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7.28.12 30 Days of Grace

     Dad and I have been running our separate races against a 30-day clock since June 27th. We were informed at his last care plan meeting that his last day of Medicare coverage will be today, July 28th. Since that announcement, Dad’s only goal over the last 30 days was to learn how to transfer himself as a double amputee with two artificial legs. That means he has to be able to transport himself from his wheelchair to a toilet, or a shower bench, or a bed and back without someone helping him. If he can do this, then he can return to his assisted living apartment. 

     I had multiple goals over the last 30 days, but the two key goals were:

  • contact a VA attorney to see if Dad is eligible for a pension income based on his service during the Vietnam war era
  • find a skilled nursing facility (SNF) he can afford 

     On Friday, June 29th, I met with the VA attorney to get the pertinent information I needed to determine if Dad would be eligible for benefits. It turns out he doesn’t qualify for the income, but the attorney suggested I explore SNFs that are in smaller towns because they are more affordable, but still provide quality care. His advice resonated with me. I know of several SNFs in rural Kansas towns that have a strong reputation for outstanding care as a SNF. The one he recommended was Parkview in Lockhart, TX. 

     On Sunday, July 1st, I took a drive to Parkview. I showed up unannounced to see how staff would interact with me. I was allowed to walk through a variety of wings and peer into semi-private rooms. I checked out all of the amenities. It was beautiful, spacious, and it had a warmth to it because of the natural light allowed to come into the facility. I knew my Dad would be comfortable here, and the price was right. But my homework wasn’t done as I needed to look at Austin SNFs. 

     On Wednesday, July 4th, I spent three hours calling 35 SNFs to get quotes on room rates. My goal was to come up with a top five list of affordable places that I could visit. Out of 35 calls, only one admissions counselor asked about Dad’s insurance. The counselor got excited when she heard “Tricare”. She said, “I have two patients who are at our facility because Tricare granted them physical therapy once their Medicare coverage ran out.” I got excited because God just revealed another option that was never presented by Dad’s social worker. 

     On Thursday, July 5th, I called Dad’s social worker to relay the Tricare benefit that Dad might be able to obtain. She responded, “I have never heard of this benefit.” (I’m thinking, “I know. God is showing us that.”) She offered to call Tricare to see if this was true, and it was. Tricare will pay 75% of the total daily charge for Dad’s physical therapy, while Dad would be out the remaining 25%. In addition, Dad’s out-of-pocket would be capped at $3,000. He can afford it because the 25% he would have to pay matches almost dollar-for-dollar the amount of credit he is getting each month at the assisted living apartment because he’s not using all of their services. God keeps showing up! 

     On Saturday, July 7th, I visited five Austin SNFs to get the feel of the environment and the interactions between staff and residents. Everyone I met was glad to give me a tour and let me ask questions. It was a tiring day, but productive because my list shrunk to two affordable SNFs to admit Dad if that was our next step. 

     The social worker officially sent in the request to Tricare for 30 days of physical therapy on July 12th. Since then it has been a waiting game. Tricare would only approve physical therapy if Aetna sent a denial letter saying they won’t cover Dad once his Medicare-covered days run out on July 28th. You would think that a simple letter could be faxed or scanned, but Aetna kept dragging their feet. As of Wednesday, July 25th, we still did not have a letter. Aetna’s delay concerned our family, so I called Parkview to find out what they needed to approve Dad as a new resident in case Tricare denied coverage. They gave me a checklist, and I promptly went to the Medical Records department on the 25th, signed a medical release on behalf of Dad at 2pm, and they were to fax the data so I could get an approval from the Lockhart facility. By 4pm that afternoon, the good news came that the Aetna letter arrived, so that got faxed to Tricare so they could make their decision. 

     In the meantime, my brother and I needed a contingency plan to move Dad out of his apartment this weekend in case Tricare denied coverage. Should Gene go ahead and reserve a U-Haul truck for Friday and see if he can take off on Friday to help move Dad? Gene was wondering how confident I was feeling about Tricare approving Dad for coverage, and all I could offer was “I think so.” Gene decided he would wait until Thursday before reserving a U-Haul truck. 

