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Thursday, March 22, 2012

Finally, I'm in Charge!

And I'm discharging PT next week. Yep. You read that right. I am discharging physical therapy next week. Me! I can't tell you how empowered that makes me feel! After all this time, and all those therapists who made me feel like a worthless piece of crap, all those discharges for "no functional improvement" and "poor prognosis" and "lack of progress", after all of that, I am finally in charge. BAH HA HA HA!!! Whoo! I feel good!

You're probably thinking I've gone completely off my rocker, bit the big one, gone off the deep end, etc. after all, wasn't it Diane who fought so long and hard for this therapy??? Um, let me explain what happened.

After that first (and quite confusing) PT session, Bob received an "Approval Notification" in the mail from the insurance company which informed us that Bob was approved for 20 units of Physical Therapy, plus 20 units of Speech Therapy, plus 20 units of Occupational Therapy!

I tell you, I was floored because the neuro doc did not request ST or OT. And I didn't think Bob had a chance in hell of getting any more of those therapies. But then, this "20 units" thing was confusing, as what is a unit of therapy?

The only experience I have had with this term "unit of therapy" was way back when Bob was in Acute Rehab and the doctor in charge there was determined to send Bob to a nursing home, so determined that nursing home representatives were starting to show up in Bob's room with their glossy brochures filled with photos of happy, smiling senior citizens and glowing reports about how great their facilities were. I remember one representative who handed me a brochure for a "skilled nursing rehabilitation facility" and I asked her how much "rehabilitation" do they actually do and she told me that, well, their patients get a maximum of 3 units of therapy every day. So I asked her what a unit of therapy was and she told me it was "15 minutes", at which point I thought, well, big whoop.

Anyway, so I was looking at the approval letter thinking a unit might not be a visit, but a time-frame, such as 15 minutes, but no matter how I figure out the math, it's not adding up. Because the admissions/PT evaluator had told us that Bob was approved for 6-8 weeks of therapy, twice a week. Like I said, it didn't add up at all.  So when the PT arrived the next day for her session, I showed her the letter and asked her what a unit was, but she had no clue.

So I called the insurance company, after the usual being transferred all around and on hold forever, I finally got through to the "approval office", who told me that a unit was a visit. And that Bob was approved for 20 home visits of each therapy and they could be used anytime up until Dec. 31. 2012.

The next thing I do is call the Home Health Care Agency and talk with the Therapy Team Leader and I tell her my idea, which is this: I want to spread these 20 units out over the entire year. That way, Bob can get off and on physical therapy all year long. I ask her if that's possible and she says, "Sure!" and tells me just to talk it over with the therapist.

So I run this by the PT at Bob's next session and she is totally on board with this idea. In fact, she thinks it's a great idea! She is going to teach me and Bob all the exercises that she can think of to increase his trunk control and weight bearing on his right leg and then discharge Bob next week. After which, Bob and I will work together on the new exercises (plus all the others) and when he has mastered the new exercises and gains more strength in his leg, I will ask the doctor for a new script and she will come back to progress us to the next level. And hopefully, we will have him up on the hemi-walker by the year's end!

How about them apples? I tell you, this is the best news we've had in a long time.

By the way, I really do like this new therapist, even though we got off to a sort of bad start. She is very enthusiastic and seems to know what she's doing. She told me that she really was impressed by Bob's progress and his motivation and willingness to work at it. That she has seen so many caregivers and patients who give up, especially in light of Bob's disabilities and the amount of time that has passed since the stroke. That she has never worked with a patient "in Bob's condition" who was not in a nursing home and she admires our fortitude and she also said that I was darn a good therapist. She's also going to report to the insurance company that our sessions were for "training the caregiver", that way, she says the insurance company won't think Bob's being discharged for "lack of progress". I do like this therapist and think I'll request her next time.

Oh, and she's put in a request to the neuro doctor to send a script for Speech Therapy so we can start that, hopefully, next week.

I am still not sure about OT. As I'm not sure what they can do for Bob at this late date, especially in light of the fact that he has no movement what-so-ever in that right arm. But we'll start with Speech and think about OT later.


Rebecca said...

My therapists looked surprise when I told them what I wanted. They may have been distressed by having me speak up, but every therapist has come on board once they see that I will follow thru on their suggestions. Kudos on making the insurance company and home health agency work for you.

Anonymous said...

Great job !! Glad it's all working for you and Bob finally. Patricia

Jenn said...

Good to hear you recognize your excellent caregiver/therapist abilities!
Refreshing to have a PT working with you within the system!
Oh law-dhy! (use southern accent heh). Can it tuly be? Moh miracles! :-)

Anonymous said...

We all knew you were already an excellent therapist in your own right. It's great to know that a licensed PT also recognized that fact and gave you the koodo's+ you deserve. Great to hear your therapist is doing all she can to work with you and Bob and is willing to work within your plans.
A big high five to ya'. Hugs, Dan

Linda said...

You are amazing! Thank goodness something is going right for you at long last. It is great that the PT was willing to admit her initial assessment was incorrect.

The occupational therapy actually has a lot of flexibility in what they can do you but no need to rush things. They can help with teaching improvement in physical transfers, hopefully help get toileting improved, setting up activities he can do as he does better and better with the PT help. Stuff like helping him adjust work space and supplies as an opposite handed artist!

Anonymous said...

great news.....
PS keep up the dancing!