Branson Memorial Day

     It's Memorial Day '16 in Branson, Missouri, a Midwest Destination Resort Town in the Ozark Mountains. Traffic is gridlocked with as many as 50,000  vacationers seeking connection to their imagined bucolic 19th century past complete with cabins and fishing and fiddle music. They will find it, although expensive and only shoddily replicated. In early December, after Branson's Tourism Commision extracts the last Vacation Dollars for A Country Christmas, our Town will transformer back to it's authentic, small, unexplainable Republican, Bible Belt Town.  By then we will be reliant for Winter Funding on Hillary's Entitlement Deposits compliments of Beijing.
     My sister and I retired here during the '08 "economic adjustment". Although our parents were from this region, and of this culture, we have had a hard time feeling "at home".  We often muse about moving  just to reinforce our apartness from District 9, this, twilight zone, place that we believe Ronald Regan created by accident.  Our speculation is that Reagan's universal appeal and oozing charisma, ingratiated his politics to rural regions inhabited by mythic souls that were never able to differentiate between Borax and "trickle down economics".  The result was that it mixed up the rich, the poor, the Jesus loving, and the Wall Street loving; all in one stew.  A generation later, at least here in the rural heartland, we are so "purpose confused" that we have fallen down the culturally rabbit hole.  
     I have included below a satire verse recently offered for my sisters 60 something birthday. It is strong biased humour, but it points to some sad truth about Our Town. 



                              A Branson Birthday


An hour of years, plus three, stranded in Branson

A small step up from a Valley Girl, indentured to Manson


Expansive forests blemished by constricted minds

 Low energy citizens self organized on a spectrum of kinds


Each has a dynamic yielding a low tide existence

 All Instinct driven, with little, if any, reasonied resistance


It's druggies, and militia, and conspiracist, and welfarist, and Jesus Promoters, three ways

But, alas, not so many Asians, or Muslims, or Phd's, or gays


For Some

It's meth and heroin and bath salts when they're too wasted to steal

They know there's a church on the corner for a pillow and a meal


For Many

It's imagined "survival by conflict", sanctioned  from heaven

Pick ups advertising "don't tread on me" or my AK-47


For a Whole Lot

It's "yessiree, life would be better if the f'in liberals would let us be free

So long, of course, that they keep sending money to my daddy and me


For Even More

It's bad backs, and knees, and and stomachs, and heads, inside and out

Disability by 40, "that's what I'm talking about"

As soon as my D-card next loads I'll send you the rent

Alimony and tires and Bingo, this months done went


For Almost Everyone

In this life, I am joint-venturing with Jesus and, praise the Lord, I am thereby shielded from scorn

It is only for his glory that he let me be born

So if I seem inattentive, or lax, or uninterested, or irrational, or bitter, or malevolent, or vindictive,, or deceitful, or just plain bored

Well, that's too damn bad, cause first comes me and the Lord


Yes, it's a wonderful life and I know you just love it here,  with all of the slothfulness, selfishness and fear

So, Hurray for Branson, shed not a tear; We'll celebrate same time, same place, next yearr







Because I Love Jesus......

Because I love Jesus, I am going to speak out about how Donald Trump captured the support of We the Christian Faithful in America  Mr. Trump likes to say that We love him because he promises, in his straight talking style, to make America Great Again. He says that Great Again means that we will be safer and richer.  Yes he says this, and We that love Jesus pretend that we want this too.  Confession...we that love Jesus and Mr. Trump have this "hidden agenda" thing going. He knows he's speaking in code and we recognize that his rhetoric is coded. He doesn't reveal, and we don't cheer, for the "Real Agenda".  

For God's sake, does anyone really think that what We, the faithful, want is to be rich.  Our hearts belong to a Homeless Carpenter, taken down by elites of his day.  And to be safe,...how absurd; we have been "born again" in this life to an unshakable ambition to escape this sinful world.  So what is the cloaked "Real Agenda" that tethers, We that love Jesus, to this Donald Trump movement. HE IS A RACIST AND SO ARE WE!  There, I said it.  We that love Jesus are not particularly pround of what we deep down acknowledge only in our own thoughts, but indeed subltly act upon ever minute of every waking day.  Kamal, the Black Dude who hosts the CNN show about race in America is really right.  Racism is strong imprinted on our DNA and may well never be purged. So yes, we really like Trump's economic and security policies because they will accelerate our unfufilled agenda to return America to it's 1953 segregated/subordinated social construct.  Indeed, we have during recent years made significant strides toward this more historically embraced societal structure.  Note the number of "aparteid schools", the incarceration stats, the combat death ratios  etc.  We are the faithful and confidently will follow The Donald into what we hope will be a more "naturally ordered tomorrow".


