when society falls behind: future changes in payment for nursing homes

we had a minor scare at work this week, but it truly could become a large crisis in the future.

on wednesday, a nursing home representative came in to talk to my co-social worker, terry, about some new rules in medicaid/medicare payments for convalescent stays. a convalescent stay, for us, means finding an available bed in a suitable nursing facility (NF) for a patient ready for discharge (which often means they are no longer suicidal so insurance is giving a payment limit), but are not stabalized enough on medications to be returned home.

the new rules would insist on a medical diagnosis, and state that a psychiatric diagnosis will not meet criteria for a short term convalescent stay (30 days or less), which is truly all that alot of psych patients need

luckily, it turns out that while it is true that this is what jcar (ithink it was jcar at least, i could be wrong though, so if you are truly interested, you may want to do research, and i will post it if i find anything to the contrary) wanted to do, they were not able to get it in place this year. jcar, by the way, is the "joint commision on (get this) administrative rules".

this makes me furious. mental illness is mostly a BRAIN illness. schizophrenia can be seen on mri's. we know that atrophy (shrinkage) occurs in the brain's of people who suffer from schizophrenia. we know it is a chronic illness. unfortunately for my patients, the symptoms are psychiatric, and we as a society still have a huge stigma around mental illness. it is no different then having cancer or anemia, down syndrome, MS..... filling out the transfer forms at work (which need to be done to allow for payment during a convalescent stay), i have no problem saying that my clients need assists in some of their daily stuff. i can think of one man who is perfectly able to get himself dressed...so long as someone says "you need to get dressed" he is also able to do his own laundry, as long as someone tells him what to do (and he definitly needs someone to remind him to use soap).

and except for PTSD (which is entirely externally based), all mental illness has an organic MEDICAL aspect, an imbalance of chemicals of some sort. and to better define my terms, mental illness is not going to therapy, it is not about the "walking wounded" at all (though they do give drugs to anyone who wants to go in that direction pretty much, and even encourage it sometimes even though there are very obvious psychosocial issues). it is about continual struggle to learn how to incorporate this aspect of yourself into your life, as any chronic illness is.

and then, this morning, bush wants to put another 440 billion in the pentagon and then make more cuts to medicare. we are not only losing the war, we are loosing our security despite going to war, which was meant to make us feel more secure....right?