Appealing a doctor's decision to discharge. Any advice?

It's a bit of a cheat, but I have heard tell of internet companies who will make edible transfers of photographs (on rice paper, presumably) - would that do the trick? Then the bakery could just give you a nice flat airfield to land it on!

I'm so glad you're making progress. The dire communications gremlin strikes again, what a hideous couple of days it managed to create for you. Chocolatey hugs

CM, Thanks - I'll take chocolately hugs any time!

Checking on options for the B-29 cake....wish I'd thought of it sooner.

I do like the idea of an airfield on the cake though.

The airfield and the B-29 on his cake sounds great. Thanks too from you and Country mouse - the cake brings a smile to me. I have a friend who does copyrighted art. I'll ask her if she thinks extending it to a BD cake is a little far reaching. This is new to me too. I'm glad my perspective helped you in this process of just trying to sort through it all.

GA, wish I had seen this sooner. Whan L was hospitalized with MRSA, in bed for two weeks, they thought they would discharge home. NOT! I requested an evaluation by PT, told them to even get in the house he had to be able to walk up, one step at a time, separated by sidewalk or landing in between, to even get in the house. PT brought in a step, L was not able to step up on it. Think of an activity, going to the bathroom, that he has to be able to do by himself safely. Have PT evaluate him. L ended up in rehab for three weeks to build up his strength.

I don't think I can pull together the bomber cake, so I've decided to work on that for a special occasion after Dad comes home from the hospital. I do have a B-52 pencil sharpener which I could use on a vanilla airfield with chocolate ribbons for the line markers.

A cousin's nephew was a submariner cook; I may contact him to see if he has any military patterns. Guess I'll have to learn how to decorate cakes and be forced to eat all those tempting samples and experiments.

On the issue of the discharge, it's now been resolved, but in retrospect, I am so glad I replaced the PCP with a hospitalist. It was shocking though how unprofessional the PCP became in his comments about other medical specialities.

Garden, sent JeanneGibbs a question about your cake.

So glad there was not a premature discharge!

About the cake ... that is a new one for me, too! I don't think the design of a B-29 is "copyrighted" LOL. Mickey Mouse is copyrighted/trademarked/whatever. So is Disney's version of Cinderella, and Mulan, etc. Bugs Bunny? Yes, he is off limits on a commercial cake, unless the bakery has designs approved by Loony Tunes.

But a B-29? Who is going to sue? Boeing? I admire that bakery's integrity, but I think they don't have a good grasp of intellectual property laws. I guess their motto must be "better safe than sorry."

Getting a bakery to do an airfield and placing a model plane or a plane-style pencil sharpener or a toy, etc. is a good alternative. I've known many home-based cake decorators who will do a lovely beach scene with seashells and big rock and then the mother takes it home and places a Little Mermaid doll on the big rock. I once did a lovely park scene, and placed a hinged porcelain box of Madeline on it.

You may or may not be able to find someone to print a B-29 on rice or frosting paper for a cake, depending on the picture. No one wants to get into trouble with copyright infringement! But there must be thousands of photos of that plane that are in public domain and you can use Bing to find them. Just limit your search to "public domain" on the license drop-down list.

(I once took an invitation I had designed into a nice copy place for many copies. The clerk told me he could not put that photo on the invitation, because of copyright concern. I asked for the manager. I said, "This is a picture of MY son. I took it with MY camera, in a public place. I OWN the copyright. And I want copies!" I got them.)

You can't blame businesses for being careful, but there are ways to get what you want on a cake, without necessarily becoming a cake decorator. :)

Glad things are going in the right direction, GA. Sending you chocolatey hugs!

I'm going into a chocolate stupor!

Jeanne, that sounds like great advice about the cake! Is a bomber cake chocolate? That would be my only concern.

GA, hoping you are coping ok today, and that there are improvements for your Dad.

Everyone, thanks for the good wishes. I thought we were over the hump, but now there are some more issues as well as potential decisions with which I don't agree. I'm still doing some research to prepare for tomorrow, but hopefully I can steer them in the correct direction so there isn't a confrontation or a decision that's devastating.

I thought this was a simple pneumonia but it's gotten complicated.

I'm going to need all the chocolate energy you can send!

Oh, GA, I'm sorry things aren't going well.

Re pleural effusions, my mom has had her chest tapped several times. Last time they did it, she had some terrible breathing difficulties and the ER personnel wanted to intubate. We said no (she's got a dnr/dni), so they used a bi-pap and that worked.

