Habit

by Susan Morse

  —Got it, Bertie. How does the appeal process work?

  —Basically, Ms. Morse, you try a series of appeals providing detailed letters from the many medical professionals caring for your mother now (who are justifiably appalled at our behavior) specifying why this decision is not just inexcusable but also seriously stupid. Through all these appeals, we will keep repeating the same denials until hopefully you will give up in exhaustion.

  —I wouldn’t count on my giving up, Bertie.

  —You’re welcome to try, Ms. Morse, but it’s a little irksome to us that your mother has an advocate like you. We wrap things up so much more efficiently if the patient is old, doped up on OxyIR, can’t write, is barely able to hold a phone, and is stuck alone to advocate on her own behalf. We have every confidence that you will fail miserably anyway, and come to regret that decision you made after your father died to save a little money on premiums by leaving Medicare, which treats patients a little more like humans and not statistics. You will curse yourself for switching your mother to an evil, stingy HMO like ESD.

  OxyIR: Tylenol with codeine. Ma’s still on it. I may have to snitch a couple for myself if this keeps up.

  —So you’re telling me you won’t pay for my mother’s care until she is better?

  —That’s right! We do realize we are being total monsters, so we’d like to offer you a tiny consolation. We’ll pay for your mother’s therapy for three days a week instead of the medically prescribed five. This is what I’ll tell you right now just to get you off our back. Hopefully, you will think it’s okay to stop paying attention. Then, when her therapists submit this inadequate program for authorization, it will go to a department that has no clue what is going on. They will say your mother is out of network, since she will still be two hours from home, in Carlisle. They’ll say we only cover patients so far outside their networks when the care is urgently needed. They’ll claim since she no longer qualifies for room and board at a Sniff, she must be fit enough to go back to Philadelphia for her continued treatment.

  —That’s ridiculous. She’s—

  —Yes, you and I know that this will not be true. But still your mother’s Arnack will have to spend hours on the phone trying to explain the mess to a series of completely new people who have been thoroughly trained to lie to her and block her every way they can by putting her on hold, disconnecting her accidentally, and so forth. Our hope is that the Arnack will give up, too, and her facility will think long and hard before admitting the next poor old lady who has the misfortune of being covered by ESD. The best outcome to all of this is if sometime soon, when people with HMOs like ESD need rehab, there will be no facilities willing to admit them at all. It will be a great savings all around. Don’t you think it’s really in all our best interest, yours included, if you just let your mother die as soon as possible?

  —I’m sorry. It’s actually your job to get me to give up on my mother?

  —Come on, Ms. Morse; don’t act like you haven’t thought of this already.

  —My God.

  —Everyone thinks about giving up, Ms. Morse, even if they’re so repressed they can’t admit it to themselves. Most people harbor tremendous resentment for their aging parents. Did you have a perfect childhood, Ms. Morse?

  —No, but—

  —And how has your relationship been over the last several years?

  —Not great. But I think it’s been sort of getting better—

  —That’s your problem. Guilt.

  —What?

  —You pushed your mother to get the cancer treatment. You’re trying to keep her alive as long as possible, right?

  —Of course, I am.

  —Have you ever wondered why?

  —Why what?

  —Why you keep trying to help her if she was such a disappointment to you. What is it that makes you keep doing that?

  —This is not about guilt!

  —You can tell yourself that. But everyone’s been there, even if their parents were nothing but delightful—the fantasy about Dad dropping dead in the checkout line at the grocery store right after a perfect physical. Mom going to bed a month or so later, feeling fine, and drifting off in her sleep. Or how about a real timesaving two-fer: Both of them could give up the ghost together arm in arm, hit by a truck crossing the street! You’ll feel much better if you just admit to these thoughts, Ms. Morse.

  —This is sick.

