What to do about Grandpa.
As the only sentient life on this planet, there are a few topics we humans refuse to think about
1 -Our own inevitable death,
2- Our parents having sex
3-What to do about Grandpa!

Grandpa is now 89 years old. He is mildly deaf, moderately demented & now he can’t get to the bathroom on his own. A Home health aide comes twice weekly to  bath Grandpa—but it’s not nearly enough help. Grandpa’s dementia is worsening &  he often keeps Grandma up late into the night with his confused ramblings. Grandma has health problems of or her own  is getting worn out! She needs help. Her children call often but live far away and can offer only moral support.

I meet poor, frazzled Grandma at 2AM on a Sunday night when she brings Grandpa to the Emergency Department. On exam he is pleasantly confused, has a wet patch in his groin area, and  has dried food in the corners of his mouth. Grandma is exasperated and  tearfully states “I simply can’t take care of him any longer!”—and” I refuse to take him home!”
 Unfortunately this is a very common scenario in our retirement oriented community. We get at least one such “case of Elder Ditch” per shift!

I do a medical workup on Grandpa & find no new medical problems except slowly worsening dementia. I call the Social worker for help. She & I both agree grandpa needs to be in an assisted living center. Now comes the ‘Catch 22”-Care centers are very expensive (in excess of $300.00 a day) Medicare will pay for up to 6 weeks in a care center BUT ONLY AFTER A 3 DAY HOSPITALIZATION. (medicare could save 3 days hospital charges if they dropped this rule)  Me and the Social worker  search diligently for an admission diagnosis (Medicare will refuse payment, or sue the hospital for fraud if we can’t find a FIXABLE PROBLEM for our diagnosis) the other option is to send Grandpa directly to a care center—private pay (most care centers will want a $1000.00 check from Grandma upon arrival)
The social worker reveals: “Grandma doesn’t have that kind of money”
The Primary Care Physician says: “Grandpa has no infection, no new stroke, no new heart attack etc. An admitting diagnosis of Weakness, Incontinence, or Worsening Dementia won’t fly with Medicare as an admitting diagnosis”.

Bottom line—Grandpa needs a care center & he & grandma have no money for this obvious necessity. Where are the children? Wisconsin, California?

At this point in the scenario I wish my back molar were a cyanide capsule and I could just bite down….

Dr Who?