Babalou, thanks for that information. Dad's pulmonary doctor yesterday said she'll try a diuretic, then a chest tap (as I sucked in my breath remembering how difficult and painfujl this was for my sister), so I need to find out more about what the hospitalist has in mind.

Were your mother's breathing difficulties specifically from the chest tap, or complications from something else? Do you know how it caused the difficulties?

If the former, I'll be on the lookout for that so it won't be unexpected, but, gee, they've already got him up to 5 liters and if he has more respiratory difficulties, they might also talk about intubating.

Thanks for the heads up. Now I can be prepared for what might happen tomorrow. And I'll ask for a bi-pap to be tried first. They've been using a vent mask; maybe they could use that.

The pulmonary doctor said yesterday that the pleural effusion is what's necessitating the high oxygen level, so depending on whether they administered Lasix or Bumex today, there should have been some change.

My nurse relative told me Bumex is 40x stronger than Lasix, so the fluid should have been rushing like Niagara to leave his body if that's what they gave him this morning, although yesterday we discussed use of Lasix.

I'm trying to contact the oxygen supplier to see if they even have portable concentrators that we could use if the need is 5.0 or above - otherwise, I'll have the back seat of my car filled with oxygen tanks!

I''m really starting to get worried now.

Thanks for your advice and comforting words.

GA, I'm glad that I hit the correct button while guessing what had you worried. What happened to mom last year was this; she'd had pneumonia and that had been treated with antibiotics. She fell at the NH, so they transported her to the hospital . After they checked out her hips, pelvis, they noticed a fairly large increase in her previously stable pleural effusion. She been tapped several times before this, so my brother said sure. They started drawing fluid and she suddenly started gasping for air (I wasn't there, I'm recounting what I remember the doctor and my brother telling me later, so forgive an inaccurate info). They wanted to intubate etc (see previous post). What they determined afterwards was that in drawing off the fluid, mom's lung, previously somewhat compressed by the fluid, was able to expand. In doing so, a small pocket of bacteria ( from the pneumonia) "bloomed" and set her into septic shock. The bi-pap and 2 different intravenous antibiotics saved her. 10 days in the hospital. The she went back to rehab/nh, but with contracture in both legs, has very limited ability to walk now.

We were instructed to bring her back to the pulmonologist for followup and a possible outpatient tap (really?), but when I called actual doctor, who is the head of the pulmonology service at the hospital, he said "stop poking holes in your mom. Let this progress at it's own rate and make sure to sign her up for hospice when the time comes. They'll be able to use morphine to ease her breathing and to keep her from feeling like she's drowning". (She's got congestive heart failure). I know that we're losing her; I just don't want it to be awful for her. I hope some of this helps.

My mother was very firm about not ever being intubated, and we intend to honor that, unless it's a temporary situation like surgery. When she was on the bi-pap, she looked so panicked, we just kept telling her that it wasn't a tube, just a "breathing thing " just like Mike ( my husband has a c-pap) has"

Babalou, I've taken notes on your last post. It's really helpful. I understand now how the respiratory crisis happened. It sounds similar in action, not necessarily in specific organs, to when my sister had a bacterial shower after a chemo session. When the line was flushed after the infusion, she shortly thereafter began shaking uncontrollably.

It was explained by one of the chemo nurses that even a small amount of bacteria that can get in the system during the flush rushes through the body and causes the reaction.

Those bacteria are bad bugs!

I can imagine the discomfort of the bi-pap; my father was on a vent mask and he hated it. I remember when I wore a respirator while doing some sanding and then painting, and I felt so confined, so trapped, and almost disoriented.

Thanks so much for sharing your experience. If Dad gets a chest tap and something happens very quickly in his breathing, I'll understand and not panic.

GA, so glad that Babalou can be there for you, there is always someone out there to answer the most complicated questions when they arise. Good for you, Babalou!

GA, I want to add that by the time I got to the hospital at midnight, the hospitalist came in to talk to talk to us and told us that they didn't think mom would survive the night. So, don't despair if it comes to that. Prediction in these situations is always tricky, but I was glad to be forewarned that we might be looking at the end. Good luck today; I'll be thinking about you and your dad.

My mom went thru the same. You need to fire the doctor before he writes the orders and then a new doctor will step in.

Bet the hospital's bottom dollar that insurance is pulling the strings of said doctor.

I have been through this before. The appeal process is frustrating. The hospitalist will discharge home if they feel the outpatient doc can handle the remainder of the care. The appeal sucks, because if it comes out not in your favor, then you have 24 hours to get your loved one out of the hospital before they start charging you for the hospital stay. The care at home sucks, because the insurance will only cover a certain amount even if a person needs more. They sent my dad home so deconditioned he couldn't even lift his arms, and still with a fever. They always send a patient home but don't start services until the next day, and even then, the next day a nurse shows up to do an "assessment", and services don't start until she gets approval from the insurance company. They set up care 2-3 times per week, and when I said what am I supposed to do on the other days her response was "well they never give more".

