Thursday, September 16, 2010

How Much Will We Have Spent?

As Mother comes closer and closer to her final moments on earth (probably two to three more days:  we have had to very much increase her morphine in the last 24 hours and she no longer has any signs of consciousness), my brother, sister and I are having frequent meetings to address the complex issues concerning the winding up of her estate.

When my dad died three years ago, the concerns were much simpler:  just make sure that Mother was cared for financially and that all assets were properly transferred into her name.

But now, huge complexities arise.  The biggest for us is her house and all its contents, and I'll write more about that another time.  Right now, we have the concern of making sure we've got the cash available to pay all final bills.  And we have no clue how much they will be.

We have not yet seen the bills from the first hospitalization, which lasted for twelve days.  Twelve days, multiple CT scans, feeding tube insertion, EEG, emergency room fees, cardiac monitoring fees, IV medications, etc.  There will essentially be a charge for every molecule of oxygen delivered through the lines wired into her rooms.  Medicare picks up much of this, but not all. 

Then there was a second hospitalization where she was just admitted under "observation" status--and I've read something that suggests the Medicare may try not to cover that one.  We also have eight days in a skilled nursing facility at some huge sum per day that gets billed somewhere, somehow, to someone, again primarily to Medicare but there may be overflow charges we have yet to see.

What we thought was good supplemental insurance turned out not to be good at all--the policy had changed radically since my dad's death.  

After hospice took over, and we brought her home, we no longer had medication charges, plus they supplied all the equipment we needed.  But we made the necessary choice to hire a night nurse, so over a week of her kind and competent services must be paid for from our pockets--or our mother's pocket, as the case may be.  We are now back on hospice covered continuous care, so that expense is probably done, however.

My sister's understanding is that as soon as the obituary hits the newspapers, her bank account will be frozen for a period of time. (OK, I'm wondering:  do they pay someone to read those every day and tell banks, "Another one down--send the liquid nitrogen on that account, NOW!).  Anyway, she's trying to make sure that enough cash is pulled out now so we'll have it later when those bills overflow the mailbox.

Years ago, my mother made the decision to donate her body to science upon her death.  Her comment, "The medical students might be able to learn a lot from a elderly woman who has never had a surgery and who took no medications except vitamins all her life."  Because of this decision, and with the paperwork long since completed, we will not have funeral costs until the cremains are returned to me a couple of years from now.  Then I will figure out what do to with them as I still have my dad's cremains in my possession as well.

I do not regret any money spent on my mother.  What I do know, however, is that we have followed the same pattern that many others have followed:  the vast majority (and in her case the total amount because of her life-long intentional avoidance of the health care system) of health care dollars spent on her were spent in the last few weeks of life.  I am intensely curious about how much will actually be billed from all this.  

And then there is something else that keeps haunting me.  I know we'll get through all this, and will not be impoverished by it.  Resources have been set aside for this; we hired the extra help not only because we knew we had to have it, but also because we knew we could. We'll go over the hospital bills item by item, but will pay what is our share.  It is the right thing to do, and we are seeking righteousness and honor in this time of loss. 

But many questions arise for me.  Both my brother and I have relinquished huge amounts of our normal work activities in order to ensure that someone is in the house all the time, and preferably two of us, just to make sure we give proper care to our mother. 

What do those do who don't have that kind of employment flexibility?

What do those do who live on the financial margin?  

Health care in general, and especially end of life care and expenses associated with death, can easily bankrupt a financially fragile family system.  In this time of grief and exhaustion, it is so easy just to throw up our hands and say, "So what?"  "What's one more expense here?"  "So what if I lose my job over this?  It's my mother (father, child, etc) that must be cared for."  Yes, that is true.  These choices must be made.  But I wonder about a system so riddled with inequities that make those particular choices too often necessary.

Just my meanderings this day, now five weeks after her stroke and on our thirteenth day of hospice care.

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