Herb is my best friend, 83, a humor writer who’s had slow-moving Parkinsons for ten years. When I had breast, then ovarian, cancer over thirty years ago, he was at the hospital. After the heavy chemo treatments, he moved into my place and cared for me.

Then, this March, it’s my turn: Over a few weeks, Herb becomes so weak he can barely stand and I drag him to the emergency room at N.Y.U.-Langone.

The rehab/nursing home place has a shiny new gym, support staff who struggle with English, and an impatient social worker. I meet her when she comes to Herb’s room to discuss his “care plan”, accompanied by a rep from a private home health aide company I shall call, Gotcha, Granny!

Why do Herb’s social worker and the Gotcha Granny rep arrive together? Why is Gotcha Granny, which charges $36 an hour for home aides, the only home aide company recommended by Herb’s rehab place? Why, when I later ask the social worker about other home aide companies does she tell me Herb’s rehab place has used Gotcha Granny for years and nobody has had any problems? This are some of the many questions in the great American healthcare system for which I do not have an answer.

Listen up, caretakers, for I am about to reveal a magic phrase that will never fail to buy you time when someone you love is about to be kicked out of a rehab facility: You call the social worker and yell, I am the Medical POA and you are NEVER to have a conversation about discharge without me!

Oops, sorry, that’s not it. And by the way, talking truth to power to the social worker who gets a vote on whether you stay or go in a skilled nursing facility: Really bad idea.

Here is the magic phrase: “cannot safely perform the activities of daily living at his home”.  Observe the way I employ it in the e-mail I dispatch to the director of Herb’s Nursing Home:

“Herb lives alone. He cannot get dressed by himself. He cannot go to the bathroom by himself.  He cannot safely perform the activities of daily living at his home, nor can he afford an aide 24/7 to help. He has Parkinson’s as well as a still undiagnosed blood disease, discharging him at the proposed time would endanger his life.”

Two hours later, I get a call from the social worker, who seems to dislike me as much as I dislike her, that Herb’s stay has been extended nine days, to the following Thursday. If I want to appeal it to Medicare, I won’t be able to do so until the Monday before. Then, feeling generous, the social worker amends it to Friday.

Read more on Substack.

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