It's my experience that "time" allowamce is what it is- 6 weeks with another 6 weeks per approval of doctor in which doctor must show 1. Patient is benefiting AND improving with care. After that 12 week total is exhausted, nursing home is the next allowable but we all know nursing homes paid by medicare or medical have income restrictions- both monthly and assets. If dad isiddle imcome which isnt much more than $1200 per month, we caregivers are stuck. After medicare refused continued treatment of mom, i put her in a way expensive facility for 6 months until she ate through have her savings. Then i rented a small home for her. Then i discovered that because her income is slightly too high- there is zero assistance. No in home anything, no respite care for me, and i cant afford to pay anyone. So i have accepted my life. My husband and i now live apart- albeit only 2 blocks but at least when other family occasionally offers help- i can go home without mom. Its not ideal but all this new Obama Care and the 2030Agenda IS the issue. I spoke with 2 in the healthcare profession and these U.N. Laws seem to NOT CARE ABOUT THE ELDERLY OR THE CAREGIVER. I was shocked to discover last week the U.S. was put under the U.N. and that our healthcare and educational system was alsi very slyly placed under the U.N. thus why Federal Appeals go no where - the Federal employees arent even aware - yet - there is is little to no employees because as the appeals go up the chain- they go out of the nation and then, stop dead at the U.N.

No, but thinking back now I probably should have. They were kicking my mother out of the NH saying to her "you're too well to stay here." Less than 48 hours later, she suffered a stroke there and deceased several days later at the hospital.

Johnny53, you raise some interesting points. If the patient is discharged, with instructions to see a specific doctor (who may also have been the doctor "managing" the in-hospital care), he not only has a follow-up opportunity but can schedule periodic follow-ups (as doctors are wont to do), so he gets some additional revenue from Medicare.

If he or she wasn't involved in the in-hospital care, he/she could still get a new patient if the hospital refers follow-up care to that doctor. I experienced that once but one visit to the referred to follow-up doctor convinced me that she was a waste of time. But she did make money from my visit!

Have you experienced so-called follow-ups by ACOs? I did some research on these when they first started calling following hospital discharge and learned some interesting facts about physician involvement with these for profit organizations. So they too do benefit when an ACO follows up.

Sometimes I think of a medical/pharmaceutical/ or medical/hospital/ACO/referral complex, somewhat akin to the military/industrial complex.

I might do some research to see if I can find out who determines what qualifies when a patient can be released....i.e., is it the standard of care in the area, by hospital, by specific illness and/or combinations thereof, by certain vital standards, by specific medical specialities, or by those anonymous and unknown "experts" employed by Medicare?

Our home care experience has been similar to yours: next day start, first time assessment (which I can understand) and some monitoring, but limited home care b/c when certain standards are met, home care stops.

First day home is rough.

I suppose it's good that the patient progresses on home care, but it also means that family or the patient need to continue PT or monitoring on their own, which isn't always feasible.

I'm sorry to learn of your father's unfortunate experience, and hope that eventually he was able to recover. Is he doing better now?

Nana, I'm sorry but I'm just not following your post. Are you referring to something other than a hospital stay? I'm confused about the 6 weeks issues as well as the U.N. Are you referring to the United Nations? I must be missing something here.

Llama, I'm sorry that your mother's death was under what probably was frustrating and trying circumstances.

Just a note that I see there are many responses which I haven't answered yet. Please don't think I'm not appreciative; I'm just taking a few at a time but appreciate the time you've taken to offer suggestions.

Dad is home, and in the short and long run it's probably for the better as once he reached a certain level, the exit doors opened widely and hands began pushing him out. More on that later.

Nanatonanny, please note there are some excellent benefits for us seniors under the Affordable Care Act [Obamacare] such as before 2011 seniors on Medicare faced paying for preventive cancer screenings and cholesterol checks out of their own pockets. Now, these benefits are offered free of charge. Plus, there is now a free Annual Wellness Visit to your doctor, thus seniors who felt they couldn't afford to visit their primary doctor at least once a year can now do so. And the closing of the infamous donut hole which will be completed in 5 years.

Let's not forget that health insurance companies can no longer cancel your policies because you have become too expensive, or deny you coverage because of a pre-existing condition. Some people are born with pre-existing conditions and had difficulty finding health insurance.