  —Yes, and that’s the problem. You’re repressing what you really want for your mother and driving yourself crazy trying to prove you’re a good daughter. This behavior is bad for you, and quite frankly, it’s bad for us. We have the misfortune of living in an era of such extreme medical advances that older parents are being cosseted and spoiled and kept alive far, far longer than they should be, Ms. Morse. It’s not exactly rational of you to help your mother out of guilt, and it’s incredibly expensive for us. The bottom line is, all this therapy and care is only putting off the inevitable. So that’s where we come in. ESD is here for you in your time of need, to provide some much-needed tough love. We make the practical decisions people like you can’t bring yourselves to consider.

  —Wait a second. I thought it was supposed to be the Democrats who want to pull the plug on Grandma. Health care reform hasn’t even been initiated yet and this is what you plan to do?

  —This is our best-kept secret, Ms. Morse. We’ve never needed a Democrat in the White House to put little old ladies out of their misery. Just get them to break their hips out of network and we’ll take it from there.

  —Wow. I had no idea ESD’s health management was so comprehensive.

  —So, Ms. Morse. Have I satisfied your needs at this time?

  —Thanks, Bertie. I think I’ll stay in denial and work on that appeal.

  The lions have slipped the latch of their pen at the zoo. The whole group is out on the prowl. They have just located a sign. It reads:

  I was already deep into the labyrinth of figuring out how to get Ma the heck out of ESD, but for other reasons. It had seemed like a good plan, back in the 1990s, to pay less every month, especially because Ma was macrobiotic and wouldn’t even take Advil at the time. She had made a living will and literally thought all doctors were fools. ESD paid for her cancer treatment last year without much fuss, and I got the hang of requesting all the approvals on time. But at the end of the eight-month process, we got a notice that Ma’s co-pays were about to skyrocket. This meant that if she were hospitalized again, savings on premiums would be completely nullified by the cost of treatment for any future illnesses.

  So I’d begun exploring a switch from ESD back to Medicare. The thing making me increasingly anxious was the chance that, because she had not finished her treatment for the Orthodox Christmas broken bones, Ma could fall into some crack between the two policies. ESD did seem to be assuring me that we were allowed to disenroll up until March 31. My last phone call to ESD, though, was with an obliging man with a very thick Spanish accent. The battery was running out on the phone because of all my time on hold, and I felt mistrustful:

  —(on phone) Are you SURE I can disenroll my mother anytime before March 31?

  —I theenk so.

  —You THINK so.

  —Well . . .

  —Look, I need to know for sure.

  —Lemme talk to my supervisore.

  Click. Muzak Muzak fading dangerously in and out.

  —Meesus Morse?

  —Yes?

  —You can.

  —I CAN?

  (I have to be sure. This is crucial. There’s this Spanish tendency to drop the “t” sound after the “n” at the end of English words. . . .)

  —I CAN or I CANNOT?

  —No.

  —No. I CAN’T disenroll my mother before March 31?

  —You can.

  —Got it. I can’t.

  —No . . . Meesus Morse, you . . . CAN.

  (The phone is fading, please, phone, DON’T DIE NOW.)

  —C-a-n, I CAN?

&
nbsp; —Yes.

  Once we disenrolled from ESD, they would no longer pay for anything. This was a little scary, and required checking back with Medicare to make sure they’d really take it all on when she changed over to them. Medicare said they would pay what they were responsible for, but they do have limits. This is why with Medicare it is important to get a Medigap.

  Arp Medigap: American Association of Retired People’s Medicare supplemental policy. A common alternative to an HMO is Medicare with a Medigap: a supplemental to pick up what Medicare won’t. Medicare premiums get taken out of your Social Security, but you have to pay for the Medigap yourself. It’s not cheap, but it’s worth it. You get your pick, and the one we’re flirting with is from AARP, affectionately referred to by those in the know as Arp.

