What sort of barbarians are we?

December 31, 2008

We can foster children, or puppies...why don't we have a fostering program for the elderly? Even if someone is willing to provide care to a non-family elder, the state does nothing but make it impossible...I have a little old 75 yo man in the hospital. Was homeless before he was admitted with extreme malnutrition, covered in sores, already missing one leg below the knee and four of the five remaining toes gone..He'd leave AMA except he can't walk. No nursing home will take him because he gets combative at times, throwing urinals or food or whatever.... He has SCC of the lung...not going to live forever. One of our colleagues is plotting to drop him off at a homeless shelter... the social worker says there is just no place to send him and he'll have to stay until he dies. The hospital can only release him to " an appropriate facility " ...whatever that is.

He is not that hard to deal with. Settles right down if you talk to him as if he was a human being...lights up like a Christmas tree if you bring him cookies or buttermilk. Are there any states out there that do better caring for folks like this? I'd drive him there myself if I could find a place for him. We treat horses better than we are treating this little guy.

Tired and frustrated.....-- Annie SkaggsLexington, KY

December 31, 2008

Inpatient hospice may be an option.T. Buice M.D.102 Swatts Streetville, GA 30204ph: fax:

Subject: What sort of barbarians are we?To: "practiceimprovement1" < >Date: Tuesday, December 30, 2008, 9:46 PM

We can foster children, or puppies...why don't we have a fostering program for the elderly? Even if someone is willing to provide care to a non-family elder, the state does nothing but make it impossible.. .I have a little old 75 yo man in the hospital. Was homeless before he was admitted with extreme malnutrition, covered in sores, already missing one leg below the knee and four of the five remaining toes gone..He'd leave AMA except he can't walk. No nursing home will take him because he gets combative at times, throwing urinals or food or whatever.... He has SCC of the lung...not going to live forever. One of our colleagues is plotting to drop him off at a homeless shelter... the social worker says there is just no place to send him and he'll have to stay until he dies. The hospital can only release him to "an appropriate facility"...whatever that is.He is not that hard to deal with. Settles right down

if you talk to him as if he was a human being...lights up like a Christmas tree if you bring him cookies or buttermilk. Are there any states out there that do better caring for folks like this? I'd drive him there myself if I could find a place for him. We treat horses better than we are treating this little guy.Tired and frustrated.. ...-- Annie SkaggsLexington, KY

December 31, 2008

Oregon has a foster home program for the elderly, Which is great since mostly we have almost no rural nursing homes. The foster homes are licensed, but not rigid, and most take three to seven people. It is a way people can make money while living at home, so often they are run by people who have one disabled family member. We have placed a couple of paranoid medicare patients in them, and they tend to do well in a home setting, with most of their medicare money going to the foster home, and a little going for personal spending money. I remember one elder lady with Lewy Body disease who spent a lot of her time sleeping in a closet because she did not like beds. Nursing homes would not have tolerated it, but the foster home just put in a mattress.

Why don't you find a way to start that where you are? Got some nice patients with disabled spouses who are at their wit's ends for extra money to live on?

Joanne, Drain, Oregon.

Subject: What sort of barbarians are we?To: "practiceimprovement1" < >Date: Tuesday, December 30, 2008, 6:46 PM

We can foster children, or puppies...why don't we have a fostering program for the elderly? Even if someone is willing to provide care to a non-family elder, the state does nothing but make it impossible.. .I have a little old 75 yo man in the hospital. Was homeless before he was admitted with extreme malnutrition, covered in sores, already missing one leg below the knee and four of the five remaining toes gone..He'd leave AMA except he can't walk. No nursing home will take him because he gets combative at times, throwing urinals or food or whatever.... He has SCC of the lung...not going to live forever. One of our colleagues is plotting to drop him off at a homeless shelter... the social worker says there is just no place to send him and he'll have to stay until he dies. The hospital can only release him to "an appropriate facility"...whatever that is.He is not that hard to deal with. Settles right down

if you talk to him as if he was a human being...lights up like a Christmas tree if you bring him cookies or buttermilk. Are there any states out there that do better caring for folks like this? I'd drive him there myself if I could find a place for him. We treat horses better than we are treating this little guy.Tired and frustrated.. ...-- Annie SkaggsLexington, KY

December 31, 2008

sounds like a worthwhile mission!