     At noon Thursday, July 26th, I called Parkview to see if they had Dad’s medical records, and they said no. That required a flurry of phone calls between me and Dad’s facility to find out why that hadn’t been done. They said they did fax it, and Parkview said they never got it. So I asked medical records to fax it again at 2:30 that afternoon while the admissions counselor was at their fax machine, and it came through just fine. 

     At 3:30pm Thursday, July 26th, Dad’s rehab team was delighted to call me to let me know that Tricare granted Dad 30 days of physical therapy! After making phone calls to let the family know of the decision, I could only thank God profusely. God delivered a grace gift of 30 more days of physical therapy to enhance Dad’s chances of going back to his assisted living apartment. By Friday morning, July 27th, Parkview gave me the approval to accept Dad in case he needed a SNF. The race against the clock is over. It’s now up to Dad to prove he can transfer by August 27th. Please keep praying for him! 

Blessings,                                                                                                                                                                                                                             Lee Ann

7.6.12 You Have 30 Days

There’s nothing like the pressure of the clock. When it was time to take a test, our teachers said we had only “x” minutes, and when the time was up, we had to turn in our papers without delay. Just glancing at our watch while taking tests added more stress. Were we ahead of schedule or behind? Clocks add pressure in the sports arena. How many times do we watch quarterbacks see the play clock run down to two seconds and frantically pressure their centers to snap the ball? The clock adds pressure to golfers. They can’t take their time to swing a golf club or read putts. If they take too long, the golf officials put them on the clock, or they get penalized strokes. The pressure of the clock is stressful. 

There are clocks in the medical world, which I learned in my Dad’s care plan meeting last week. Medicare has a standard of 100 days for senior adults who are in a skilled nursing facility (SNF).  It doesn’t matter what medical condition brought them there. If they are in a SNF to recover from a stroke, they have 100 days. If they were in a car accident and need a SNF, they have 100 days. If they just became a double amputee, they have 100 days. Medicare has set the clock for recovery, and if the patients haven’t recovered by the 100th day, they are no longer covered. They become a private pay patient.  

Dad feels the pressure of the 100-day clock. The physical therapist in Dad’s care plan meeting announced that if he can’t transfer by the 100th day of rehab, he will not be able to return to his assisted living apartment. Dad lost 70 days waiting for his new prosthesis, as he didn’t feel safe trying to transfer with one artificial leg while waiting for his new one. Dad had difficulty embracing the news that he had 30 days left to learn how to transfer with both artificial legs. He said, “I just got my new prosthesis on June 21st! Thirty days sound like a very short time frame. I’m not sure I will be able to do it that quickly.” 

I can’t imagine what Dad is feeling. It feels unfair that a double amputee has to perform rehab as quickly as a stroke victim. But the therapists weren’t as sympathetic. They made it clear that they have helped many double amputees learn how to transfer with just one artificial leg. So the clock is ticking. I told Kendal, the social worker at this meeting, that Dad had VA benefits, so I need to begin pursuing this avenue. Kendal warned me that the VA is not known for providing long term care unless it is connected to his time in the service. My heart sank. Kendal handed me a VA brochure so I could contact the VA attorney to see if there might be other benefits we could pursue. I thanked the ladies for including me in the care plan meeting. I kissed Dad goodbye before heading back to the office. I gave him a pep talk and said, “You have 30 days to show you can transfer yourself. You can do it!” 

As I headed to the car, it struck me that Dad is not the only one who has 30 days. I, too, have 30 days, but my list looks different than his goal to transfer. I need to meet with the VA attorney as quickly as possible. I need to visit with the nursing director at his assisted living apartment. What is the protocol to terminate the rent agreement in case he’s not going back there? If he can’t go back home, then our family needs to deal with moving all of his stuff out, but where? There’s no room at a nursing home facility. How much of his things should we donate versus keep? I have to figure out the financial implications. If he doesn’t qualify for VA benefits, then all of his income could potentially go toward nursing home expenses, which means we’re looking at Medicaid. What about credit card bills? Most importantly, I need to shop for affordable nursing care and do site visits. Whatever facility is best for my Dad will need to have an available bed, preferably a private room, on July 29th. I also need to figure out how to transport him. He doesn’t fit in my car, and if the facility is not in town, then finding transportation may be a problem. I feel the pressure of the clock. 

