Here's an important warning about Medicare payment (or lack thereof) for patients who are hospitalized merely "for observation." It can end up surprising senior citizens with thousands of dollars in unpaid medical bills -- bills that are the patient's responsibility.
  
http://www.nbcnews.com/video/nightly-news/54026469/#54026469 
  
I'm guessing this is just a symptom of things to come as the working population dwindles and the ranks of Americans on Medicare and Medicaid continue to swell.

In the case described in this video, long-term care insurance probably would have helped the patient to some extent.

But with or without such insurance, it's up to each of us to pay attention -- especially if we hear the word "observation" being bandied about.

A couple of years ago, we lost an ancient shagbark hickory. It was my favorite tree, with its great twisting branches, enormous leaves, dangerously heavy nut casings and captivatingly craggy bark. It was a tree of great interest, if not beauty, every season of the year.

Remembering that tree this morning, I searched my "trees" folder for a photo of it. Astoundingly, I couldn't find a single one.

I have photos galore of every ornamental tree we've planted over the last 25 years -- pagoda and Cornelian cherry dogwoods, Japanese tree lilacs, weeping cherries, crab apples, magnolias and mountain ash as well as stunners like a Camperdown elm, weeping katsura, paperbark maple and a shy but graceful American redbud. I even have multiple photos of gone-but-not-forgotten trees that didn't make it, from an adorable dwarf willow to the risky sourwoods we planted in 2001; they managed to limp along in my pH-neutral soil for only a few years before refusing to bud out in the spring of 2004.

But there wasn't a single photographic record of that great old shagbark hickory.

In fact, the only grand old tree represented in this collection is the giant red oak now growing precariously close to our roof. Estimated by arborists to be at least 150 years old, it keeps the house cool in summer and protects us from the worst of winter. It is truly beautiful in every season, and arresting in its great old age -- if one bothers to look.

There were precisely two photos of this tree in my folder, including the one shown here. 

I have apparently taken the older things in my little world for granted, treating them as backdrops for all those beautiful young things clamoring for my attention.

I wonder how many of us do the same thing with the elderly in our lives, spending time with them on special occasions like Christmas and Easter, maybe even taking a photo or two of them with the rest of the family, but reserving our day-in, day-out attention for the shiny new youngsters in our lives -- self and children, pets and homes and even careers.
 
I'm ashamed to admit that I was guilty of such not-so-benign neglect myself, as my photo folders attest. I have literally thousands of shots of dogs and cats and perennials at every stage of the growing season, and many hundreds of my favorite roses -- but fewer than 50 of my parents, and only a handful of my beloved Granny.

They were too often, it seems, mere backdrops for what I considered the main show.

It's too late for me to do anything about it. But for many of you, it's not; I hope you're doing a better job than I did of lavishing the aged in your lives with the love and attention and respect they deserve.

Please don't take them for granted. Because indeed, one day it will be too late.

I spend a lot of time with elderly nursing home residents. One thing I’ve noticed over the years is that those with an abiding faith in Jesus Christ are happier, less likely to complain of loneliness or pain, and rather than being fearful of death, say they’re looking forward to going Home to be with the Lord and to joyful reunions with loved ones who’ve gone on ahead.  

In fact, whatever their individual circumstances might be, Christians in long-term care seem to be happier than non-Christians in long-term care.

If this is true, shouldn’t all nursing homes put some major emphasis on feeding the spirit? At least as much as they do, say, entertaining those in their care, and reminding them of the good ol’ gone-but-not-forgotten days?

Certain that researchers have studied this issue, and that the scientific literature would confirm my anecdotal observations, I did a scholar.google.com search for validating reports.

And was blown away by what I found. Which is to say: precisely nothing. It would seem that no one has even looked into this very obvious issue.

I started out searching for “Christianity” and “elderly,” figuring I’d find some studies on the impact of the former on the latter in long-term care settings. Astoundingly, just 11 articles popped up, none even remotely related to my quest.

I changed “Christianity” to “religion” and found 75 articles. But “religion” was mainly buried in lists of words such as “cognition, stress, mental health, personality, and sexuality.” I found nothing addressing my specific interest – at least, nothing in English. There was one report on the impact of Buddhism on blood pressure in northern Thailand, and another of the spiritual well-being of the elderly in France. But that was about it.

Yet do a search for “elderly” and “depression,” and nearly 1200 listings instantly appear.

Why has this very obvious issue been overlooked by researchers? Are they all atheists unwilling to even consider Christianity and its impact on the spirit? Or does that description better suit those holding the purse strings?  

Let’s get one thing out of the way up front: No nursing home is perfect. 

It won’t surprise you to hear that money is a primary reason that many fall short of the ideal. On the one hand, states are adding more stringent and costly regulations every year because – well, because that’s what bureaucrats do. On the other hand, as nursing homes’ expenses continue to climb, Medicaid reimbursements are plunging, so that these facilities are actually losing money, day after day, on residents who have run out of their life savings.  

