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Old 05-14-2019, 09:49 AM
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Nursing homes: as sleazy as ever?


Last Monday my PCP was going to talk to the social worker about my exit plans. Yesterday she was talking about me becoming a permanent resident. She's worried about me needing fulltime nursing care. Huh? All I need is to be able to use a walker, which I haven't been able to do because of my broken foot, foot wounds. and crappy knees. Now the break has mended and the wounds are closed (they were bad). All I need is Cortisone shots to the knees, which was delayed until the wounds healed. My home is better set up for me than it was. If I need to I'll just buy a used Hoveround to get around better. I'm not a prisoner and what i need are the shots, a couple more weeks for the new skin to thicken, start using a walker, and I'm gone.

What would motivate her to say that? I think it's because the state's checks haven't bounced and they noticed that I'll be on Medicare in a month and their checks won't bounce, either.
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Old 05-14-2019, 12:18 PM
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Did you ask her why she was suggesting that?

(I agree. Get the hell out while you can.)
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Old 05-14-2019, 12:21 PM
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Yes, get out. You'll quickly notice the lack of smell of urine.
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Old 05-14-2019, 05:15 PM
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It depends on how much money you are willing to spend. There are a lot of "assisted living facilities" that have spacious rooms and even a few good sized apartments, nice dining rooms, excellent food etc. Buuuuuuuuut, you basically have to give them all of your money at the outset, and once its gone, so are you. Locally to me, these places start out at around $4500 and go up from there.
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Old 05-14-2019, 05:33 PM
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Run, just as fast as you can. Which is a tall order with your feet and knees. Get help from kids, get in a wheelchair. Have the getaway car revved up and sitting on go. And leave. They can't make you stay.
Since I owe you a big solid, let me know and I'll come break you out. We can go on the run like Bonnie and Clyde.
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Old 05-14-2019, 05:42 PM
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Nah, I'll stay here until I'm ready to go, then I'll go. And if they choose to throw me out when my insurance stops, I could leave today. Okay, two weeks.

But I have my eye on them. I feel like my PCP here betrayed me.

Last edited by dropzone; 05-14-2019 at 05:43 PM.
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Old 05-14-2019, 06:00 PM
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Aw, man. I was up for a road trip.
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Old 05-14-2019, 06:02 PM
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I used to know these things but my memory is a bit hazy. Permanent resident = full time nursing with no time limit, like maybe you're over your allotted time as a rehab patient, insurance-wise, and this is how you would extend your care until you don't need it anymore. Your PCP judges that you need full time nursing now and this will continue for a future period of time. Your social worker arranges this care for you. Impending Medicare probably does have something to do with it. You can find out.
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Old 05-14-2019, 07:02 PM
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Why didn't she just say that?
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Old 05-14-2019, 07:05 PM
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I've come to realization and have confirmed with several doctors that a good part of medical diagnoses is based on statistical data. It may be that statistically, someone of your age, in your condition is likely to require full time care and the recommendation for you to be admitted is a CYA. Better to have you admitted now, rather than have you return home and get worse, possibly claiming that they shouldn't have released you.

Also, I don't know about other states, but in Hawaii, admittance to the good, reputable nursing home is difficult to get. My Mom went from the hospital to a private nursing home for a few months, but as she got better (i.e. wasn't completely bedridden), we were given a time limit before she had to leave. Note that we paid almost the monthly bill ourselves, but she had to leave because they needed the room for someone else in more dire need. Yes, there's an argument to be made that the next person requiring more care would bring in more money, but it was an emphatic no that she shouldn't stay.

We were blessed to find a private full-time care home for the bargain price of $4000/mo, whereas other homes were asking for several thousand more. Part of the reason for the lower cost was because at the time of admittance she wasn't completely bedridden and able to generally wash and care for herself. The last few months of her life, she did become completely bedridden, but the caregiver didn't ask for an increase despite the owner of the home/company asking for one.
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Old 05-14-2019, 07:24 PM
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Why didn't she just say that?
This is a classic case of get it in writing and get a second opinion if there's any questions. Doctors, like lawyers have at least two types of speeches. One they use with other professionals and the other they use with laypersons. Have her detail the reasons for her recommending extended care for you in writing and have someone versed in the field go over and explain it in detail to you.

Especially when we're emotional about something or have a preconceived mindset, we tend to hear things, both positive and negative differently.

When my Mom was in the hospital with pneumonia, the doctor verbally explained the severity of her condition and the options, basically do nothing and let her recover best as she could at 87 or perform a surgery to remove the fluid from her lungs with a 50/50 chance of survival and a 50/50 chance of the fluid returning away.