As I get my track shoes on to race the clock, I am comforted knowing that God already has the facility picked out. He already knows what the financial picture will be. My family is ready to help me get him moved out if necessary. The Lord will help me navigate through the VA system. In the end, God is sovereign, and He is the true caregiver. I look forward to seeing how He leads our family to do what’s in the best interest of my Dad and be financially sound. Please keep the prayers coming. The next 30 days is filled with stress. Dad has 30 days to learn how to transfer, and I have 30 days to find an affordable facility in case he can’t transfer. The Lord will get us to this finish line in a glorious way. He always does. 

Blessings,                                                                                                                                                                                                                                                         Lee Ann

6.27.12 It’s Time to Transfer

     I love taking vacation and unhooking from the normal paces of the real world. The hard part is returning to the office. My goal is to get traction on a normal schedule throughout the week. But I have one more goal for Monday. I need to call Dad’s physical therapist to see how he is progressing since I was gone a week.  

   “Tammy, this is Lee Ann calling on behalf of my Dad. I just got back from vacation, so I wanted to check in with you to see how my Dad’s therapy is going.” 

   “I am glad you called. We discharged your father last week for lack of progress,” Tammy said. 

   “What do you mean ‘lack of progress’?” I asked. “That sounds odd given that this facility is a ‘rehab’ facility.” 

   “What I mean is your Dad is self-limiting.” She continued, “We do physical therapy with many amputees, and we teach many to transfer from their wheelchairs to beds, or toilets, or shower benches with just one leg. When we try to work with your Dad, he just tells us ‘It’s not feasible.’ When we try to push him, he gets angry. In fact, when he told us he could transfer, we asked him to show us, and when he couldn’t, he got very angry with us. The bottom line is when patients don’t want to participate in therapy, we discharge them since there is nothing else we can do.” 

   “So he’s existing in his room, except to go to the dining area for meals, but getting no therapy,” I said. 

   “That’s right,” she said. “We have given him strength exercises for his arms, but he is not really doing much of those either.” 

   “So where do we go from here?” I asked. 

   “Your Dad feels certain that once he gets his second artificial leg, he will be able to transfer, and then we will be able to discharge him back to his assisted living apartment assuming his hypothesis is correct.” 

   “I hope he’s right,” I said. “What kind of timeline will he have to demonstrate that he can transfer once he gets his new leg?” 

   “It is my understanding that your Dad is running out of days according to the Medicare allowance of 100 days,” Tammy offered. “I believe he is going to have about two weeks to accomplish this, or we will be looking at other alternatives.” 

   “That sounds like a short timeframe given that he doesn’t have arm strength to push himself out of his wheelchair,” I said. I decided to change the direction of the conversation to be proactive in case Dad is not able to transfer.

   “I want to be sure that any decisions regarding a transfer to another facility are made not just by my Dad, but also by my uncle, brother and me. We need to make sure that the decision made is not only in the best interest of my Dad, but also financially sound.” 

   “That is no problem, Lee Ann,” Tammy assured me. “I will make sure you’re included in the care plan meetings going forward so you are involved in the decision-making process.” 

   “Thank you, Tammy. I appreciate your time to update me.” 

     This is the conversation I had with the physical therapist on Monday following my vacation. Tammy’s report was very different than what Dad told me when I asked him, “How is your therapy going?” His answer was, “I can do it, it’s just not pretty.” My internal dialogue was “So if you can transfer now, why are you still here?” But I responded, “I am glad to hear that. So when do you think you’ll be discharged?” 

   “I don’t know,” Dad said. “I am starting to feel like a permanent resident here.” 

     I feel sad for him, but I am also not surprised. Dad’s amputation surgery was April 2nd, and no fitting for a new artificial leg could happen until his stump stopped swelling. It was June 14th before he got fitted, and it was June 21st before he finally had a new leg. That is a long time to wait for a prosthesis. And if Dad made up his mind that he couldn’t transfer without two legs, then two and a half months have elapsed without much practice in transferring. Before I left for vacation, I had this premonition that Dad was going to have problems negotiating this critical therapy. It felt like the cards were stacked against him. 

