Medicare's pound-foolish rules

The Boston Herald

Beverly Beckham

She doesn't say, "I can't" or "I won't," or "Why me?" She simply doesn't complain. She wakes up in the morning, puts a smile on her face and plays the hand she's been dealt. She has to use a slide board to get from her bed to her wheelchair. The middle-of-the-night transfer is the toughest. It's dark and she's tired and it's a huge effort to shimmy onto the board, position the board onto the wheelchair, ease her body into the chair and wheel out of the bedroom into the bathroom.

Every morning, she draws her blood, records the sugar level, and gives herself a shot of insulin. Eye drops are next, bottles of them. Then she takes her pills. After this, she makes herself breakfast. She keeps her dishes in a drawer now, not on a shelf, because she can't reach the shelves. The same with the pots and pans and the food in the refrigerator. Everything has to be reachable.

After she eats, she rinses her dishes, puts them in the dishwasher, wheels herself back into the bathroom, washes and dresses, and then makes her bed. This is hard, exhausting, time-consuming work when you're 86 and you don't have legs and you have heart disease and high blood pressure and diabetes and you can't see anymore, though you pretend you can.

For months after her second leg was amputated, there were people in and out of her house helping her. Therapists came to teach her how to put on her artificial legs, a nurse filled her syringes, sorted her pills and monitored her blood pressure. A home health care person gave her a hand bathing and dressing. They were her personal cheering squad, Emma and Marsha and Trisha and all the people who worked with her and praised her and encouraged her. They were the physical and psychological boost she needed.

Then came the cutbacks. Home health was the first to go. Weekends were eliminated, then evenings. Then the therapists said she had progressed as far as she could. Grandma wasn't walking although that was her goal, to be able walk into her family room. But they said, no. Her therapy was finished.

So Grandma called New England Sinai Hospital and Rehabilitation Center and asked if she could get therapy there. This meant, of course, more work: getting up, getting dressed, getting on her prostheses, getting out two mornings a week, transferring to a car, out of a car, pushing herself through the hospital, pushing herself even harder than she'd been pushing.

You would think that this kind of initiative and determination would be rewarded. But instead Medicare has punished this woman by terminating the few home services she had left. The reasoning? If she's well enough to leave the house for therapy, she no longer needs home care.

An 86-year-old without legs can get in and out of her shower alone? A nearly blind woman can fill her own syringes with insulin and sort her own pills? A person with a history of heart disease and hypertension cannot bother with her blood pressure, which, since the cutbacks, has been hovering at 200?

That's what Medicare says.

Should she have a stroke, however, or fall or require emergency treatment, then Medicare will certainly pay for her care, which will cost taxpayers far more than a few hours of home help. But that's the way it is today. If you're responsible and you save for your old age, you get precious few senior services. And the little you do get you lose if you don't play the game, if you don't give up, lie in bed and say "I can't."