Oregon has a foster home program for the elderly, Which is great since mostly we have almost no rural nursing homes. The foster homes are licensed, but not rigid, and most take three to seven people. It is a way people can make money while living at home, so often they are run by people who have one disabled family member. We have placed a couple of paranoid medicare patients in them, and they tend to do well in a home setting, with most of their medicare money going to the foster home, and a little going for personal spending money. I remember one elder lady with Lewy Body disease who spent a lot of her time sleeping in a closet because she did not like beds. Nursing homes would not have tolerated it, but the foster home just put in a mattress.

Why don't you find a way to start that where you are? Got some nice patients with disabled spouses who are at their wit's ends for extra money to live on?

Joanne, Drain, Oregon.

Subject: What sort of barbarians are we?

To: " practiceimprovement1 " < >Date: Tuesday, December 30, 2008, 6:46 PM

We can foster children, or puppies...why don't we have a fostering program for the elderly? Even if someone is willing to provide care to a non-family elder, the state does nothing but make it impossible.. .

I have a little old 75 yo man in the hospital. Was homeless before he was admitted with extreme malnutrition, covered in sores, already missing one leg below the knee and four of the five remaining toes gone..He'd leave AMA except he can't walk. No nursing home will take him because he gets combative at times, throwing urinals or food or whatever.... He has SCC of the lung...not going to live forever. One of our colleagues is plotting to drop him off at a homeless shelter... the social worker says there is just no place to send him and he'll have to stay until he dies. The hospital can only release him to " an appropriate facility " ...whatever that is.

He is not that hard to deal with. Settles right down

if you talk to him as if he was a human being...lights up like a Christmas tree if you bring him cookies or buttermilk. Are there any states out there that do better caring for folks like this? I'd drive him there myself if I could find a place for him. We treat horses better than we are treating this little guy.

Tired and frustrated.. ...-- Annie SkaggsLexington, KY

-- Annie SkaggsLexington, KY

December 31, 2008

Hi ,

I'm a hospice medical director in Oregon and struggle to find placement for

patients like this every week. care is extraordinarily helpful and I

can't imagine practicing without them, but there are still too many patients -

usually hospice medicare/medicaid, or palliative care patients like this man -

who fall through the cracks. Medicaid doesn't pay enough for most of our foster

care homes to accept these challenging cases. Usually we search for nursing

homes whose beds are suddenly full when they hear the report from the hospital.

It is a constant reminder to me how sad our system is. Rather than support

each human being no matter where they are in the socioeconomic ladder or life

stage, we expect our patients to meet certain insurance criteria or prognostic

criteria so we can give them the help they deserve. It's not surprising he is

angry at the staff that attend to him - it's a healthy reaction to the situation

our society has put him in.

The medicare hospice benefit is wonderful, but it is too limited. Why must

people be dying before they get extra care, why must doctors have to

prognosticate less than 6 months to help their patients get home care?

Inpatient hospice is extremely limited for financial and regulatory reasons.

Most hospices would not offer inpatient hospice

for this patient unless he has symptoms (ischemic leg pain for example) that

require aggressive, active symptom

management or RN monitoring. In his case, he would have to be in the last days

of life before it is offered. Hospices typically only reserve 1-2 inpatient

hospice beds for the lower reimbursed " respite "

rate - and so most hospices would not offer this patient inpatient hospice care.

Even on hospice in most communities, the approach would be the same futile

process

of lining up yet another nursing home. . . . meanwhile, what this patient needs

is a home, a dedicated caregiver, and a team to provide home care.