After explaining it to my sister twice alone (during which she was in denial that my Mom didn't have long to live in either case), he reluctantly sat down with her and myself for a third time and explained it to both of us. Even then, my nature being analytical and my sister's nature being emotional, we both picked up on different things, but we ultimately agreed to explain to my Mom why a painful surgery with a 50/50 chance of survival wasn't a choice we'd recommend. She didn't have to surgery and recovered as well as an 87 woman could and lived for nearly two more years.

Last edited by lingyi; 05-14-2019 at 07:25 PM.
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Old 05-14-2019, 07:44 PM
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Why didn't she just say that?
Borrowing from the post above, maybe she did, and you heard it as you're never going home. You wrote it though as she is concerned that you need full-time nursing right now and into the future. Nothing about that is false. So it's likely not much has changed, and whatever the case you have every right to go looking for definitive answers.
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Old 05-14-2019, 07:56 PM
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She speaks tersely and I try to remember conversations verbatim. I will try to get a clarification, if not from her then her PA, who is a native English speaker.
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Old 05-14-2019, 08:30 PM
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It depends on how much money you are willing to spend. There are a lot of "assisted living facilities" that have spacious rooms and even a few good sized apartments, nice dining rooms, excellent food etc. Buuuuuuuuut, you basically have to give them all of your money at the outset, and once its gone, so are you. Locally to me, these places start out at around $4500 and go up from there.
A luxury facility starting at $4500 a month? hahahahaha. My moms nursing home is costing her 10K a month, which is what she had to spend to get to “not totally horrid”. And that’s not counting actual medical care, though Medicare picks up most of that. And this isn’t even in an expensive area, just a mid-sized city in the Mid-South.

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Old 05-14-2019, 08:49 PM
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If you have 30 days left on Medicare, yeah, she may not entirely have your best interests at heart. But when Medicare runs out, if your assets are safe and they can only get Medicaid for you, they'd just as soon you go home and never come back.
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Old 05-14-2019, 08:58 PM
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A luxury facility starting at $4500 a month? hahahahaha. My moms nursing home is costing her 10K a month, which is what she had to spend to get to “not totally horrid”. And that’s not counting actual medical care, though Medicare picks up most of that. And this isn’t even in an expensive area, just a mid-sized city in the Mid-South.
Thats a small 1 bedroom apt. With "you don't actually need any help but your old enough or alone enough to want someone on hand 24/7 just in case" level of care
Plus, Idaho, good chance the cost of living is over all lower here than there
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Old 05-14-2019, 09:04 PM
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I think my doctor doesn't understand my home stuff and plans, though I've explained that Middle was her mother's nurse for a number of years. She has preconceptions of me being an old man who lives alone and will just go home to rot and die. She doesn't know I'm working at getting that customer service job, or want to be there when they vinyl side my house, or want to zip around on my almost street legal electric scooter, or finish my tricycle so I can pedal and build up my legs to their former majesty. She hasn't asked, so I need to volunteer that info.
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Old 05-14-2019, 09:11 PM
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If you have 30 days left on Medicare, yeah, she may not entirely have your best interests at heart. But when Medicare runs out, if your assets are safe and they can only get Medicaid for you, they'd just as soon you go home and never come back.
No, I'm on Medicaid with Medicare kicking in in three weeks.
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Old 05-14-2019, 09:48 PM
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Thats a small 1 bedroom apt. With "you don't actually need any help but your old enough or alone enough to want someone on hand 24/7 just in case" level of care
Plus, Idaho, good chance the cost of living is over all lower here than there
I spent some time at one of the nicer assisted living facilities up here. You buy your residence and then you pay a monthly fee for services. It's staggering only if you don't know what a regular nursing home costs per month. In this one, a 2BR 2 bath in independent living was $3500 a month or so, the highest it gets. They have a huge number of residents and a massive philanthropy fund, meaning even if residents do deplete their assets over time, even when moved to nursing care if that is needed, that's their home and they stay there throughout. That's not all that shocking I guess for a decent organization, but I had no idea.

Now in retrospect, all the residents from faraway states make more sense to me.
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Old 05-15-2019, 01:08 AM
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I think that, same as many primary schools warn parents of incomings that their kids may need special education at some point (regardless of the actual kid; and both because a lot of kids do need some sort of help at some point and because the sooner you get parents who've never thought about it to think about it, the better), many facilities which serve both as short-term clinics and as long-term homes do provide the information on their long-term services routinely.

