A Navy veteran gets dumped for not cooperation in the Medicaid application process. You would have done it differently I bet.

The story in the Des Moines Register goes like this:

  • In July of 2013 the police and social services determined that John Chedester, 65 a Navy veteran was unable to live in his own home.  He was removed from his home and admitted to Elmwood Care Centre.
  • At the time of admission he was diagnosed with “post-traumatic stress disorder, diabetes, elevated blood pressure, congestive heart failure, sleep apnea and other ailments”.
  • “He had little or no family support, and he required supervision and assistance with walking and hygiene, according to state reports.”
  • Because he was a veteran he asked to be moved to the Iowa veterans’ home.  This did not happen and there is no indication as to why it didn’t happen.
  • Sixty days after he was admitted to Elmwood Care Centre he was given a letter telling him he was going to be involuntarily discharged for non-payment (October 23).
  • Further, staff reported that he was uncooperative with staff when they tried to sign him up for Medicaid, which would have paid for his care.
  • It was also reported that Chedester displayed signs of disorganized thinking and incoherent and illogical rambling speech.
  • Elmwood made arrangements for him to be moved into a nearby apartment building and even offered to have the furniture in his house moved to the apartment.  He refused that help and all help accessing home health services.  He refused to take his medications or use his prescribed oxygen.
  • The move took place on November 1, into an empty apartment. That same day a neighbor watched what was going on and tried to intervene.  The next morning this same neighbor called police and Chedester was taken to the hospital.
  • He spent 11 days in two different hospitals and, curiously, was ultimately transferred back to Elmwood Care Centre, where he remains today.

Slicing and Dicing

This facility is operated by Trillium Health Care Group out of Florida and they have strongly condemned what the local facility staff did and the Administrator is no longer working for the company.

  • I find myself wondering why the State of Iowa’s social service department was not deeply involved in this situation.
  • I wonder why the Iowa Department of Veterans Affairs was not involved.
  • This seems like the perfect time to get the ombudsman involved in the situation.
  • It seems as if somehow this guy who seemingly has serious mental health issues got sideways with the facility administrator and that, rather than dealing with it in a professional fashion, she reacted in a punitive manner.

The Culture Question

For me the bottom line is that, at least at this facility, there was a critically toxic cultural environment where a resident being impossibly difficult was sufficient reason to treat him inhumanely.  I find myself wondering how it was that the director of nurses, the social services designee and, for that matter, staff nurses and care givers could watch this all unfold without calling anyone.   I can only assume that there was such a culture of fear or apathy that all of these people were frozen in place to the point of allowing a resident, albeit a difficult one, to come close to dying. Because responsibility flows up-hill, one has to ask if this was a rouge administrator (which is possible) or if this is reflective of a corporate cultural problem that allowed an administrator to behave this callously. What Would You Do? While this story is a huge balled up mess where a whole bunch of people did the wrong thing, the question I would like to toss out to the community is this: If you have a frail resident (which is most residents) who refuses to pay their bills or help in the process of getting government assistance what do you do? In this particular instance before it devolved, what would you have done? Steve Moran

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