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Dying from a bowel obstruction is a terrible way to go. Just sayin.
That $100K bill was paid at pennies on the dollar.
Medicaid reimbursement for the ICU is not "pennies on the dollar". The Russell Equation for ICU cost nationally is almost $5,000/day. Medicare pays New England urban hospitals just shy of $10K/day. This isn't a routine office visit and insurance company reimbursement for that. This is the most expensive medicine on the planet.
ALS where your body shuts down around you and your mind is still 100% functional is a terrible way to go.
When a late-80's patient with advanced dementia rolls in the door, palliative care is the appropriate way of rationing our very scarce health care dollars. Just sayin.
The nurse gave us a DNR written by the doctors and nurses at Robert Wood Johnson hospital (NJ) after he was admitted. It included no feeding tube, they said it prolonged suffering; this is according to medical professionals and what they would have wanted. We also covered our butts by having my dad do something called 5 Wishes which gave him the option to write what life support means to him. End stage disease; things looking bad, no chance of recovery. He ended up with a DNR that we printed and put on the front door, his bedroom door and over his bed so that if my hub or myself were not there, my mother was not to prolong his life. In my dads EMT experience in NJ; they did not resuscitate with a DNR when called out. Thankfully we never had to use it.
Please understand that a DNR has nothing to do with a feeding tube. Nothing. It is a separate order for very specific circumstances; cardiac arrest. Nothing else. What he initially had was an advanced directive that stated he did not want a feeding tube. Some forms state "artificial nutrition" instead. That might matter. His representative (identified in the directive) could also make other medical decisions that came up if he could not, based upon their understanding of his wishes. The "5 wishes" document is basically an advanced directive that is recognized in many states. It identifies who his representative is, what he wants or does not want in terms of treatment. In itself it is NOT a DNR.
Last edited by Parnassia; 10-25-2018 at 02:31 PM..
Please don't ever do that to me! One day I'll have to do my own 5 wishes and advanced directive but I trust my hub and son wouldn't do any of that to me. After my dads fight, we all know what each other want.
Remember, the advanced directive also protects your hubby and son so they can carry out your wishes without being challenged. If there isn't one that is recognized by that state, agreed upon by all, signed and notarized, some unexpected person could cause a conflict at the worst possible time. Don't assume, protect.
So, DNR's and Advanced Directives are very tricky and don't always address what you think they do.
Yes, they are. The reason for that are the numerous challenges and confusions created by vague documents that didn't go into the weeds. If you want your wishes carried out no matter what, STACK THE DECK in your favor. Don't assume, don't leave it up to someone else's discretion or assume it will only happen when the person who knows what you want is on hand. Other people have their own beliefs and they may not be the same as yours. Be specific and use the form accepted by the establishment in your state. If it isn't specific enough, write additional details into it. Most templates allow that as long as the final document is signed and notarized or witnessed (some states permit either but not all).
If you refuse to sully your sacred person by setting foot across the threshold of some medical professional's doorway in order to get the accepted DNR order, that's up to you.
(Warning....extremely heavy sarcasm ahead)
When your Prius gets T-boned by a semi loaded with sustainable electric vehicles, you choke on a vegan muffin at the local holistic market, or you get electrocuted by a solar panel voltage regulator, and you end up in cardiac arrest in public, the emergency response person who starts working on you won't find a DNR they can honor. They have 6 minutes. They resuscitate you despite the fact that you didn't want them to. There is nothing to advocate for you. If you do survive (possibly with brain damage or other disabilities that will change your life) and you spitefully decide to sue them for it, good luck. No court will rule in your favor either. The only person who gets to live with regret about arranging that DNR bracelet is you.
Medicaid reimbursement for the ICU is not "pennies on the dollar". The Russell Equation for ICU cost nationally is almost $5,000/day. Medicare pays New England urban hospitals just shy of $10K/day. This isn't a routine office visit and insurance company reimbursement for that. This is the most expensive medicine on the planet.
ALS where your body shuts down around you and your mind is still 100% functional is a terrible way to go.
When a late-80's patient with advanced dementia rolls in the door, palliative care is the appropriate way of rationing our very scarce health care dollars. Just sayin.
Medicare and Medicaid are not the same thing.
Medicare pays hospitals by diagnosis.
From your original post the hospital stay should have been more than $100K if paid at $5k to $10K per day.
ALS is terrible. A bowel obstruction is excruciatingly painful. I know; I have been there and done that. Even someone with dementia can experience pain.
So, DNR's and Advanced Directives are very tricky and don't always address what you think they do.