When my mother was in the hospital and later in such a facility, at different points the nurses and the social service worker checked with my brothers and me on what kind of arrangements were available once she got out: part of the reason she was moved from the hospital to the clinic was because at that point the home situation would have been a worse option, she was released fully (with home nurse visits) once she was well enough for her domestic arrangements to work. Having a walk-in shower was a plus; that it's small was a minus. Having neighbors who she can call and two sons who live nearby were pluses; a tendency to leave her emergency button anywhere was a minus. And so forth.

In your case, you've already thought about what is it you need and you already have a house that's prepared for someone partially disabled; for many other people, that information is a life-saver.

Last edited by Nava; 05-15-2019 at 01:12 AM.
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Old 05-15-2019, 01:40 AM
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I spent some time at one of the nicer assisted living facilities up here. You buy your residence and then you pay a monthly fee for services. It's staggering only if you don't know what a regular nursing home costs per month. In this one, a 2BR 2 bath in independent living was $3500 a month or so, the highest it gets. They have a huge number of residents and a massive philanthropy fund, meaning even if residents do deplete their assets over time, even when moved to nursing care if that is needed, that's their home and they stay there throughout. That's not all that shocking I guess for a decent organization, but I had no idea.

Now in retrospect, all the residents from faraway states make more sense to me.
At the facility physically closest to me they have a small subdivision that is exactly that. In the main building, the ground floor apts are smallish but each has an exterior door so you don't have tto go in and out the main building doors if you don't want to. 2nd floor apts are a little bigger, and 3rd and forth floors apts are around 1100 sqft. 5th floor has 5 apts 2200 sqft each. Those are the truly luxury apts. I don't recall what tthe cost was for those but I do know its around or above 10,000/month. This facility just finished building a full gym complete with dry hot room (sauna?) Steamy hot room, hot tub and jacuzzi and I believe I was told they are going to start building the indoor swimming pool this year.
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Old 05-15-2019, 01:32 PM
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Doctor and social worker were in and we discussed my situation. They want me well enough that I can make it at home and not have to come back. There was also a threat that if I check myself out, like if some beautiful but insane Bonnie Parker cosplayer snatched me, they would mark on my permanent record that I left against the recommendation of my doctor. Also, she has no power over my shots; that's up to wound care and the physiatrist who will jab me. We agreed that I want to do it right and I'll remind the wound care doc when he's here Friday.
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Old 05-15-2019, 02:42 PM
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Permanent record! My foot..er your foot. Where are we, Nazi Germany?
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Old 05-15-2019, 03:10 PM
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Worse yet, my MEDICAL RECORD that can be seen by INSURANCE COMPANIES!!!!
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Old 05-15-2019, 08:34 PM
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Doctor and social worker were in and we discussed my situation. They want me well enough that I can make it at home and not have to come back. There was also a threat that if I check myself out, like if some beautiful but insane Bonnie Parker cosplayer snatched me, they would mark on my permanent record that I left against the recommendation of my doctor. Also, she has no power over my shots; that's up to wound care and the physiatrist who will jab me. We agreed that I want to do it right and I'll remind the wound care doc when he's here Friday.
That all sounds reasonable. You sound good too. Somebody knows what they're doing.
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Old 05-15-2019, 08:48 PM
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That would be me. ( or ?) I'm not a used-up husk of a human they are used to, but my short-term memory is weakening. I'd blame the Zoloft but doc says I shouldn't judge it until Saturday, the 2-wk anniversary of starting on it. Like drugs adhere to schedules.
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Old 05-15-2019, 09:06 PM
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There was also a threat that if I check myself out, like if some beautiful but insane Bonnie Parker cosplayer snatched me, they would mark on my permanent record that I left against the recommendation of my doctor.
If you leave "against medical advice" you're going to have a hell of a lot of explaining to do to whomever your insurance carrier is. You may also have trouble getting ANY care facility anywhere to admit you in the future. Not saying this is inevitable, but it certainly can happen.
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Old 05-15-2019, 09:17 PM
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I assumed that and it's why I chose to do what they tell me.
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Old 05-15-2019, 09:24 PM
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It depends on how much money you are willing to spend. There are a lot of "assisted living facilities" that have spacious rooms and even a few good sized apartments, nice dining rooms, excellent food etc. Buuuuuuuuut, you basically have to give them all of your money at the outset, and once its gone, so are you. Locally to me, these places start out at around $4500 and go up from there.
Yep. My father is in one. He needs to be there -- they specialize in "memory care," and his dementia makes it impossible for him to live on his own.

But $4,500? Wow. Here in NYC, it costs $18,500 per month. And that's at the lowest level of accomodation -- more luxurious quarters are available in the same facility.