I share your frustration. I have some dreams for solutions - a revolution of

sorts - that requires our system to commit a cohesive team of health providers

and social workers to each patient through many life stages wherever they live,

rather than commit the patient to their insurance whims .

--

Stew Mones MD

Family Medicine

Hospice and Palliative Medicine

A Practice in Healing Modern Medicine

Eugene, Oregon

--------- What sort of barbarians are we?

To: " practiceimprovement1 " < >Date: Tuesday, December 30, 2008, 6:46 PM

We can foster children, or puppies...why don't we have a fostering program for the elderly? Even if someone is willing to provide care to a non-family elder, the state does nothing but make it impossible.. .

I have a little old 75 yo man in the hospital. Was homeless before he was admitted with extreme malnutrition, covered in sores, already missing one leg below the knee and four of the five remaining toes gone..He'd leave AMA except he can't walk. No nursing home will take him because he gets combative at times, throwing urinals or food or whatever.... He has SCC of the lung...not going to live forever. One of our colleagues is plotting to drop him off at a homeless shelter... the social worker says there is just no place to send him and he'll have to stay until he dies. The hospital can only release him to " an appropriate facility " ...whatever that is.

He is not that hard to deal with. Settles right down

if you talk to him as if he was a human being...lights up like a Christmas tree if you bring him cookies or buttermilk. Are there any states out there that do better caring for folks like this? I'd drive him there myself if I could find a place for him. We treat horses better than we are treating this little guy.

Tired and frustrated.. ...-- Annie SkaggsLexington, KY

-- Annie SkaggsLexington, KY

December 31, 2008

,

God bless you for your compassion and a kind heart.

At 07:46 PM 12/30/2008, you wrote:

We can foster children, or

puppies...why don't we have a fostering program for the elderly?

Even if someone is willing to provide care to a non-family elder, the

state does nothing but make it impossible...

I have a little old 75 yo man in the hospital. Was homeless before he was

admitted with extreme malnutrition, covered in sores, already missing one

leg below the knee and four of the five remaining toes gone..He'd leave

AMA except he can't walk. No nursing home will take him because he

gets combative at times, throwing urinals or food or whatever.... He has

SCC of the lung...not going to live forever. One of our colleagues

is plotting to drop him off at a homeless shelter... the social worker

says there is just no place to send him and he'll have to stay until he

dies. The hospital can only release him to " an appropriate

facility " ...whatever that is.

He is not that hard to deal with. Settles right down if you talk to

him as if he was a human being...lights up like a Christmas tree if you

bring him cookies or buttermilk. Are there any states out there

that do better caring for folks like this? I'd drive him there

myself if I could find a place for him. We treat horses better than

we are treating this little guy.

Tired and frustrated.....

--

Annie Skaggs

Lexington, KY

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12:06 PM

December 31, 2008

ing a puppy or dog/cat/kitten is easy and cute. If it poops or pees on the floor mop it up 1-2-3.

A child is often easier, not always for special needs kids. But "oh, the reward of watching htem grow", blah blah blah. I'm watching my kids grow and the mess in the family room is NOT rewarding.

The elderly usually need tremendous amounts of care - diapers (not difficult), wound care (home care nurse does it), cooking/feeding, entertaining for a few minutes a day, behavior issues (the hardest part). I personally find it easier to restrain a 3 year old rather than a 73 year old. Pretty much the guy you are describing is full time care. Thus the need for a fulltime "foster child". Plus Hospice to help.

If I were rich and had zillions of time, I'd start a program with your idea, Annie. If I didn't have little kids myself, I would take him. You ARE the best...

To: practiceimprovement1 < >Sent: Tuesday, December 30, 2008 9:46:19 PMSubject: What sort of barbarians are we?

