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    Medicaid expansion must remain safe in healthcare reform

     

    Mr. K. is mentally savvy and understands the perils of his situation. He cannot clean his house or cook because of his medical conditions. There is no railing to his second floor and he can’t make it up the steps without it, so he doesn’t use the second floor anymore. He cannot safely get in or out of a shower, so he just washes up at the sink. He is unable to pick up after himself or afford a housekeeper. There are newspapers and magazines and books all over his rancher, many on the floor as potential tripping hazards. If he drops anything, it is dangerous for him to pick it up, because of his leg weakness and balance disorder.

     

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    Navigating a walker through his living room could be perilous. His floors are an obstacle course. Mr. K. has been hospitalized three times in the last seven months. The first one with a compression fracture of L2, from a fall. He had pneumonia at the time. His pain was too severe for him to walk, so he spent two months in a nursing home. He was discharged home only to fall again shortly thereafter and suffer rhabdomyolysis and dehydration after lying on the floor for two days because he couldn’t get up.

    After that admission, he was again discharged home with the plan that his two sons would check on him every Tuesday, Thursday and Sunday, and also do his shopping. Unfortunately, there are a lot of hours between those days, and he was recently bitten by a feral cat (he encourages the cat to come around by leaving food in his garage). By the time his son came, Mr. K.’s arm was three times its normal size, and he was just admitted again with cellulitis.

    He refuses visiting nurses or home care companions mainly because he is concerned they will see the condition of his house and make him leave. He cannot afford a ‘life alert’ button. He would rather use that money to feed the cats.

     

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    This is a patient who definitely needs nursing home placement. The ideal situation would be an assisted living that would accept Mr. K. and his cat. In our area, that is only available if you have a significant amount of money in the bank and can afford a hefty monthly fee. I doubt Mr. K. will make it to his death without permanent placement in a nursing facility.

    Next: This dear man will need Medicaid! 

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