It's a real concern of mine that at this rate he'll outlive his money. Then what? I have no idea.
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Old 05-15-2019, 09:46 PM
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yeah CA has an attitude of "you don't have to do what we tell you to do but we don't have to pay for the results of what happens if you don't "regarding certain types of care

Last edited by nightshadea; 05-15-2019 at 09:47 PM.
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Old 05-15-2019, 09:56 PM
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Yep. My father is in one. He needs to be there -- they specialize in "memory care," and his dementia makes it impossible for him to live on his own.

But $4,500? Wow. Here in NYC, it costs $18,500 per month. And that's at the lowest level of accomodation -- more luxurious quarters are available in the same facility.

It's a real concern of mine that at this rate he'll outlive his money. Then what? I have no idea.
Medicaid will generally pick it up once the assets are completely depleted. It’s important that he not gift or transfer anything, if that has happened in the last several years he may be ineligible for Medicaid. They can and will try to take the primary residence if he lives alone, there are restrictions if he doesn’t but that doesn’t necessarily mean it’s safe. I’ve kept these comments general because the specifics may vary from state to state. I recommend contacting a lawyer that specializes in Elder Law, you can do things like set up an exempt trust for funeral expenses.

I’m dealing with this very issue with my Mom right now. I’ve spent my day digging through her papers and trying to access her online accounts in order to get the papers the lawyer needs.

Last edited by Ann Hedonia; 05-15-2019 at 09:58 PM.
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Old 05-15-2019, 10:12 PM
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That would be me. ( or ?) I'm not a used-up husk of a human they are used to, but my short-term memory is weakening. I'd blame the Zoloft but doc says I shouldn't judge it until Saturday, the 2-wk anniversary of starting on it. Like drugs adhere to schedules.
If you have a history of not being meds compliant, I could understand a concern for you not being around people to watch out for you and make sure you take the meds you need when you need them. Compliance can be an elephant in the room, patients don't like to think or admit they've not been taking their meds as prescribed.
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Old 05-15-2019, 10:27 PM
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I tell them when my meds are due. They are still late, throwing off my timed to the minute schedule. Did I mention I'm OCD?
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Old 05-15-2019, 10:40 PM
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At the facility physically closest to me they have a small subdivision that is exactly that. In the main building, the ground floor apts are smallish but each has an exterior door so you don't have tto go in and out the main building doors if you don't want to. 2nd floor apts are a little bigger, and 3rd and forth floors apts are around 1100 sqft. 5th floor has 5 apts 2200 sqft each. Those are the truly luxury apts. I don't recall what tthe cost was for those but I do know its around or above 10,000/month. This facility just finished building a full gym complete with dry hot room (sauna?) Steamy hot room, hot tub and jacuzzi and I believe I was told they are going to start building the indoor swimming pool this year.
This one was more like a small town. There is a CVS Pharmacy and a bank branch in the main clubhouse, and a walk-in health clinic just for the employees. Pools, fitness rooms, several restaurants, with bars, in fact I interviewed a 100-year-old gentleman at one of the bars.

This might be sounding like a fairy tale. Just look into Erickson Living properties if you're inclined. The residents came from everywhere.
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Old 05-15-2019, 11:28 PM
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We were lucky enough to find a place for Mom in suburban Chicago that had independent living, assisted living, and skilled nursing care units. There was a buy-in, which she managed with the proceeds from the sale of her home, and a monthly fee that was low enough that she could live on her pension and social security. This place is a nonprofit, so when the resident leaves (usually feet first), the buy-in is refunded as soon as the apartment is sold . It's a very nice place, beautifully designed, and with several restaurants onsite. Mom was happy there.

They're not all sleazy.
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Old 05-16-2019, 08:01 AM
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All I know is that, of the senior living facilities my wife and I have been in, two out of three were sleazy--see my current thread about a drug mixup yesterday.
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Old 05-16-2019, 09:01 AM
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All I know is that, of the senior living facilities my wife and I have been in, two out of three were sleazy--see my current thread about a drug mixup yesterday.
I see that. It doesn't say to me that they're trying to poison you, it does say that their institutional protocols could maybe use a tune-up. Mistakes do happen but it's reasonable to try to ensure zero point zero instances of medication errors, I mean absolutely nobody is against that idea. Patients and their families have to have trust in the system. So I definitely would have reported that to the admin and I would expect a response.

