This is Part 2 of what I've now realized will have to be a three-part piece about S.N.F.s (Skilled Nursing Facilities) and how I dealt with them when my mother — and soon after, my girl friend — were being assigned to them. Part 1 is here and should be read before proceeding with this chapter.
Let me remind you: Some S.N.F.s are quite satisfactory and perhaps even very good at supplying the services they are supposed to supply. But some are not and my mission was to get the two most important women in my life, one at a time, into the best S.N.F.s available at the moments of decision. My mother had spent one night in a bad one and it was one of the ghastlier nights she ever endured. I was determined she would never experience another one like that…
But how to prevent it? The rules of her Kaiser health insurance mandated that after her doctor ruled she was well enough to leave the hospital, she either had to go to a private home (hers or someone else's, which would have meant mine) or move to the first S.N.F. in that area that (a) Kaiser had a contract with and (b) was ready and willing to accept her. In neither her home nor mine could she receive the care and treatment she needed.
To solve this problem, it was important to remember that there were no human villains involved; at least none that I could talk to…so getting testy with individuals wouldn't help. The problem was with the rules…and while rules can sometimes be artfully bent, they cannot (usually) be broken. In this world, I think we often spend too much time arguing about rules with people who don't have the power to change or waive them. What you can do occasionally is to find ways to get around them.
If I was going to circumvent them to her advantage, the first thing I had to do was to fully understand those rules. Several of the folks with whom I dealt at Kaiser were very friendly and helpful. They were willing to explain the system to me, especially since they could see that I only had one concern here, which was to do what was best for my mother.
When the moment came for her to be moved to an S.N.F. this time, I asked again for a list of the possible locations. As I recall, there were seven of them. A symathetic staff member there tipped me off that two of them would probably not please me. They'd had complaints about them — not enough (yet) to sever their association with those businesses but enough to warn me about them. I visited the other five, politely asking for a tour of each…and by now, I'd learned enough to ask better questions.
The person taking me on the tour was always some sort of administrator at the facility and they were all very proud of the businesses they ran. I listened to their sales pitches but I also tried to get away from them and explore a little on my own. This wasn't hard to do since all those administrators were very busy people and they kept being called away from our tour to handle some matter. But if they weren't, I'd just ask to use a men's room and I'd visit not just one but every one I could find. That told me a lot about the cleanliness of that S.N.F.
And I'd strike up conversations with other employees there. Most people who get into any kind of nursing or medical care have a solid streak of empathy in them and as long as I kept it friendly and casual, they figured I was not going to get them into trouble for anything they told me. One question I asked that told me a lot went something like this…
"This seems like a nice place but I just have to make sure. I had my mother in another Skilled Nursing Facility recently and it seemed like a nice place when I toured it. But late at night, she said, people were screaming and yelling a lot. That doesn't happen here, does it?"
You would be amazed at some of the candid, "don't-tell-anyone-I-told-you-this-but…" responses that evoked. The administrators taking me on my tour all denied that ever happened but the nurses, orderlies, interns (etc.) were honest and I often heard something that caused me to immediately scratch the place off my list. I wound up crossing off all five available S.N.F.s and went back to the lady at Kaiser who was in charge of arranging to move my mother into one of them.
"Those are the only ones in our working area," she told me. "She has to go to whichever one will accept her." I asked if I could get a list of — and go inspect — the S.N.F.s in the adjacent working area.
Kaiser is a big organization. They were trying to move my mother to an S.N.F. within a ten mile radius. "Well," I asked, "what about outside that ten mile radius?" She didn't know why that couldn't be done but said that a certain Mr. So-and-So (I forget his name) would have to okay it. I went to see Mr. So-and-So and our conversation went roughly like this…
MR. SO-AND-SO: I've been here nine years and no one has ever suggested this.
ME: I've been bringing my mother to Kaiser for a lot longer than that and I'm suggesting it. Look, if my mother suddenly moved her residence to twenty-five miles away, you'd make the nursing homes in that area available to her. And you'd assign a Kaiser doctor in that area to check in on her in the nursing home in that area. Why can't we do that without her moving her home?
MR. SO-AND-SO, after thinking a bit: Well, the only problem I can see would involve transporting her farther. We have ambulances and drivers who are supposed to stay within the area.
ME: I have a car with a full tank of gas. I will get her there and take her home and whatever else has to be done. Besides, my mother would much rather have me drive her somewhere than one of your drivers and it won't use up their time or the gasoline Kaiser pays for.
He thought for another few seconds and then said those wonderful words, "I can't think of a reason to say no." An hour later, I was driving around that adjacent area, checking out S.N.F.s that were more than ten miles away. I found a real good one in Torrance. It was 22.3 miles from my home but I decided it was worth the drive. If I could time my visits to not involve driving at rush hour, I could get there in about 40 minutes.
The place was so far superior to options closer to me, I decided it was worth the commute. I had a nice chat there with the fellow who ran the place and we bonded. Turned out he had once been an avid reader of Marvel Comics and was delighted to meet a guy who'd worked for both Stan Lee and Jack Kirby. I'm reasonably sure though that wasn't the main reason he agreed to make a private room available for my mother and to tell Kaiser that they would welcome her.
As I left there, confident my mother would like the place, I had a sudden thought. Some of you may recall a long, maddening tale I told here back in this message. I was hiring caregivers from an agency that supplies such folks and while we had some good ones, most of them didn't stick around long and I caught two of them — one after the other — stealing money from my mother.
Those ladies were immediately fired but even after I supplied solid proof of their crimes, the police never got around to arresting or charging or even looking into the matter. I did sue the caregiver agency and they reimbursed me for the losses.
Most of the caregivers we had for her were fine and honest and a few were pretty good. The best one was a lady who I wished had stayed with it but she had to give up caregiving for personal matters. As I was driving home from my inspection of the S.N.F. in Torrance, I suddenly realized something: That great caregiver lived in Torrance! I pulled over to the curb, found her number on my phone, called her and asked if she was interested in part-time work helping out my mother there. When I told her which S.N.F. it was, she said, "That's about six blocks from where I live. Absolutely!"
So that's how my mother not only got into a good Skilled Nursing Facility but also had her own private caregiver there who'd come by whenever I couldn't. The caregiver did her laundry and brought her better food than they served at the S.N.F. and kept her company and ran errands for her. If you had to be in a place like that, it was about as good an experience as it was possible to have.
My mother returned to that S.N.F. a couple of times. She passed away there and all the right things were done. And it was only possible because we found a way around the rules.
This has been the second of three parts here on this topic. In our third and final installment, I'll tell you what happened when I had to find the right S.N.F. for my dear friend Carolyn. This one was more difficult but I found a new way around the rules…one that was inspired by the legendary Sgt. Bilko. It did not involve lying as he sometimes did. Anyway, you'll understand why I'm illustrating this story with photos of him.