Paul's Heart

Hot Potato – Health Care At Its Lowest

We all remember the game of Hot Potato that we played in elementary school. Everyone passes some sort of object around in a circle or back and forth to a partner until the teacher yelled “stop.” The goal of course, to not get stuck with the “hot potato”. Now of course, the game would have been a lot more interesting had the potato been real, and hot, like fresh out of the oven. No one would even want to touch that potato.

My post today is not about a hot potato right out of the oven, and it is clearly not a game. But it is a situationor a game that individuals do not want to get stuck with holding. And just as someone passing a hot real baked potato, someone is going to get burned.

First, the participants: a hospital, two nursing homes, an insurance policy, and a man and wife who have been together for over forty five years. If you have followed my posts, you know I am not an advocate normally for the first three entities. Today will be no exception. But I know it is going to be odd, as I am in the middle of my second divorce, to hear me defend and support a long term relationship and marriage as I am about to tell you about. For privacy, the names are not being used to protect their privacy, as well as their case as it is being fought, and I have joined.

The situation is this, an elderly couple, having experienced so much tragedy in their lives, made the most of what they had with each other. A tragic accident left one spouse to care for the other over two decades ago, and at no time, did the spouse ever waver from caring for the loved one. But then, the health of the healthy spouse suffered, quite seriously and became no longer able to care for the other spouse. This paragraph by itself is sad enough. Now it gets worse. Because of governmental bullshit, like spoiled brats with their arms folded in the sandbox, are simply willing to stand by, and hold their positions. Caught in the middle… the man and his wife.

So here is how the “potato” is getting tossed back and forth. The nursing facility that is preferred #1, that both spouses could live out the dying spouse’s days, will not accept the current supplemental medicare coverage purchased by the spouse. Facility #2 will accept that coverage, but not the spouse who has different needs. However, if the spouse drops the supplemental coverage, or it expires, then facility #1 can take the spouse. Unfortunately, there is an enrollment period requirement, which had past two months ago. In other words, this dying spouse must wait until the next enrollment period comes around to be with the other spouse. I do not believe that there is that time.

As I am prone to do, I am an advocate. I shake trees and rattle windows. I immediately began to contact government officials, local and state to see what could be done to help this couple. And lo and behold, an exception had been found for the enrollment period requirement for such a situation. It is not perfect, but it is a start. And as the situation was discussed with facility #1 that it looked hopeful to reunite the couple of forty-five years, we were informed that the spouse could not be accepted after all, because of a device that had been implanted for his terminal care.

So now the rollercoaster of health hell continues around the track. Insurance will pay for a visiting nurse to maintain this device in the spouse’s personal home, but not in a nursing facility. Nor will the insurance pay for the facility to perform the maintainance. What to do? That is right, begin the process to remove the device, which prevented the spouse from returning frequently (every two weeks) to the hospital to have the work done. But by removing the device, this would reunite the couple.

I continue up the corporate chain with this, working with local and state officials, and working my way up to Federal, trying to find reason why they “WON’T” make one freaking exception for someone who wants only one thing that is left in life, to be with their spouse one more time. I am not sure how much time is left, but I am asking for help, from anyone reading this, share this story on Facebook, or any media. This couple is not the only one in this situation, yet it is the very definition of what is wrong with our health care coverage.

My marriages may not have worked out, but this couple’s marriage did. And just as in the movie “The Notebook,” they deserve to be together one final time.