4-7-2023 A UTI has hit Linda hard

On Monday, the very day Linda was discharged from hospice, she tested positive for a urinary tract infection. UTIs can wreak havoc on the elderly, and Linda is no exception. We contacted her primary care doctor, who immediately started her on antibiotics, but she has been lethargic and largely unresponsive for the past three days. She wakes up briefly here and there, just long enough for us to give her medications and a little food (a smoothie and toast, or a cookie), before she goes back to sleep.

As her body fights off the UTI, her blood sugar has gotten incredibly high and her breathing has worsened, so we have increased both her insulin and her supplemental oxygen.

At the same time, a representative from Pathways, the agency we used for hospice, called today to give me some bad news. With Linda no longer on hospice, my hope had been to transition her to Pathways' palliative care, so we could still have nursing support. We found out last year that their palliative care team didn't accept her HMO, but they said that they accept most PPO plans. So, as I mentioned in a previous post, last week I upgraded her insurance from an HMO to PPO before Medicare's March 31st deadline. I had hoped that things would work out in Linda's favor for a change. 

But they didn't. The representative was calling me to say they still won't accept her new insurance either. And now it's too late to change the plan again.

That raises the obvious question: Couldn't I have found out if they accepted a particular insurance plan before switching? Believe me, I tried. But in an incredibly frustrating Catch-22, neither Pathways, Anthem, nor the insurance broker who helped switch the plans could tell me for sure if Pathways would accept the upgraded PPO plan for palliative care. Pathways told me that they wouldn't know if they accepted the insurance for palliative until after they ran the new insurance card through their system. The fact that Pathways was listed as "in-network" meant nothing, because Anthem's system does not distinguish between its hospice care and its palliative care.  

How messed up is our healthcare system when not even the insurance company or the agency can decipher what's "in-network" and what isn't? As I've discovered again and again, trying to make sense of the rules at play is nearly impossible.

But the phone call from Pathways helped in one respect. During the conversation, I told the agency rep that Linda's condition had worsened considerably due to the UTI. Within 30 minutes of my hanging up the phone, their social worker called to tell me she was on the way. She came to our house to see Linda, even though Linda is technically no longer under their care (the insurance issue notwithstanding, Pathways has been wonderful).  While she was here, she also did an informal evaluation and called in the results to the nurse practitioner at Pathways. 

Both the social worker and the nurse practitioner recommended that Linda's primary care doctor send in a new order to have her readmitted to hospice. Once the doctor sends that in, Pathways will send a nurse practitioner over to do a re-evaluation. If Linda does requalify, that means we didn't even make it a week this time. 

So, it has been a very upsetting day. Earlier I wasn't doing so well! But I've shaken things off a bit. I know that we'll figure things out as best we can, just as we've been doing. We will continue to do what's in our power to keep Linda cared for and comfortable, and things will happen as they're going to happen. If Linda does go back on hospice, palliative care will be a moot point anyway.

Although Linda slept most of today, she was awake more today than she had been yesterday. In fact, I just heard her caregiver asking Linda how she was feeling, and Linda faintly talking back. She was awake long enough to take her medications. That might mean that she is getting to the other side of this, and that the antibiotics just need time to clear the UTI from her system.