David didn’t get COVID in the hospital. He also didn’t return to the assisted living memory care facility. I called the AL administrator every morning with as much information as I had – hardly any. The doctor was never available, and you can’t lie in wait for doctors by telephone. A week went by, and David was still “under observation,” still classified as an outpatient. There was talk of releasing him to rehab. The social worker found a place in a rehab facility some distance from St. Cloud; it was a facility she endorsed. But neither Medicare nor his insurance company would cover rehab because of his outpatient status. Then the hospital decided to discharge him within 24 hours, and only to a “skilled nursing facility.” Medicare would pay nothing. He would be admitted as a private pay resident.
Why had David never been admitted as an inpatient? Why could I never speak to the doctor? The social worker had warned me that he was likely to be ineligible for rehab if he was discharged without being admitted as an inpatient. We talked about this every day for a week, and she advocated for his admission as an inpatient. It didn’t work.
The social worker and I went through the list of nursing homes that Kate S and I had visited. None had openings for someone with David’s needs. The social worker checked for openings at a greater distance from me. I checked the Medicare ratings and chose the one with the highest scores – a place I’d never seen, 20 miles from home. It happened to be the same facility that housed the rehab unit where she had hoped to place David. I said yes over the phone. I asked her to find out whether I could see the memory care wing and the room that David would be assigned. The answer was no: the lockdown was complete. And ironically, he wouldn’t be moving directly to memory care; he’d be housed first in the rehab unit that his insurance had refused to pay for. I called the assisted living memory care director and gave notice.
The hospital palliative care team got permission for me to attend the discharge meeting. The team’s nurse explained to David what would be happening and why, and she guided him through the Physician Order for Life-Sustaining Treatment (POLST). She told me when to pick David up the following day. The social worker told me what to bring to the nursing home. I wrote out a list, said goodbye, went shopping, and packed a suitcase.