This is why many nursing homes now promote themselves as short-term rehabilitation centers for people recovering from illness or injury; the higher reimbursements paid out by insurers, both public and private, help them make ends meet. But even then, the numbers are tricky, and every nursing home has to do more with less these days. There will inevitably be times when something or someone falls short of expectations.

Nevertheless, even in this environment, there are some real gems out there in the world of nursing homes/rehab facilities. I’d like to introduce you to my favorite, Care-age of Brookfield, in Brookfield, Wisconsin.

Disclaimer

My Christian mother lived at Care-age for seven years, dying there in May of 2000. I’m not proud of that – we could have taken her in, but I was a feminist atheist then and, much as I loved her, it would have been too much of an inconvenience to have her living here, too much of a distraction from my all-important work. (Talk about idols – but that’s another subject entirely)

After she died, in my despair, I began volunteering at Care-age, visiting a growing list of elderly women every week – at first, because they each reminded me in some way of my mom, and later, because I’d investigated the possibility that her imaginary Friend in the sky might have been the real deal, and had discovered that, once again, she had been right.

In a nutshell: I became a Christian myself. The love of God gripped my heart, and has made hanging out with my “old ladies” the joy of my life.   

The difference: Christ

I believe that it’s this divine love pervading Care-age of Brookfield that makes all the difference in the quality of residents’ lives.

It’s not a Christian facility, and I do hope I’m not getting anyone in trouble by saying this. I’ve never met the owner and have no idea where he stands on this question.

But I’ve visited and volunteered at other nursing homes, and the difference is palpable. From the top down, so many of the staff members are born-again Christians that love, patience, kindness and extraordinary service seem to dominate.

Just yesterday, for instance, I saw a wonderful young singer lifting up his Savior in beautiful song for a huge group of residents; he concluded his performance by giving everyone a free copy of the gospel of John.

I found one aide patiently, and with great good humor, helping two residents figure out how to put on a (very confusing) new pocketed shawl.

I watched another employee leading a dozen especially disabled men and women in a hymn sing, complete with five-star devotional readings; she does this a couple times a week, doing the hard work of gathering these residents herself.

And I witnessed an entire flock of nurses taking the time to talk and laugh with an elderly man who was beaming with joy at the hilarity his jokes were generating.

These are just a few snapshots of what I see around every turn at Care-age – staff members delivering peace, joy and love to assuage the challenges, heartaches and disappointments of debilitating disease and old age.

The proof: people want to live here

Like I said, no place is perfect. Sometimes the food is less than gourmet. There can be staffing shortages on some shifts, especially among those who do the hardest work. Sometimes a resident has to wait too long for help getting to the bathroom, or is treated with disrespect by a renegade employee. And no one can fill the void left when children are just too busy to visit for weeks or months on end.

But get this: One of my dearest friends at Care-age – let’s call her Lucy -- could be living with her daughter, who regularly begs her mother to pack her bags and come home.

But Lucy doesn’t want to.

“There, I’d be alone so much of the time, while my daughter does her thing, visiting friends or shopping or fixing up the house and yard. Here, I’m around people my own age. We have the same interests and memories, and there’s always something going on in Activities. And the staff is so nice – I just love them, and I love this place. It’s one big happy family and I’m here for the duration!”  

And Lucy isn’t the first one who has expressed such feelings to me over the years.

On the flip side, I have a wonderful and very fragile old friend who lives with one of her children – a child who loves her very much and seems to treat her with great affection and tenderness. The trouble is, she’s alone most of her waking hours (the child works, of necessity) and she has no other companionship. Visitors are rare, outings even rarer. Having spent a good deal of time at Care-age herself as a volunteer, she knows she’d be happy there. But nursing homes are expensive, and her kids don’t want her to spend her money on one. Case closed.

Finding your own Care-age  

It’s apparently difficult to find a place of this caliber. Unfortunately, a beautiful building and luxurious amenities don’t reveal much about the character of a place, or how you’ll be treated there.

If I were looking for a home for myself or a loved one, and Care-age had disappeared, I would begin by asking everyone I know for input, and then doing thorough internet searches for comments, reviews, ratings and awards. (Care-age has been ranked among America’s top nursing homes by US News & World Report for three years running now, and has been named to the Best of Brookfield list every year since 2009.)  

I would check with the state group in charge of nursing-home regulation. In Wisconsin, it’s the Department of Health Services; you can find out a lot about individual facilities from a resources such as this.   

Having narrowed down my search through investigations like these, I’d visit the top three or five on my list. I’d arrive armed with a list of questions of personal import and would seek permission to ask those questions of several residents – in private, if at all possible (I don’t know if that would be legal, let alone permissible – but I would make the request). I’d take a close look at their activities calendars. And I’d ask if they had any testimonials or thank you letters on file. 

If the need wasn’t particularly urgent, I might pop in at a few different times, if I could, just to see what’s going on and how content people seem and how clean the place was over time.

After all of that, I would listen to my heart: Which facility seemed like a place that I’d like to call home?  

If you’re in need of finding a great long-term care facility, today or years down the road, I hope that you’ll find a treasure just as wonderful as the one I call my home away from home!