  A couple of weeks ago, Ma and I had called Arp to start the ball rolling. Leaving ESD was not as easy as Arp made it sound. Having been jerked around enough by the system, I was deeply wary, and terrified to actually commit until I was sure I wouldn’t inadvertently get Ma into a jam where nobody would pay for her care. What was freaky was that each time I called Arp, I got a new person with a different version of how things would go. One would say yes, switch her any time and we will start paying for her rehab therapy from the day you switch. Next day, I’d call just to double-check before disenrolling from ESD. A new, grumpier Arp doppelgänger would need to hear my story all over again before I could even get to any questions:

  —Name.

  —von Moschzisker.

  —Spell it.

  —Small-v-as-in-victor-o-n-as-in-Nancy. New word. Capitol-m-as-in-Mary-o-s-as-in-Sam-c-as-in-camera-h-z-as-in-zebra-i-s-as-in-Sam-k-e-r. It’s pronounced von Mush-ISSker.

  (Daddy had a brilliant spelling technique, but I was too grumpy myself to indulge in it:

  v as in wiener schnitzel

  o as in eau de cologne

  n as in encephalitis

  M as in empire

  o as in aubergine

  s as in estuary

  c as in seaside

  h as in agency

  z as in xenophobe

  i as in eyesore

  s as in escarole

  k as in que sera sera

  e as in eejit

  r as in aardvark. Or Arnack or Arp, come to think of it.)

  The Arp doppelgänger would go on to say that even after the switch, ESD would still be responsible for Ma’s rehab. Then I’d call ESD and, of course, their position was pretty consistent: Once Ma disenrolled, they would not pay for a single thing. Meanwhile the express train was roaring though the stations on the way to the deadline for the switch, March 31.

  Every time I called Arp, Medicare, or ESD, they would try to trick me into their automated phone system’s deathtrap. Here’s how to bypass their robot questions (maybe mark this page):

  —Are you calling about a claim?

  —Agent.

  —I’m sorry; before we switch you to an agent, we need some information. Please enter your member number by pressing the touchtone buttons on your keypad, or if you have a rotary phone—

  —Agent.

  —I’m sorry, but that number is not in our system. Please—

  —Agent.

  —I realize you would like to speak to an agent. To assist us in directing your call, please spell your last name—

  —Agent.

  —Please hold for the next available agent.

  Click.

  Followed by forty minutes of sporadic, sputtering Muzak.

  I’ve learned to use speakerphone so I can be hands-free to put away the laundry or check out Medicare websites for more information. On one of these sites, I notice a familiar name: an old neighbor whose photo keeps turning up on all the websites for Pennsylvania’s senior citizens business, right under the state seal and Governor Ed Rendell’s beaming Democrat face. Andrea, whose daughter Noni went to school with Eliza. So Andrea is Secretary of Aging? Our home intercom systems were so similar they used to interfere with each other. Occasionally, I’d be alone in my house and hear Andrea’s clanking pots and pans and her voice crackling out of the intercom:

  —Noni?

  —What?

  —I can’t hear you. NONI?

  —What?

  —WHAT?

  After the novelty wore off, we decided it’d be safer to use different channels. I think I have Andrea’s home number in the school book. Hmmm . . .

  Click.

  Medicare’s sputtering Muzak stops playing. I leap to attention, and snatch up the phone.

  Foreboding silence.

  Ring. Ring. Ring.

  —If you’d like to make a call, please hang up and dial again.

  If any of this seems familiar, you have my sympathy. You also probably know what comes next:

  Medicaid: Not to be confused with Medicare. Medicaid pays for the total health care needs of low-income people who can’t afford drugs, or even things like co-pays. This is what people in Ma’s situation can turn to if they still need to stay at their Sniff but Medicare won’t pay the room and board any longer and their funds are running out, their children are not made of money and their grandchildren would like to go to college.