We can foster children, or puppies...why don't we have a fostering program for the elderly? Even if someone is willing to provide care to a non-family elder, the state does nothing but make it impossible.. .I have a little old 75 yo man in the hospital. Was homeless before he was admitted with extreme malnutrition, covered in sores, already missing one leg below the knee and four of the five remaining toes gone..He'd leave AMA except he can't walk. No nursing home will take him because he gets combative at times, throwing urinals or food or whatever.... He has SCC of the lung...not going to live forever. One of our colleagues is plotting to drop him off at a homeless shelter... the social worker says there is just no place to send him and he'll have to stay until he dies. The hospital can only release him to "an appropriate facility"...whatever that is.He is not that hard to deal with. Settles right down

if you talk to him as if he was a human being...lights up like a Christmas tree if you bring him cookies or buttermilk. Are there any states out there that do better caring for folks like this? I'd drive him there myself if I could find a place for him. We treat horses better than we are treating this little guy.Tired and frustrated.. ...-- Annie SkaggsLexington, KY

December 31, 2008

Thank you for your compassion.

I googled " hospice lexington kentucky " and got this:

http://www.hospicebg.com/

With SCC, sounds like he'd be a candidate.

Earl , MD PhD, FABPMR, Fellow in Palliative Care,

Mount Sinai School of Medicine

I would rather that my spark should burn out

in a brilliant blaze than it should be stifled by dry-rot.

--Jack London

January 1, 2009

He will be a candidate when he decides to accept their help. So far, he is not in that much pain. But even if they get involved, that doesn't solve the problem of where he can live out his days in peace. Hospice can come to nursing homes, but they don't own any, at least not here. So far he has to stay in the hospital unless someone will take him home with them...the only one even remotely looking like a candidate for THAT is yours truly and that would not be very practical. Nobody is home during the day...he needs someone around. There is a complex of apartments near here with a lot of handicapped and mentally ill residents; I'm working on getting them to accept him. Wish me luck!

Thank you for your compassion.

I googled " hospice lexington kentucky " and got this:

http://www.hospicebg.com/

With SCC, sounds like he'd be a candidate.

Earl , MD PhD, FABPMR, Fellow in Palliative Care,

Mount Sinai School of Medicine

I would rather that my spark should burn out

in a brilliant blaze than it should be stifled by dry-rot.

--Jack London

-- Annie SkaggsLexington, KY

January 1, 2009

probably a stupid question but- does he have any money? own a home to get a reverse mortgage? then he stays at his home and someone comes in?Or rents/shares his place with reduced to litte rent for teh caretaker who could be a young woman maybe with a kid or two?

There are many people in society who could benefor from each other but no way to connect them.

He will be a candidate when he decides to accept their help. So far, he is not in that much pain. But even if they get involved, that doesn't solve the problem of where he can live out his days in peace. Hospice can come to nursing homes, but they don't own any, at least not here. So far he has to stay in the hospital unless someone will take him home with them...the only one even remotely looking like a candidate for THAT is yours truly and that would not be very practical. Nobody is home during the day...he needs someone around. There is a complex of apartments near here with a lot of handicapped and mentally ill residents; I'm working on getting them to accept him. Wish me luck!

Thank you for your compassion.

I googled " hospice lexington kentucky " and got this:

http://www.hospicebg.com/

With SCC, sounds like he'd be a candidate.

Earl , MD PhD, FABPMR, Fellow in Palliative Care,

Mount Sinai School of Medicine

I would rather that my spark should burn out

in a brilliant blaze than it should be stifled by dry-rot.

--Jack London

-- Annie SkaggsLexington, KY

-- If you are a patient please allow up to 24 hours for a reply by email/please note the new email address.Remember that e-mail may not be entirely secure/ MD

ph fax

January 1, 2009

If he does, he forgot where it is a long time ago...As best we can tell he has been homeless or in jail for most of the last 3-5 years. He seems to have no possessions beyond the clothes he came in with.

probably a stupid question but- does he have any money? own a home to get a reverse mortgage? then he stays at his home and someone comes in?Or rents/shares his place with reduced to litte rent for teh caretaker who could be a young woman maybe with a kid or two?