Of course there is no chance that We who love Jesus, will vote for Obama's friend, Hillary. Further, we will instruct our women to do likewise and reprove those who fail to heed our mandate.


The Nursing Home Nightmare


  Who among us has good things to report about Nursing Homes?  Virtually no one!  Old buildings with drab decor, prison like furniture, dark shared sleeping rooms with cheap privacy curtains and shared institutional bathrooms; “not the first choice for mom’s last home”. So why do these facilities continue to be an important component in our nation’s solution for coping with an aging population?  In one word, “MEDICAID”.  Before 1965, when Medicare became available, there were only a small number of church/benevolent sponsored Nursing Homes.  Only with Government funded support did a widespread private industry respond to the heartbreaking neglect of the nations‘s poor elderly.  Google says that Medicaid is a State/Federal Health Program for the “needy”, but as it has turned out 50 years later, about 90% of Advanced Age Seniors are “needy”, so it’s really a program for all of us except for those few "financially fortunate" families. 

    You see, it costs more than $4000 per month for mom to occupy that 200 square foot curtain defined space in a bleak building that no one wants to call a home.    Given that life expectancies for newly admitted patients are on the rise, and 5 years is often expected....well it’s going to cost around $250,000, for mom to end life in this institutionalized patient model.   Of course, as you well know, exactly none of the 90% happen to have $500,000 available to pay for their parents care....so what to do?  The Answer is:  #1  Take all of mom’s assets  #2  Redirect mom’s Social Security/Retirement checks to the Nursing Home  #3  Have Washington borrow the shortfall from the Chinese and send it to the Corporate Owned Nursing Home.

So what does Mom get for the $250,000, of which about $50,000 will come from Mom’s Social Security/Retirement, and the balance which will come from Beijing by way of Washington Borrowing..  Well she will get the right to put a television on her side of the shared room, but probably not a personal chair, nor will she get an unrestricted telephone. She will get three meals daily, nurse aide support as necessary, an emergency call pendant and weekly/emergency visits from an Vocational Nurse.  Mom will routinely see a Doctor (far more likely a Nurse Practitioner) monthly for a very brief in-room visit. The Doctor will be allowed to bill Medicaid separately for these visits.

Once stabilized as a Nursing Home Patient, Mom will most likely no longer see her Primary Care Physician, nor be taken to the Hospital ER, nor Admitted to the Hospital for Condition Changes arising from general health decline.  Indeed, the Nursing Home will receive funding from Medicaid to fund the cost of educating Patient Families not to insist on Hospitalization except in the most extreme situations.  While the Nursing Homes Management, charged with maximizing census and thereby Medicaid Revenue, cannot prevent families from arranging for Non-Nursing Home Services to be provided for Mom, they often constrain family choices by veiled threats to report alternate choices to local “Senior Abuse Agencies”.  Families in complicated moral situations are fearful of Nursing Homes issuing “AMA”, (Against Medical Advise) Reports to alternative Care providers, as the price to, literally “get Mom out of a horrible place”.


Why do Nursing Homes follow such a Hard Line regarding their control over their patient’s post-admission choices?   The Answer is that it fulfills the basic reciprocity in the Nursing Home's business dynamic with the Hospital.  Under Medicare regulations Hospitals are financially penalized when Seniors repeatedly return to the Hospital with a chronic health issue.  The unacknowledged, but strong understanding between the Hospital and the Nursing Home is that the Hospital will aggressively insist that when discharging an “unstable seniors”, the patient will  be admonished that they absolutely must receive Nursing Home provided Skilled Care.  Admonishments, it is often reported, involve threats of  “Senior Abuse Reporting”.   The Nursing Home reciprocally accommodates this "census driver benefit" by managing Mom’s condition exclusively in-house....less expensive for Medicare/Medicaid, better for the Nursing Home and the Hospital-- for Mom....not so much!  This may be acceptable, even efficient, for “disenfranchised America”, but unfortunately this protocol is applied to all seniors exposed to the system. 

