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Post by the light works on Oct 10, 2018 4:54:33 GMT
any time a loved one is terminally ill, and particularly if they are also more or less incapacitated, a person always gets stuck with the question of when to say when. this is the reason why Oregon requires medical insurance (or medicaid) to pay for end of life counseling, so the person can lay down guidelines for loved ones on when enough is enough. case in point, I have a relative who will ultimately lose the ability to swallow. there is already a directive in place that there will be no feeding tube.
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Post by OziRiS on Oct 10, 2018 6:55:08 GMT
The smart thing to do is have the discussion long before it's ever needed, while you're still healthy, so your loved ones have no doubt about what you would want them to do when the day finally comes. The last thing they need is to carry around the doubt (and possibly guilt) of whether or not they did the right thing for the rest of their lives.
I'm only 34 and have no known medical issues that could potentially cost me my life, but the most important people around me know exactly when to say when on my behalf if something ever happens to me that requires them to make those decisions. They also know how I want my remains disposed of when I'm gone, so there's no discussion about anything and nothing to feel guilty about afterwards.
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Post by rmc on Oct 10, 2018 12:35:20 GMT
I think the problem here is that the hospital is looking at it like he is more-or-less immediately terminal, and my brother and I recognize that our father is tougher than they apparently realize.
I know if he is actually terminal at this point my brother has a DNR worked out for him already.
Trouble is the hospital is all, "yes, let's go that way. Better quality for him.". Meanwhile, we are like, "hold on. He's getting better."
Apparent disagreement on if this is really it, basically. And, it also appears the hospital wants it to be the end now, mainly so it is more easy for the HOSPITAL rather than my father. All my father has to do for now is put up with the BiPAP, being turned every so often to prevent sores since he's partially paralyzed, and put up with the thickener for his drink. Oh, and continue to recover from pneumonia, which he IS doing.
Otherwise, yes. There is an understood procedure in place when his time comes.
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Post by the light works on Oct 10, 2018 13:45:43 GMT
I think the problem here is that the hospital is looking at it like he is more-or-less immediately terminal, and my brother and I recognize that our father is tougher than they apparently realize. I know if he is actually terminal at this point my brother has a DNR worked out for him already. Trouble is the hospital is all, "yes, let's go that way. Better quality for him.". Meanwhile, we are like, "hold on. He's getting better." Apparent disagreement on if this is really it, basically. And, it also appears the hospital wants it to be the end now, mainly so it is more easy for the HOSPITAL rather than my father. All my father has to do for now is put up with the BiPAP, being turned every so often to prevent sores since he's partially paralyzed, and put up with the thickener for his drink. Oh, and continue to recover from pneumonia, which he IS doing. Otherwise, yes. There is an understood procedure in place when his time comes. hospitals' programming is based on getting the patient reduced to the minimum level of care and out of the hospital as soon as they possibly can, because medical insurance pushes for that and threatens to withhold payment for unnecessary care. |
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Post by rmc on Oct 10, 2018 15:15:36 GMT
Just so it remains 'hospital programming' and not some rogue individual's obsession with making the situation easier for themselves. Not hooking up the BiPAP when they really should would be one way to wear him down rather conveniently, while probably garnering no objection from my father too, by the way. And, it could also be conveniently explained away later as a mere oversight. You know, that sort of carp.
Or, just as bad: honestly forgetting to hook him up when they need to.
