.20 bill. I mean they are just wearing me down to the nub. But I decided to give it one more try. I’m waiting for the return call.

To be continued……

And you really, really do…….

Just have to laugh….

Cathy Sikorski