The list goes on and on.

Now I remember some of the legislative history of DME cutbacks: Part D. Funds needed to be made available for Part D, and from what I was told by a DME supplier, the cuts were taken from DME allocations.

Interesting social re-allocation in terms of diminishing funds for one large inclusive category to fund another large by highly defined category, which by the way doesn't benefit us at all because we take few meds.

But it's a method of medical/social engineering.

Too many posts to read and then one about cakes :). I'm surprised rehab isn't recommended if he can't walk. Second, if u get to rehab have him evaluated for longterm nursing if u feel needed. Much easier to go from rehab to nh. Medicare only pays the first 20 days and after that partial up to a 100. After that would be private pay which would be a lot of money.

Just an update; there are still a lot of questions and suggestions raised that I want to address individually, perhaps in the hope that it might help someone else. At this point I'm not even sure if I updated this post after the PCP was replaced by a hospitalist, who apparently wasn't very happy to participate even though he agreed to. He wasn't particularly pleasant with my father.

There was no discussion of discharge until I was ready to leave the hospital after visiting on Friday. Just as I was in fact leaving, the nurse of the day came in and said she's ready to discharge Dad. No prior notice, no one had the courtesy to call me. So of course I didn't bring anything with me for the discharge, specifically the oxygen tanks.

To say I was disgusted if not more than that is an understatement. I was MAD! Before packing up, I thought about options:

1. To refuse to take him home would have really hurt Dad's feelings and he would have felt abandoned. But he would have called a friend who would have picked him up. So that really wouldn't have accomplished anything.

2. I did refuse to sign the discharge papers. The nurse advised me that by giving me a copy, I was agreeing to their terms. I advised her I'd never seen such a provision, and that the electronic signature which she inferred was created was NEVER authorized by me; I never signed any such consent. She wasn't prepared for that and moved away from that issue, stating that the discharge papers didn't have to be signed anyway.

I actually felt kind of bad for her b/c it was as if she was the messenger with the bad news while the doctor just wrote the order and left everything to someone else - which is as it should be it the "someone elses" know that the discharge was ordered. They're not mind readers.

3. There were some medical issues that I've addressed outside of the hospital circle, and the 2 issues that remain will be raised this week in doctor appointments.

4. One issue that was especially ridiculous was the irresponsibility of whoever was in charge of discharge notifications. But I did glance at the assignment board and saw that the nurses apparently have a maximum load of patients, and it may be that the discharge planner's patient load is the same, although in my experience they plan discharge right from the beginning so there wasn't that much to be done.

5. The scripts for DME supplies were given to me, not faxed as they should have been to the DME suppliers. That changed when I complained, and the discharge planner made arrangements to get one aspect of the supplies from the hospital's own supplier.

6. There obviously was no way to provide oxygen on the way home, I refused to go home, get a tank and return, so a tank had to be borrowed, again from the hospital's DME supplier. But I'm responsible for taking it back. I'm thinking of submitting an invoice to them for time and mileage charges. Seriously. That screw-up was a major one.

7. The hospitalist changed a med regime that's been in place and successful for 11 years, w/o any explanation. I'll address that with our regular doctors, but I thought it was idiotic and irresponsible to discontinue a cardiac med that's been determined to be necessary by the cardiologist (who wasn't consulted).

8. The bigger reluctance though, was whether Dad was ready. However, he hadn't been getting any support for several hours except from the cafeteria and wandering staff who stopped by to say hello (that was a nice gesture). All other services had been D'C'ed. I thought that odd, but never realized it until advised the discharge had been signed that morning, but nothing was done about it until the afternoon. Again, the nurse apparently had a full load of patients, so she may have had patients with more immediate needs.

9. The best answer was provided though after Dad was home, warm and comfortable. By Saturday night he was so much better, with so much improvement, that it was in fact good that he was discharged.

10. I intend to address the screw-up issues with the hospital Admin and the Customer Service follow-up rep, from the perspective that:

(a) the hospital has been providing good service and care for years

(b) perhaps there are some issues of which Admins are unaware that should be addressed to continue that level of care

(c) I'd prefer to continue going there than go to another hospital but I will switch if necessary

(d) so I'm making recommendations and suggestions, with the request they have the courtesy to advise me if these changes are implemented so I can decide whether or not to find another hospital and

(e) I'd hope that they could resolve this at hospital level but may just contact the corporate parent for advice on how to handle my concerns.

That should be like involving an unwanted in law, so I'm hoping they jump on the suggestions.

Given that this hospital is now for profit, I'm hoping they also see the $$$$ flying away toward another hospital and move on my suggestions.