There are many people in society who could benefor from each other but no way to connect them.

He will be a candidate when he decides to accept their help. So far, he is not in that much pain. But even if they get involved, that doesn't solve the problem of where he can live out his days in peace. Hospice can come to nursing homes, but they don't own any, at least not here. So far he has to stay in the hospital unless someone will take him home with them...the only one even remotely looking like a candidate for THAT is yours truly and that would not be very practical. Nobody is home during the day...he needs someone around. There is a complex of apartments near here with a lot of handicapped and mentally ill residents; I'm working on getting them to accept him. Wish me luck!

Thank you for your compassion.

I googled " hospice lexington kentucky " and got this:

http://www.hospicebg.com/

With SCC, sounds like he'd be a candidate.

Earl , MD PhD, FABPMR, Fellow in Palliative Care,

Mount Sinai School of Medicine

I would rather that my spark should burn out

in a brilliant blaze than it should be stifled by dry-rot.

--Jack London

-- Annie SkaggsLexington, KY

-- If you are a patient please allow up to 24 hours for a reply by email/please note the new email address.Remember that e-mail may not be entirely secure/

MD

ph fax

-- Annie SkaggsLexington, KY

January 1, 2009

Would he be better off if he committed a crime and were imprisoned??

> If he does, he forgot where it is a long time ago...As best we can tell he

> has been homeless or in jail for most of the last 3-5 years. He seems to

> have no possessions beyond the clothes he came in with.

>

> On Thu, Jan 1, 2009 at 9:39 AM,

> wrote:

>>

>> probably a stupid question but- does he have any money? own a home to get

>> a reverse mortgage? then he stays at his home and someone comes in?

>> Or rents/shares his place with reduced to litte rent for teh caretaker who

>> could be a young woman maybe with a kid or two?

>>

>> There are many people in society who could benefor from each other but no

>> way to connect them.

>>

>> On Wed, Dec 31, 2008 at 10:28 PM, Skaggs

>> wrote:

>>>

>>> He will be a candidate when he decides to accept their help. So far, he

>>> is not in that much pain. But even if they get involved, that doesn't solve

>>> the problem of where he can live out his days in peace. Hospice can come to

>>> nursing homes, but they don't own any, at least not here. So far he has to

>>> stay in the hospital unless someone will take him home with them...the only

>>> one even remotely looking like a candidate for THAT is yours truly and that

>>> would not be very practical. Nobody is home during the day...he needs

>>> someone around. There is a complex of apartments near here with a lot of

>>> handicapped and mentally ill residents; I'm working on getting them to

>>> accept him. Wish me luck!

>>>

>>>>

>>>> Thank you for your compassion.

>>>>

>>>> I googled " hospice lexington kentucky " and got this:

>>>>

>>>> http://www.hospicebg.com/

>>>>

>>>> With SCC, sounds like he'd be a candidate.

>>>>

>>>> Earl , MD PhD, FABPMR, Fellow in Palliative Care,

>>>> Mount Sinai School of Medicine

>>>>

>>>> I would rather that my spark should burn out

>>>> in a brilliant blaze than it should be stifled by dry-rot.

>>>> --Jack London

>>>>

>>>

>>> --

>>> Annie Skaggs

>>> Lexington, KY

>>

>> --

>> If you are a patient please allow up to 24 hours for a reply by email/

>> please note the new email address.

>> Remember that e-mail may not be entirely secure/

>> MD

>>

>> ph fax

>>

>

> --

> Annie Skaggs

> Lexington, KY

>

--

Graham Chiu

http://www.synapsedirect.com

Synapse - the use from anywhere EMR.

January 1, 2009

ah Graham. He might be...