     First, he is heavy. His weight is an obstacle to push himself up. Second, he has lost significant arm strength. Because of his weight, his arms really need to be strong. How does a rehab hospital define strong? If Dad can push himself up in his wheelchair and hold himself up for ten seconds, then that is considered good arm strength. Have you ever tried that? I did just to make sure I could! If you’re not exercising, that can be harder than you think. Third, once he can stand up on his two artificial legs, he needs to show balance and stability, which is very hard after losing a leg. The brain and the leg need to start talking again. Third, he fears falling. Dad can’t picture using his walker and venturing too far from his wheelchair in case he falls. Finally, he fights depression. His level of discouragement influences his decision to not work at building arm strength. 

     When I walk into his room, the therapist has only one goal taped to the wall, “Push yourself up in your wheelchair and hold for 10 seconds. Do this once every 30 minutes.” Dad is struggling to accomplish that one goal. I tried to give him a pep talk. “Dad, your arm strength will come back, but it’s a process. Celebrate pushing yourself up and holding for three seconds. In 30 minutes, try it again, and you may hold yourself up for four seconds. Just keep working at it, and you’ll get there.” 

     My Dad has gambled on the hypothesis that he will be able to do transfer activities with two legs. It is plausible, if he can build up arm strength, that he can do this and go back to his assisted living apartment. I just don’t think it can happen in two weeks. I will see if my hunch is right. I have been asked to attend his Care Plan Meeting tomorrow to discuss Dad’s issues and the roadmap ahead. I have a feeling that it’s time to transfer, but it won’t be back to his apartment. May God’s grace be sufficient for my father to deal with this potential change. May God pour out His wisdom generously on our family as we seek God’s leadership to show us where he should be transferring next. Please keep us in your prayers. 

Blessings,                                                                                                                                                                                                                             Lee Ann

4.29.12 We’ve Got Mail + Video

Do you appreciate when someone writes you? I feel special when I receive a letter because someone took the time to connect with me. I love getting letters. In fact, I save them. 

Saving letters must run in my family. My grandfather, a lieutenant commander in the Navy, was called to duty during World War II, leaving behind a wife and three young boys. He and my grandmother exchanged many letters to keep the family connected. 

When my grandparents passed away, Dad inherited boxes of letters, not only written from Poppa Lee and Gran Jones, but the letters Dad wrote to them. The year Dad downsized his living space, he entrusted these letters to me. I’ve got their letters from 1943 through the 1970s. Can you imagine the family history at my fingertips? Here was my opportunity to learn about the lives of my grandparents, whom I hardly knew. And learning about Dad was a bonus.                                                       

My intentions were good. I’ve had these letters – 3,000 by conservative estimate – for seven years. I started a project of scanning them but stopped after 40 when I discovered my scanner liked having brittle paper for lunch. Then I entertained a goal of reading a letter a day, which was a lovely idea, but it didn’t happen. I talked myself out of it because I wanted to read them in chronological order, which would have meant going through all 3,000 of them. The letters remain unread. 

This undertaking made me think about God and how He intentionally preserved His letters to us. I wonder if we appreciate that God has composed the greatest love letter ever written to mankind. God preserved His letters in the Bible because He wanted to show us how much He loves us. I have learned my legacy as part of God’s family by reading the Bible daily. I am certain that if I were as intentional about reading the letters of my family, I would be enriched with that legacy as well. 

God has a series of letters waiting for us in the Bible. We’ve got mail, and it’s time to read it!

Blessings,                                                                                                                                                                                                                            Lee Ann

4.15.12 Be Anxious for Nothing

Philippians 4:6-8 – “Do not be anxious about anything, but in everything, by prayer and petition, with thanksgiving, present your requests to God.  And the peace of God, which transcends all understanding, will guard your hearts and minds in Christ Jesus.”

     Imagine your doctor telling you he needs to admit you because your leg needs to be elevated to deal with fluid drainage from the ulcers. You head to the hospital in good faith with the premise of managing the leakage. Now imagine your doctor coming in a few days later to look after your wounds and announcing that your arterial circulation has significantly deteriorated and that an amputation is the best option to move forward. When he called me to share the news, he was feeling overwhelmed and scared. Dad was in a difficult position, and I was unsettled about it. Shouldn’t a doctor who has been treating my Dad on a regular basis have a higher level of awareness as to the real condition of Dad’s leg? This didn’t feel right to me. Dad was a captive audience, and he had to make a decision that could potentially place him in a nursing care facility. I asked Dad’s permission to call his physician.

