Looking at Late July Discharge from Mission Terrace

I had a good call with Mission Terrace today, which included Dr. Omelid, the social worker, the physical therapist, and Bill.  The purpose of the call was to check in on Bill's progress and to discuss possible next steps leading to his discharge.

Dr. Omelid began by saying that he felt that the best (and safest) next step for Bill would be for him to move into an assisted living facility where he would have 'round the clock care available. When asked for my opinion about that, I shared that I had been going on the assumption that Bill would return home and would have IHSS (in-home support services, paid for by Medi-Cal) to assist him with daily living. These services would be in place for up to 4 hours per day. I stressed that Bill can't afford to move into an assisted living facility without selling his home first. It's not an ideal option for now, and, Bill wants to return home.

I referenced the book I had just finished, Being Mortal by Atul Gawande, and how it talks about the importance of older people living dignified and meaningful lives w/ some degree of autonomy and independence. Dr. Omelind concurred that this is important, and said that it would be a reasonable plan for Bill to move back home with a few hours per day of support in place. He added that there would be some risk involved, but he is generally supportive of trying this out and seeing how it works. He said that Bill could be released in 2-3 weeks, and between now and then, Mission Terrace would start allowing Bill more autonomy to get a better sense of how he would do living alone. Bill kept saying, "I've been living alone since 1999 and have only fallen once."

I also spoke about back-up plans I'm working on, such as our pending housing application for the Napa VA Home, and looking into assisted living places in Oakland for further down the road.

Bill called me after the group call had ended and said that he was pleased with the conversation and is on board with the discharge plan that we had discussed. He said that he is in no hurry to leave MT, as he has made some good friends there and feels that he is actually helping the guy with whom he's sharing a room; he considers this man a good friend now. Bill's morale seems quite high -- a big improvement over how it had been when he first got there.

I am going to let Mission Terrace know that I'm planning to come to SB July 25-28, and request that they plan for Bill's discharge to be around then. I'd like to be in town for Bill's transition, but my schedule is somewhat constrained by a major home construction project that will start on July 24th.

All in all, Bill seems happy and healthy, and the medical staff at MT are being reasonable and understanding.

Added: I left message with Giselle (social worker) saying that July 26-27, 2017 would be ideal discharge dates, as I will be in SB then.

 

 

Update from VA Home Yountville

VA Home Yountville admissions volunteer Dick Sutton returned my call today; I had left a message to inquire on the status of Bill's housing application, of which I had sent the final part (C) in late May, during my trip to Santa Barbara.

Dick gave me this report:

• Bill's application was received as "complete" on May 15, 2017. This is odd, since I sent in the missing medical records on May 26th. Perhaps Central Files at the VA in Los Angeles had also sent a copy of Bill's medical records directly to Yountville, and what I sent was a duplicate? In any case, this is GOOD NEWS.
• Yountville's review process for Bill's housing application will take two months. Then, Bill will receive an acceptance letter that will include an assignment of the level of care that he will require.
• I believe there are four levels: the higher the need, the longer the wait. It's best to get in at the lowest possible level of care, i.e., "independent."
• After the acceptance letter is sent out, VA Yountville will put Bill on a waiting list.

Dick said that the time to call Yountville will be after Bill receives his acceptance letter. The question to ask is not "How long until Bill gets admitted," but "What movement are you seeing on the wait list for Bill's particular level of care?"

Dick's message was not particularly encouraging. He said there are 1,000 residents at Yountville and 750 of them are residential/independent. When higher level care spots open up, they are usually filled by those who already live there.

If Bill gets in within a year, that would probably be fine. After all, I am currently working on figuring out a good interim solution involving Bill continuing to live at home with support services in place. 

Productive and Rewarding SB Visit: May 19-27, 2017

I visited my dad in SB from May 19-27, and saw him make much progress doing physical and occupational therapy at Mission Terrace.

On June 1, 2017, I spoke with Giselle Landell, the social worker at Mission Terrace, who informed me that Bill continues to benefit from PT and OT, and Dr. Omelid estimates a possible discharge timing of late next week (around June 9th).

Giselle will keep me apprised of further updates on timing and progress.

In the mean time, Bill has been approved for Medi-Cal insurance, which, as of May 1, 2017, will retroactively cover all of his medical expenses, including Cottage Hospital and Mission Terrace, 100%.

Jennifer Alvarez, the social worker assigned to Bill's case at SB County Social Services, has said that Medi-Cal sent a letter to Bill on May 26th confirming insurance coverage, which should be sent to Bill's home this week. Brian Bailey has agreed to retrieve the letter and produce a copy for Mission Terrace so that they can coordinate with Billing.

MT will also coordinate Bill's next steps -- receiving in-home support -- with IHSS, a div. of Medi-Cal (I think).  I understand that Medi-Cal will cover 4 hours a day of in-home support, which may include (or cover additionally) physical therapy in the home.

Bill is in good spirits, is healthier than ever, and is making physical progress. He looks forward to going home!

I miss him terribly and try to talk to him a few times a week on the phone. I wish I could drop everything and move to SB to be with him during this transition!

While I was in SB from May 19-27, 2017, I accomplished the following:

1. Had Bill sign a Durable Power of Attorney under the direction of lawyer Erin R. Park, recommended by Cindy Brokaw. Brian B is assigned as a co-agent of Bill, along with me.
2. Submitted the requisite financial documents (bank statements, letter) to Santa Barbara County Social Services to ensure that Bill qualifies for Medi-Cal. On May 26th, I got a call from the kind social worker assigned to his case, Jennifer Alvarez, confirming that he is approved to receive 100% Medi-Cal coverage retroactive to May 1, 2017. (This was the best news ever!!!)
3. At VA Clinic in SB, secured remaining medical records (2016) and Part C completed by VA, and sent package to VA Home Yountville for housing app to be complete. Thanks, Lupe!
4. Confirmed continued monthly support through WF.
5. Went to Union Bank with POA and signed up as co-account holder.
6. Visited with Bill a lot, had some great talks about mortality, marriage, faith, regret, etc. It was serious quality time!
7. Confirmed with Colin Mak, Walpole, that I would handle monthly El Zoco fees of $315 on Bill's behalf.
8. Dined and/or with Wendy F, Gretchen W, Lara E., Brian and Cindy, and Linda Trujillo.

I had wanted to meet with Sue Irwin about real estate plans, but was too busy. Not urgent; next time.

On the home (Oakland) front, I continue to look casually at assisted living facilities as possible housing for Bill in near future.

Mercy Retirement and Care Center sounds like a good possibility. It's in Fruitvale and Danny Vasquez is contact. (He called me while I was driving to SB and was the most pleasant sales rep of any elder living home I had dealt with to date.) The place costs about $3K/month.