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Post by OziRiS on Oct 10, 2018 16:18:50 GMT
hospitals' programming is based on getting the patient reduced to the minimum level of care and out of the hospital as soon as they possibly can, because medical insurance pushes for that and threatens to withhold payment for unnecessary care. If that's what they're trying to do here, it seems they're either pretty bad at assessing when the patient is ready for the minimum level of care, unintentionally extending his stay through simple incompetence, or someone has come to the conclusion that the minimum level of care at this point should be purely palliative. Either way, it doesn't sound like they're doing a very good job pleasing the insurance company. From what I'm hearing, the best strategy towards that goal at the moment would actually be to help get him used to the BiPAP and water thickening agent, cure that pneumonia and send him back to the nursing home. It honestly sounds to me like that approach would take substantially less time and effort than either of the two alternatives, because he isn't getting better without the machine and he doesn't seem to be in a hurry to die eihter. |
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Post by the light works on Oct 11, 2018 2:06:46 GMT
hospitals' programming is based on getting the patient reduced to the minimum level of care and out of the hospital as soon as they possibly can, because medical insurance pushes for that and threatens to withhold payment for unnecessary care. If that's what they're trying to do here, it seems they're either pretty bad at assessing when the patient is ready for the minimum level of care, unintentionally extending his stay through simple incompetence, or someone has come to the conclusion that the minimum level of care at this point should be purely palliative. Either way, it doesn't sound like they're doing a very good job pleasing the insurance company. From what I'm hearing, the best strategy towards that goal at the moment would actually be to help get him used to the BiPAP and water thickening agent, cure that pneumonia and send him back to the nursing home. It honestly sounds to me like that approach would take substantially less time and effort than either of the two alternatives, because he isn't getting better without the machine and he doesn't seem to be in a hurry to die eihter. you're missing that this is driven by accountants, not people who have any understanding of how infirmity works. |
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Post by rmc on Oct 11, 2018 13:07:35 GMT
If that's what they're trying to do here, it seems they're either pretty bad at assessing when the patient is ready for the minimum level of care, unintentionally extending his stay through simple incompetence, or someone has come to the conclusion that the minimum level of care at this point should be purely palliative. Either way, it doesn't sound like they're doing a very good job pleasing the insurance company. From what I'm hearing, the best strategy towards that goal at the moment would actually be to help get him used to the BiPAP and water thickening agent, cure that pneumonia and send him back to the nursing home. It honestly sounds to me like that approach would take substantially less time and effort than either of the two alternatives, because he isn't getting better without the machine and he doesn't seem to be in a hurry to die eihter. you're missing that this is driven by accountants, not people who have any understanding of how infirmity works. The light works, as to accountants driving hospital policy, this could be true I suppose. But, what I seem to be witnessing looks to be driven more by incompetence on some sort of individual level, or a particular individual's need to do less bothersome chores. In other words, an individual who ends up circumventing the policy you are trying to describe. |
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Post by rmc on Oct 11, 2018 13:24:14 GMT
Need to clarify my statement made over ten minutes ago to the light works:
When starting this thread it was about moving him out of the only place where they had an operational BiPAP (the hospital's ICU), thereby causing his health to fail needlessly.
Now that he's been in the ICU steadily, it has started to become more about the issue where someone seems to forget to put that available BiPAP on him when he needs it.
So the first situation would have involved hospital policy or protocol, whereas the more recent situation seems to involve carelessness.
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Post by the light works on Oct 11, 2018 14:12:02 GMT
you're missing that this is driven by accountants, not people who have any understanding of how infirmity works. The light works, as to accountants driving hospital policy, this could be true I suppose. But, what I seem to be witnessing looks to be driven more by incompetence on some sort of individual level, or a particular individual's need to do less bothersome chores. In other words, an individual who ends up circumventing the policy you are trying to describe. I was referring to moving him out of the ICU as soon as his best condition warranted it instead of considering that his best condition was achieved BECAUSE of the care only available in the ICU. the latter appears to be people operating in drone mode. I had a complaint on a medical call one night - it was the second call on the same patient that night. one of the medics (coincidentally we had the same car for both calls) pulled me aside and mentioned that the previous time, the patient had been out the front door before they could even get the ambulance ready for another patient. |
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Post by rmc on Oct 11, 2018 15:20:21 GMT
I only have US Army medic training to go by (meaning not too many nearby bean counters to deal with directly), but there seems to be an overall driving force keeping some sort of high-level balance in order in many medical environments such that the situation essentially ends up favoring the hospital and its workload over any long-term, seriously ill patient. For instance, when in the field and when a medical unit is overwhelmed, a medic may need to black tag an individual even though he's not quite dead yet, in favor of attending others more likely to survive.
Therefore, whether by bean-counter or not, the end-game plan seems to be to begin to turn a cold shoulder at a certain point: as their resources are apparently better served elsewhere. Meanwhile, my brother and I, as well as my father too for that matter, seem to have a different view and expectation.
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Post by the light works on Oct 11, 2018 16:00:16 GMT
I only have US Army medic training to go by (meaning not too many nearby bean counters to deal with directly), but there seems to be an overall driving force keeping some sort of high-level balance in order in many medical environments such that the situation essentially ends up favoring the hospital and its workload over any long-term, seriously ill patient. For instance, when in the field and when a medical unit is overwhelmed, a medic may need to black tag an individual even though he's not quite dead yet, in favor of attending others more likely to survive. Therefore, whether by bean-counter or not, the end-game plan seems to be to begin to turn a cold shoulder at a certain point: as their resources are apparently better served elsewhere. Meanwhile, my brother and I, as well as my father too for that matter, seem to have a different view and expectation. on the civilian side, we prioritize the reds, and won't black tag until they stop breathing. - and positional breathing doesn't count as not breathing. |
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