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Old 05-23-2019, 05:41 PM
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Holy Hell. Some of the figures spoken here give me the chills. If any of my dependants were expected to pay 3x to 10x my mortgage a month to keep my ass alive hand me a shotgun and I will personally save you the money. Are we so afraid of Death that we will deplete everything we have, and burden our children, for a few months or even years of life. Narcissistic world view much. Newsflash...you are not a unique snowflake. History and society won't miss you. You had your time. You raised your kids. Lived your life. Why would you burden your family like that?
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Old 05-23-2019, 08:03 PM
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Nursing home doctor (post acute hospitalist is my official title) chiming in here. In my area of south Texas, physicians tend not to be the ones who decide on a discharge date. Most of the time the therapists, DON, and administrator come up with a date, which tends to correspond to around the time that insurance will cover. The attending physician is notified of this date and asked to sign off on it. If the attending disagrees often enough and tries to do his or her own thing, referrals for new patients will dry up. I know this from first hand experience at some of the less reputable facilities. If your attending is a community doctor it’s even more likely that they just go along with whatever the facility staff recommends since those doctors spend most of their time in their outpatient practices rather than in the nursing homes. It sucks that things work this way, but the owners of the facilities fire administrators and DONs who don’t try to keep the insured patients as long as possible (again, based on first hand experience).

I hope you heal up and get out of there as quickly as possible, if you haven’t already.
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Old 05-23-2019, 10:11 PM
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Holy Hell. Some of the figures spoken here give me the chills. If any of my dependants were expected to pay 3x to 10x my mortgage a month to keep my ass alive hand me a shotgun and I will personally save you the money. Are we so afraid of Death that we will deplete everything we have, and burden our children, for a few months or even years of life. Narcissistic world view much. Newsflash...you are not a unique snowflake. History and society won't miss you. You had your time. You raised your kids. Lived your life. Why would you burden your family like that?
Family members don't pay unless they want to. And nice people don't turn the elders out into the desert when they need constant care, or whatever you have planned, so this is the system we have.
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Old 05-24-2019, 09:38 AM
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My favorite Plan Z is to feign senility and sneak out of the house on a very cold Winter's night. There are worse ways to go than hypothermia, and there are reasons why I don't own a gun.
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Old 06-01-2019, 02:14 PM
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Zoloft's a bust. My symptoms are back in force, with me obsessively shopping for sesame sticks and a hoveroundish scooter because I doubt I'll be walking worth a shit when I can leave. I'm eating more than I have in years, compulsive eating things I don't even like, so my weight loss trend has reversed. Worst of all,
SPOILER:
I can, um, no longer bring myself to "completion" despite some first-class stimulation. Impotence, even when alone, is unfun and doesn't help me keep my prostate clear.
But has my bozo psychiatrist been back to check how the transition from Prozac has gone? NO! and even my PCP is mad.

Fucked up dump.
  #43  
Old 06-02-2019, 05:28 PM
Nawth Chucka is offline
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Quote:
Originally Posted by dropzone View Post
Zoloft's a bust. My symptoms are back in force, with me obsessively shopping for sesame sticks and a hoveroundish scooter because I doubt I'll be walking worth a shit when I can leave. I'm eating more than I have in years, compulsive eating things I don't even like, so my weight loss trend has reversed. Worst of all,
SPOILER:
I can, um, no longer bring myself to "completion" despite some first-class stimulation. Impotence, even when alone, is unfun and doesn't help me keep my prostate clear.
But has my bozo psychiatrist been back to check how the transition from Prozac has gone? NO! and even my PCP is mad.

Fucked up dump.
I'm sure you and your PCP know what's worked for you and what might not, but I wanted to chime in that I'm on Bupropion and not only has it been great at helping me in my depression, I don't deal w/ anything you've mentioned above - and I really like sesame sticks.
  #44  
Old 06-03-2019, 10:23 AM
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dropzone is offline
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For some reason SRIs don't work the same for everyone. I have a stash of 3-months of fluoxetine but I want to give Zoloft a fair test.

Speaking of personal stashes, I'm supposed to get acetaminophen and ibuprofen every 6 hours, BUT THEY ARE ALWAYS OUT OF THE IBUPROFEN! It's a good thing I have a stash of it so I can get properly treated without the nurses running to other units trying to find some.
  #45  
Old 06-03-2019, 06:08 PM
Nawth Chucka is offline
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Quote:
Originally Posted by dropzone View Post
For some reason SRIs don't work the same for everyone. I have a stash of 3-months of fluoxetine but I want to give Zoloft a fair test.

Speaking of personal stashes, I'm supposed to get acetaminophen and ibuprofen every 6 hours, BUT THEY ARE ALWAYS OUT OF THE IBUPROFEN! It's a good thing I have a stash of it so I can get properly treated without the nurses running to other units trying to find some.
For reference, bupropion is an NDRI; it's often added to an SSRI and AIUI the 2 work together.
If I run out of ibuprofen it will be an emergency.
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