Lack of control

Ironically, as I was working on yesterday's post about hospice, I was about to receive a call that the transfer had not gone through correctly. One thing about Medicare rules is that plan changes have to happen on the first of a month. 

That means Mom is still with her previous care provider -- who does not provide hospice services -- for another month at a time when we are measuring her life in weeks.

There is a lot that it probably won't change. Music therapy and therapeutic massage can be nice, but that's about improving some moments, probably not changing the course.

I do worry about some of the medication options. I did feel like a total failure and cried.

I thought I was going to write about dementia today, and dealing with it in a parent; that is a thing that many in my generation will deal with.

There's not a lot that you can control with dementia either, so it all kind of fits.

Apparently, Elder Place is notorious for requiring five days to get things switched over. I think we started the paperwork four days before the end of the month. It seemed like it should have been fine. The hospice group was surprised when I called and told them.

I called Elder Place before starting the switch because I wanted to make sure I wasn't selling them short or being underhanded or anything like that. I am pretty angry that they didn't warn me that it might be cutting it too close, and I am going to tell them that, probably later today.

However, it wouldn't have changed the switch to them when it happened because there were no other options.

We needed someone who took Medicare and Medicaid and did on-site or video visits and would do them specifically to Waterhouse Ridge and had an opening for an appointment to start primary care soon.

We thought we found someone who could work, but while they were okay with video visits for established patients, they would not do video appointments for new patients. We were going to have to drag Mom to Northeast Portland in November. Transporting her was difficult already, but that was far. Anyone located closer would be over three months to get in.

Medicare rules do affect things, as does some of the infirmity that comes with aging, but an additional problem was doctor availability. That was not limited to seniors; it came up a lot for many patients that I spoke to through my work.

That is not just a matter of insurance and means and doctors burning out, but also the education of new doctors to fill the ranks. That system is seriously flawed and there is no reason to be optimistic about it improving under this administration. 

You can't control any of that. It sucks, but it's part of life.

It would not be unreasonable -- as people plan family gatherings for the holidays -- to try and have some conversations about things that might happen and how those things might be dealt with. 

People might talk about insurance for long-term care, which can be very expensive, but also might not fit certain needs. 

It is not uncommon to find that you have enough money to not qualify for benefits but not enough money to pay out of pocket, which generally involves a process of running through all of the assets until they are gone. 

This has led some spouses to divorce so that the one who is expected to live does not have to do so bankrupt.

(My family was lucky; we didn't have anything to start with.)

Those things aren't good, and they aren't practical. Let's say you can afford the insurance, but then whatever happens happens in a way that doesn't meet the terms (that happens surprisingly often with supplemental insurance like AFLAC). 

Really, what we would want is a society with better overall coverage, which would benefit everyone. 

There is a bigger discussion there, which could open hostilities at some family dinners.

I'm not trying to solve that right now.

What I am saying -- and this is not a solution to anything -- is that there are extreme limits to what you can predict and control.

That doesn't mean it's not worth thinking about it and acting on things that do seem important, but just that there are limits, no matter how smart and hard-working you are.

Sometimes that leaves you crying and feeling like a complete failure.

Then you get back to work, if for no other reason than that there is nothing else to do.