    In summary, as a safety net for the millions of “Advanced Age Seniors with no financial resources to access the private market", the safe and secure, but almost always  dismal and depressing, Nursing Home Option is,a GodSend.  For those families whose temperament, resources and moral imperative compels a better “Advanced Years Lifestyle” for their Mom...well, there are many far better options.  Understand this....Mom does not have to be a “faceless economic pawn” in some Health Industry CEO’s quest for a better bottom line.


The Cost of Saving My Life is to Forfeit the Rest of My Life!

     All Americans are delivered a daily diet of "Media Medication Commercials".  Every possible "dis-ease" is frightingly illuminated, followed by a recommended  prescription medication promising resolve.  Common to all advertisments is a perfunctory warning regarding limitations and side effects. These warning always ends with the CYA admonishment to......"Call Your Doctor".  A Serious Question is implicit.  Will "Calling Your Doctor" really resolve anything? 

     Well first, we all know that we can no more call "our doctor" than we can just dial-up Barack Obama.  At best we will have a brief conversation with a minimally trained receptionist whose only latitude is to schedule an appointment or instruct urgent patients to visit their Hospital ER.  At worst, "calling your doctor" yields only a telephony message asking for a call-back number, a call which never comes.  While this "in due time" protocol may be appropriate for sore throats, migraines and toenail fungus, it is not responsive to Advanced Seniors experiencing highly unstable symptoms. In these situations everyone know that the Senior should forget about their Doctor and go straight to the Hospital ER. 

      These seniors, having no practical options, are making these trip in stagering numbers. They, and their concerned family members, should realize that these Hospital ER encounters are "life changing", often for the worse.   As such, Advanced Senior must  consider that being "admitted" to the Hospital  may not only result in significant expense, but that their very freedom may be at risk!  

     This may sound preposterous, the incitings of a social alarmist, but seriously you Baby Boomers with 80's aged parents.....it happens every day;  here's Why & How!  It's all about the money. Under Medicare Payment Policies, Hospital's who "Re-Admit" Seniors for recurring related health issues are severly financially penalized by Medicare..  Indeed Doctors treating In-Hospital patients who have been Re-Admitted will also suffer starting soon.  Not surprisingly the consequence of this disincentive is that Doctors with support from Hospital Social Workers and Discharge Planners are literally "strong-arming" Advanced Seniors" to give up their private residences in favor of residence in a Nursing Home.  The motive for this almost standard practice is that the Nursing Home's are incentivized by Medicaid/Medicare to minimize Hospital Re-Admissions in favor of less expensive pallative responses to patient condition. Nursing Homes are paid special allowances to fund their expense in "educating patient families" that often it is best that unstable Nursing Home Patients not return to the Hospital.  Actually the Hospital/Doctor mandate is often so strong that family resistance to Nursing Home relocations threatens Civil Authority intervention. 

     The practice is becoming so frequent and the strategies so cavalier that if you don't allow the Hospital to discharge your aged parent directly to the Nursing Home, well you may have to deal with the Adult Protective Services Division of the District Attorneys Office.  This is a pure violation of civil rights, but regrettably not a violation that will likely have protestors rallying in the streets.  It will however likely reduce the Medicare Cost.  Sadly, it also dooms a whole lot of Advanced Seniors to spending their remaining days withering in the most pathetic social model ever contrived by 20th Century Politicians.  


Re-Admissions......"Not In My Hospital"

                         The follow "Onion Editorial" is fictional, but the truth just SCREAMS

      I am a Hospitalist.  I attend to mostly elderly women admitted by ER docs.  Mpst often these patients present the common signs of advanced age, heart/lung/stomach complicated by a destabalizing episode such as a fall or an infection.  We say UTI and CatScan a lot. I often speak with levity about these patients and the fear origins of their instinct to scurry on down to the Hospitals ER.  Of course I'm clinically sympathetic, but.....these are problems that should be relegated to a savy Nurse at the Nursing Home down the street.  The Chinese, who fund our out of control Entitlement Programs can't afford for me to be involved in these Merry-Go-Round stories.  Without days of eliminating tests, I can't be sure that there are not more critical issues present.  Neither I nor the Hospital can run that risk.  What to do?  When the profile presents, I do everything I can to direct the likely repeat patient to a new life, albeit a more impoverished life. at the Near Midnight Nursing Home. You might not like this strategy but I'm an elitist and have no time nor patience for little things.