The People Who Know Things

Day 21 ends with Mark being placed! Finally. Moving to a skilled nursing facility. This has not been an easily won battle. Mark’s been ready, the docs say, to be discharged for a few days. Hospital social workers have been trying to find a skilled nursing facility that will take him. I think of them as The People Who Know Things. They’ve been trying to bring me up to speed on how this massive part of the US health care system works. The problem seems to be Mark’s combination of needs. He’s still confused and being guarded by a sitter to keep him safe. The People Who Know Things tell me the only option for keeping him safe once he’s discharged to skilled nursing is to be placed in a locked unit, and the only kind of locked unit is dementia.

This sounds both terrible and great. It’s great because once Mark got out of the neuro ICU, which is locked, the next units he has been on are unlocked. Surprisingly, for the fact that this is the major trauma hosptial in our city, there’s almost no security other than in the ER. You can walk right in, take the elevators up, and walk into the units without ever saying hello to a single staffperson. That also means that Mark could probably figure out how to make it to the elevators and end up anywhere in the hospital, or out of it for that matter, and it’d take a long time to find him. I like the idea of him not being able to get lost or escape.

The People Who Know Things are having a hard time getting Mark a placement. They ask me for parameters. They print off lists and ask me to prioritize my choices. I’ve heard of none of these places. The print offs are from internet searches and they have star ratings. What do these mean? Not much, the People tell me. They take my random rankings and make calls. Rejection, rejection, rejection. We move from facilities within 5 miles to within 10, then 15. T “Why won’t they take him?” I’m trying to understand. The People tell me that they don’t want to take someone who is not only needing rehabiliation from brain surgery, but who also has to be go to chemo. Facilities don’t want to cut into their bottom line by having to transport Mark to his many trips to the hospital.

Yet another list of options is generated. One social worker points to the name of a facility and says, “My dad was in this one. It was good.” Okay, I said, making it my latest top pick. She called, and miraculously, they said yes. We had a placement. Within a day, Mark would be transported by ambulance to a skilled nursing facility.