So, this morning the Hospice Nurse Team Leader called me...
...to discuss "the best system" for Mom and me involving Mom's use of oxygen. I told her that I believe I've already discovered the best system but told her to go ahead and hit me with her best shot.
    Her major concern was a shocker. She told me that the way we're using oxygen (the way we've been using it for some years, in fact) "is not covered by Medicare"; specifically, the number of E tanks we use per week. Just so you know, my mother is on Medicare/TriCare for Life. This new information about lack of coverage came as a surprise to me because the way we are now using oxygen is the way we've been using it for some years and we've never gotten a bill. She told me that the company supplying us with our oxygen has been "eating the extra cost". I responded with surprise and mentioned that if they've been eating the extra cost, they've been doing this for some time, at least a couple of years if not more, and that doesn't sound right. She agreed and will look into it.
    Here's the how and why regarding my mother's oxygen use:

• Her prescription is for 2-4/lpm Continuous 24 hours per day. It's been prescribed like this for several years.
• We have one concentrator in the bedroom that she uses when she sleeps (12-14 hours a day or more).
• When she is up she is hooked to E tanks I follow her around with the mobile caddy or slip them into the back of her wheelchair in a caddy which hangs from the back of the chair. At present, at 3/lpm (which may go down or may go up, who knows), we go through about 3 tanks a day when she's up.
• I nixed the idea of a concentrator in the living room for the following reasons:
  • It is much easier to contain the oxygen delivery cord with mobile oxygen than with concentrator oxygen. This is important because she is oblivious to the cord and I have tripped over the cord on occasion. For us, a concentrator delivery cord is not only an accident waiting to happen, it's an accident that has already happened, more than once.
  • The heat factor from an extra concentrator is enormous. This isn't a problem in winter; for instance, almost all of the heat in my mother's bedroom is delivered from the concentrator and, in the winter, my mother sleeps warm. However, in the summer it is an acute problem since we do not have central air conditioning. We have a room air conditioner for the front of the house and a portable evaporative cooler for the back of the house. When my mother is up she is heat sensitive. In the summer in her bedroom she is heat sensitive. Ameliorating the heat in her bedroom during the summer is challenging enough; having to work around the extra heat in the front rooms would probably be impossible.
  • While it would seem, considering how little my mother actually moves, that a living room concentrator wouldn't be much of a problem, again, she does move from place to place on occasion every day. During these moves I would be spending some moments transferring hook-ups and securing the concentrator cord, which I don't have to do, right now. Sounds like a small thing but, when your days are largely composed of "small thing" chores, the ability to do away with a small chore here and there is reason for relief.
• The Hospice Nurse suggested a liquid oxygen tank in the living room. Although some months ago I researched the possibility of liquid oxygen with the oxygen company owner/manager, primarily because I thought it would allow us to get rid of all the tanks we use, after a long discussion which covered the possibility of oxygen burns from leaking liquid oxygen and the volatility of the product, I decided we were better off changing out tanks than risking me being injured and unable to serve my mother well for days and possibly even weeks. As well, I don't have medical insurance. All we need is for me to suffer a liquid oxygen burn, with or without complications.

    I explained all this to the Hospice Nurse Team Leader and repeated my astonishment that a business would eat oxygen charges for a couple of years or more. As well, I explained how Medicare/Tricare works, the explanation for which seems to (I repeat, seems to) preclude the possibility of the company eating not only their profits but their costs.
    The Hospice Nurse promised she would look into this further and get back to me. She agreed that it is hard to believe that a company would willingly go into the red for as long as this company is claiming they've been doing providing as much oxygen to a client as my mother uses in the manner in which it is delivered.
    Although I forgot to mention this to the Hospice Nurse Team Leader, it has come to my attention within the last few days that Hospice, in a roundabout way through one's insurance provider(s), covers only prescriptions that are directly related to the client's reason for terminality, covering these fully. Although this means that only three of Mom's prescriptions, the inhaler meds, the oxygen and the Protonix (which will be changed to Prilosec) will be covered by Hospice, this isn't a problem for us since, with doctor's prescriptions, which the doctor is willing to write, Mom's insurance picks up the rest except for the minimal co-pays required by Medicare/TriCare for Life, and we can have these prescriptions filled at the pharmacy of our choice (Hospice works through specific pharmacies, some of which are mail pharmacies). Thus, if, through Hospice, the way Mom uses oxygen is not covered, it makes sense to me that, since it was covered before Hospice through Medicare/TriCare (as, I'm assuming that the information that it wasn't fully covered is not correct), Hospice can declassify the oxygen as a terminality med, reclassify it as an Emphysema/COPD med (its previous classification) and it will be fully covered, as before (assuming that it was fully covered before).
    Protocol. That's the alternate name for the Hospice Rx Medication Game. If you don't want to be rear-ended by Hospice, you need to become proficient in Protocol.
    It's almost 1130, Mom's 12-hour-sleep-mark. Time to check the dew point...ah, 34 degrees, okay, nominally, for evaporative cooler usage...and awaken the Mom.
    Later.
- posted by Gail Rae @ 11:29   email  this post