     I was candid with him on the phone. 

     “My Dad understood that he was being hospitalized to elevate his leg and deal with the fluid drainage,” I told him. “He trusted your advice, and now you tell him that his leg needs to be amputated. Can you help me understand what’s going on? Was there more to your conversation with Dad prior to his admission that I didn’t know about?”

      “You are absolutely, one hundred percent correct,” the doctor said. That was the premise.  I had no idea how badly his arterial circulation had deteriorated until I looked at him.” Our family knew this day was coming when Dad would face another amputation. The goal was to save his leg as long as possible. The doctor acknowledged the many treatments Dad had undergone to manage these ulcers and thereby extend Dad’s independence. But the ulcers weren’t healing. He was given two choices. He could undergo an amputation or continue the battle to manage the ulcers.

     Saving the leg means a debridement surgery. This entails scraping away dead tissue in and around his wounds to create a healthy bed of tissue for skin grafts to close the wounds. Dad went that route a year ago. It took a couple of debridement surgeries just to clean out the ulcers and clear away the dead tissue. Then there was the surgery to take skin and graft it to the wounds to close them. This was a viable solution last year because his arterial circulation was very good, but that is not true this year. His arterial circulation deteriorated significantly, which made the debridement/skin graft approach an ineffectual treatment. His only other choice was to amputate.        

     Dad knew in his heart that an amputation was the right decision. Once he consulted with the orthopedic surgeon, Dad agreed to it. Over the weekend I notified family, Dad’s church family, and my Sunday School Class to pray for Dad. Since his surgery was scheduled for Monday, April 2nd, I went to the hospital Sunday evening to pray with him. As I was driving to the hospital, I wondered if Dad would be feeling anxious. Would he be having any doubts about his decision? When I arrived at Dad’s room, the power of prayer was already on display in Dad’s spirit! He was not feeling any anxiety. He was sitting on the edge of his bed exuding a peaceful demeanor. He was nonchalant about the amputation. When I marveled at his calmness, he said, “It’s like I’m ignorant of what’s happening.” That is God honoring the many prayers of His children on behalf of my Dad! But the power of prayer was not the only thing on display.

     God illumined the spiritual maturity of my father during our prayer time. I opened our prayer by asking God to pour out His grace, His mercy, His compassion, His peace, His love, His comfort, His healing, and His encouragement upon my father. I asked the Lord to allow this surgery to be successful. I prayed that the Lord would give Dad a victory in rehab so he could return to his assisted living apartment. I thanked the Lord for what this surgery will mean to Dad. Dad will no longer have nurses in his apartment every other day redressing wounds. There will be no more trips to clinics for lymphatic treatments. He won’t have to take pain medications that dull his memory. He won’t be in and out of hospitals to fight infections with antibiotics. He will feel more independent with more free time. As I finished my prayer, Dad began to pray. He acknowledged that there were just too many blessings to count. He prayed with a spirit of gratitude for all God has done for him. He prayed for those who are spiritually lost. Then he started to pray for me. 

     This is something special that Dad does often. Whenever I am with him and he desires to express appreciation for the things I do for him, he will go beyond a simple “thank you”. He will verbalize his prayer with me present. That evening he recited his favorite, “Lord, thank you for Lee Ann.” he began. “Please reward her generously for all that she does for me.” Now understand I am in a hospital room attempting to minister to him, but instead he is focused on praying God’s blessings over me. I hope I will be spiritually mature enough some day to focus on others instead of myself. His great faith in God’s sovereignty, God’s faithfulness to take care of him, and God’s perfect will for him is a tremendous model for anyone. I kissed him goodnight and knew in my heart that God had “prepped” Dad’s heart with immeasurable peace. 

     The surgeon called me at 8:50 Monday morning to let me know the surgery was a success. The recovery nurse called me at 10 a.m. to let me know he would be back in his room by 11:00. Each call was a confirmation that God was taking care of my father. There is nothing like the power of prayer. I believe God honored the multitude of prayers that went out for my Dad. God hears us when we pray and lovingly responds. Let’s praise God from whom all blessings flow. You can be sure that’s what my Dad is doing. 

Blessings,                                                                                                                                                                                                                            Lee Ann