My “why” for wanting to be a part of fixing healthcare was further bolstered this weekend.

This is me visiting my dad today in the facility he’s spent the last few weeks in. After years of dealing with depression, alcoholism and worsening neuropathy he had a fall that resulted in a broken shoulder. Falls aren’t uncommon for him, they usually lead to an ambulance visit and ride to the ER, but this one was different. He already required almost total care support at home from his wife but she simply can’t do it any longer.

After going back home again after the shoulder brake a readmission was needed simply because he should have never been discharged home and his PCP said that was the ONLY way to get a referral to the needed place of treatment. This readmit led to a discharge to a SNF for rehab/therapy services. After 3 weeks in the SNF, I received a call and letter from the utilization management company his Medicare Advantage plan outsources this service to. It said that he no longer needs constant care and therefore they were stopping coverage for his stay and therapy.

I can assure you he does in fact still need consistent care as he’s unable to get out of bed. He can not toilet himself even struggles to eat due to lack of mobility of his shoulders and arms. I appealed the decision but that too was quickly overturned.

While the decision and letter are frustrating as it shows a complete lack of understanding of the situation. What is most concerning is the total lack of care management support, discharge planning, transition planned, you name it. Neither the facility, the MA plan or the outsourced vendor have offered any support. All I’ve been told is that we won’t “kick him out” because they know he’d be homeless but that means a $307 per day private pay stay until all of his money is gone and he can qualify for Medicaid.

While I’ve found myself in the caregiver position, I’ve learned a lot being on the patient side of these decisions. I’ve learned how complicated it can be to get someone on Medicaid. I’ve learned about countless other things. But what I’ve also experienced is the deep need that many many many seniors have in what can be the most scary and critical time of their lives. This is way more complicated that’s it needs to be.

I’m fired up more than ever to build a better healthcare solution that provides a more caring member and patient experience. We can and will do better!

More to come on this journey as I continue to hear and learn how many people struggle with these challenges.