A mini medical marathon... Seven days at the nursing home, following three days at the hospital... a total of ten days away from her “little apartment” - so far. This, the result of a midnight fall in her bathroom has left Mom a little down in the dumps... Nothing broken but a bruised coccyx, a super sore ankle, and a little confusion.

Today (as Mom’s “primary caregiver”) is my first meeting with her case manager. A little uncertain, I’m wondering - who decides what at this little get together? Will it be informational, cooperative and/or adversarial?

Theoretically, case managers are like quarterbacks; they assemble information from the various players involved in Mom’s care, and determine what the next play should be. As such, our meeting should be informational and cooperative. Mom will be present, pleasant, and playing with a full bag of marbles. We’ll talk about where she’s been and where she’s going... She’s at such-and-such a rehab’d state... in need of a little more ABC... before she can go to blah, blah, blah. Simple, huh?

But I sense it won’t necessarily go this way...

It’s a well-worn joke in my family that I have an aversion – on every level – to “The Man”... that I am woefully mistrustful of most public and private service providers to which we are partially or fully enslaved; Comcast, Verizon, and the insurance industry being top place holders.

Especially the insurance industry as a whole... the complicated behemoth that often decides whether we live or die – quite literally.

And I am typically unable to contain my distaste for The Man... it seeps into my facial expressions, creeps into my tone, and manipulates my body language. I’ve stopped feeling guilty about my mistrust, or feeling less than those who do trust, but I still steel myself for battle when I sense even a whif of The Insurance Man coming to take advantage of me or anyone I love. 

This is where the adversarial part of my question comes in. I’m not sure whose team the seemingly lovely case manager is on... ie: who’s paying her?  

Thankfully, Mom has the crown jewel of senior health insurance... a golden package containing Medicare, Blue Cross/Blue Shield Gold, and some supplemental sparkle called Medex. The total cost of her shiny monthly nut? About $1500. Painful.

One would think this level of medical insurance would cover 365 days a year for the remainder of her 92 year life... that she could go pretty much anywhere-the-eff she wants to go. At least I would think that... but I would likely be wrong.

Laws, laws, laws.... both, state and federal, muck it all up, and I believe part of the case manager’s job is to make this reality more palatable.

Despite my (grossly apparent) presentment (not to be confused with presentiment), I have to keep my focus on Mom... On her wants, her needs, and her feelings. In short, my job today will be to keep my personal distaste for the insurance machine out of the meeting, and to actually quarterback Mom’s emotional concerns... to make sure the powers-that-be understand Mom is not going anywhere until she feels ready to do so... that despite her expansive Medicare benefits, and/or her primo BC/BS provisions, the nursing home may not send her home until she feels ready to go.

The puzzling part of all this is that Mom unknowingly sends mixed messages to her various care providers, making a definitive diagnosis of her actual condition difficult to discern. Her desire to be kind to all humans and to assume their best intentions can sometimes distort the reality of what’s taking place...

How do you feel today Mrs. C?

(Mom smiling) I feel pretty good.

VS.

How’s the pain today Mom?

(Not smiling) Like an 8...I’m feeling pretty discouraged...

And so, a true understanding of Mom’s actual state of rehab’dness will require my best efforts in interpretive, inferential, and forensic skills. I’ll be forced to read between the lines (which may be difficult while clutching my shield against The Man).

But this is what I’m in training for... a practice run for my future caregiver duties... an opportunity to practice smiling and nodding... to have faith that The Man won’t release Mom if she doesn’t feel ready to go... even if her eligible insurance days are used up... an opportunity to exercise patience and compassion with all parties involved... to give The Man the benefit of the doubt... in short - to take a page out of Mom’s playbook.

Hopefully.