  At this point, I am showing signs of wear and tear. David is still away doing The Seafarer, the Broadway play he’s waited for eons to do. For ten years, David has nobly turned down every stage offer, Broadway or no, because the schedule had been too hard on the kids the last time he did a play. But for this show, I told him we were finally ready—it’s fantastic. Now this get-out-of-ESD-with-the-rats-and-move-into-Arp thing is happening and I hate to regret our decision, but wow. The fear factor has catapulted me into a strained mental state for a couple of weeks now. Colette is busy drawing up fresh Operation Ma financial projections and trying to keep Felix up to speed on the spreadsheets, which is no mean feat. She’s alternating between being unbelievably helpful and sort of scarily, cold-bloodedly efficient. She knows we can’t commit to pay indefinitely for Ma’s health care, and she tries really hard to give me the space to face facts and deal with them in my own way, but what it boils down to is that talking to Colette these days is like having a root canal in the middle of a tax audit.

  Ma has agreed to close up the apartment, and we are confronting the possibility of literally hundreds of thousands of dollars needed to get her comfortably through to the end, which is looking less and less pretty.

  Colette’s waiting for me to say the word and she’ll fly over here. She is like a rock, every morning on the phone and throughout the day, too. So is David, who’s getting a little concerned because he’s never heard me sound so utterly, hopelessly stumped. It feels like every ounce of energy is being used calling, calling, thinking I have a plan, then having some new insurance person on the phone shoot it down.

  When the boys stayed home for a snow day recently, they carefully steered around me, pacing back and forth in my headset, on their way in and out from sledding. Sam impresses me. This morning on the way to school, he informed me that there is something not right with this ESD stuff. Either he’s reached a breakthrough and is emerging from adolescent narcissism a little ahead of schedule, or my condition is looking bad, bad, bad.

  And, I have lost the impulse to eat: It seems to make no sense to stop for breakfast or lunch, and then I’ll suddenly realize it’s time to make dinner. Because the boys need to be fed, I’ll throw something together and sit there with them, but putting the food into my mouth feels as foreign and unthinkable as jamming it into my ear. I have shed twelve pounds in two weeks, which, I’ve decided, is not actually such a bad thing.

  So, my old neighbor is Secretary of Aging for Pennsylvania. Wow, who knew? She sure looks like she’s important. One night after not eating dinner, I call her at home, apologizing for taking advantage of our mutual schools and addresses to ask a favor. Not at all, Andrea says, this is her job. The pots and pans clattering in the background sound sort of normal and reassuring. Andrea tells me Noni is at Mount Holyoke now—h
ope her cell phone reception is better than their intercom was.

  Next morning:

  Ring. Ring.

  —Jack Wasserman.

  —Jack Wasserman? You answer your own phone?

  —Yes?

  —Wow, I mean, I’m sorry. This is Susan Morse. Andrea—

  —Oh yes, Susan, Andrea’s told me you’d be calling.

  —You know who I am?

  —Yes, I hear you’re having some trouble. Tell me all about it.

  Words cannot express my relief. For those of you out there in Pennsylvania who need a Jack Wasserman in your life, I’m sorry to say he has recently moved on to head a new department educating Pennsylvanians on Long-Term Care preparation. This is good, he’ll do a great job and we clearly need educating. So here’s what you do instead of talking to him: Just Google the number for the Apprise office in Harrisburg. All Jack’s people are still there and they will help you (he says they’re like pit bulls, and he is right). They’ll answer the phone and everything. Not only that, they seem to know exactly what to do—it’s their job and they are there for you no matter who your neighbors are, God bless them.

  So if you end up in anything like our situation, hang in there and hip-hip-hooray for government funding. Medicaid can carry you through the lapse between the HMO’s plug-pulling tendencies and your mother’s hopefully full recovery. She can get out of her HMO and set up that Arp Medigap if you have the funds. Keep up the appeals, because chances are you will win.

  Then, when a few of the ADLs are up and running, if she’s lucky your mother (or mine) can go back off Medicaid, wave good-bye to the Arnack, pack up her stash of OxyIR and return to her Nork or her Alf. And you can start shopping for your own Long-Term Care policy.