Yes, they are. The reason for that are the numerous challenges and confusions created by vague documents that didn't go into the weeds. If you want your wishes carried out no matter what, STACK THE DECK in your favor. Don't assume, don't leave it up to someone else's discretion or assume it will only happen when the person who knows what you want is on hand. Other people have their own beliefs and they may not be the same as yours. Be specific and use the form accepted by the establishment in your state. If it isn't specific enough, write additional details into it. Most templates allow that as long as the final document is signed and notarized or witnessed (some states permit either but not all).
If you refuse to sully your sacred person by setting foot across the threshold of some medical professional's doorway in order to get the accepted DNR order, that's up to you.
(Warning....extremely heavy sarcasm ahead)
When your Prius gets T-boned by a semi loaded with sustainable electric vehicles, you choke on a vegan muffin at the local holistic market, or you get electrocuted by a solar panel voltage regulator, and you end up in cardiac arrest in public, the emergency response person who starts working on you won't find a DNR they can honor. They have 6 minutes. They resuscitate you despite the fact that you didn't want them to. There is nothing to advocate for you. If you do survive (possibly with brain damage or other disabilities that will change your life) and you spitefully decide to sue them for it, good luck. No court will rule in your favor either. The only person who gets to live with regret about arranging that DNR bracelet is you.
I think those emergency response people would be covered by Good Samaritan laws, wouldn't they, so they couldn't be sued for their rescue efforts? As long as they acted within their scope of practice, and didn't act irrationally. Or so I read it.
I think those emergency response people would be covered by Good Samaritan laws, wouldn't they, so they couldn't be sued for their rescue efforts? As long as they acted within their scope of practice, and didn't act irrationally. Or so I read it.
That's what I understand too, but there's always someone who may still try to make their displeasure known. It could result in a lot of misery for someone involved until the case is refused.
Please understand that a DNR has nothing to do with a feeding tube. Nothing. It is a separate order for very specific circumstances; cardiac arrest. Nothing else. What he initially had was an advanced directive that stated he did not want a feeding tube. Some forms state "artificial nutrition" instead. That might matter. His representative (identified in the directive) could also make other medical decisions that came up if he could not, based upon their understanding of his wishes. The "5 wishes" document is basically an advanced directive that is recognized in many states. It identifies who his representative is, what he wants or does not want in terms of treatment. In itself it is NOT a DNR.
Sorry was really early, my brain wasn't thinking. It was an advanced directive by the doctors and nurses. It covered everything and along with 5 wishes where the person can write what they want, it should be pretty fool proof as long as 5 wishes are taken in that state.
I just sent a copy of 5 wishes to an 85 year old friend diagnosed with stage 4 breast cancer, doctor wants her to do chemo but reality it's end stage disease; chemo would shorten her life for sure. She's getting 2 more opinions at least, one a university cancer center that will hopefully tell her the truth
My advance directive wont hold water in my state, but its written out anyways.
I decline the following:
Blood transfusions
organ harvesting
science project for organs
life support machines
dialysis
chemo
amputation
resuscitation.
feeding tubes
any device that inhabits my body.
No incubating tube
I accept hospice and its meager talent to wash my face and let me linger til the next visit.
Sorry was really early, my brain wasn't thinking. It was an advanced directive by the doctors and nurses. It covered everything and along with 5 wishes where the person can write what they want, it should be pretty fool proof as long as 5 wishes are taken in that state.
I just sent a copy of 5 wishes to an 85 year old friend diagnosed with stage 4 breast cancer, doctor wants her to do chemo but reality it's end stage disease; chemo would shorten her life for sure. She's getting 2 more opinions at least, one a university cancer center that will hopefully tell her the truth
Sorry to hear about your friend. She certainly could be offered chemo...a patient should at least know that option is out there so they can make a more informed choice. If it wasn't mentioned because everyone made assumptions about her, well that wouldn't be great either. It probably wouldn't attempt to "cure" anything unless of course she wants to make that effort. Some patients do better if they feel they are fighting, refusing to submit, not being passive. Others don't. She doesn't have to do anything. There are palliative chemo approaches. The intent is to ease symptoms, but if she's otherwise not in a condition to tolerate it, obviously no benefit. Just because something is tried doesn't mean it can't be stopped. Obviously a lot of debate over that and there should be.
The term "chemo" is extremely broad. It doesn't just mean toxins. If you start a regimen of targeted nutrients, vitamins that support one organ but inhibit something else, and pain control that is technically chemotherapy. It will come down to what SHE wants to do using the information she gets. I hope she has someone who will "listen" and take notes at her appointments so they can go over everything and talk about what she wants together later.
Last edited by Parnassia; 10-26-2018 at 03:34 PM..
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