Tag Archives: access to care

Dementia and Mobility

Our society favors those who are mobile and swift. Technology evolves to increase the speed at which our messages can be sent to make choices, make connections, and make money. How can dementia patients, painfully slowed by disease, participate in a world that seems to move faster all the time?

Between the Pond and the Woods

A Lake Frances fisherman:  He doesn’t let mobility problems keep him away from the trout

A shadow of stress now haunts my mother’s every step. Last week it was time for her six-month neurological check-up and I didn’t want to take her. I worry every time she tries to walk, especially if she has to enter a car. She seems to have forgotten how to bend her knees. At times she looks like she can’t remember what legs are for. I told my sister I thought we should cancel the appointment. It’s not like the doctor has a new elixir to restore her skills. I felt that transporting her was more likely to lead to a fall than to any health improvement.

My sister disagreed. She was determined that Mom should see the doctor. Just in time, we got a wheelchair which solved some of Mom’s mobility problems. Then, to further persuade me, my sister discovered a service called Freedom Taxi, an ADA compliant transportation company. Freedom operates  a fleet of taxi vans equipped with drop-down ramps for wheelchairs. The patient never has to get out of the chair, which is pushed up into the back of the cab and secured with a locking belt. A companion can ride up front and offer soothing words to calm and reassure the person in the back.

The service was not without glitches. I called days in advance to order the taxi pick up and I’m very glad I did. Later when I did an Internet search for the company, I stumbled on the Freedom Taxi Yelp reviews — which were awful. But the unhappy Yelp writers were all passengers who had ordered regular taxis on the day they needed service. None of them got timely pick ups. Our wheelchair taxi showed up for Mom exactly on time — both when taking her to the doctor’s office and when picking her up after the appointment.

Services like these are now proliferating as the number of older people with dementia and disabling illness soars. The society seems most likely to address mobility problems when money can be made from solving them. Hopefully, the cost of services like these will decrease as the number of providers rises. I hope mobile support will also expand beyond big city hubs to smaller communities with high need.

The whole experience made me appreciate the incredible mobility I’ve always enjoyed. It’s a gift you take for granted until life forces you to grow a new pair of eyes and see what it’s like to have your movement curtailed. I thank heaven for my legs, my car, and the good health that still allows me to propel myself around this green planet. I’m also very grateful that we’ve found a new and safe way to move mom around when it’s absolutely necessary.


Reality Check$: Cost of Care for Dementia Patients

Years ago my mother told me she had two wishes: 1) She wanted to see our high school football team beat the local powerhouse (Mt. Carmel) and, 2) After working for so many years, she wanted to collect just one unemployment check. Paying her health insurance every month reminded me of this. I hoped she would get something back from the Part B premium she’d paid for so long.


Be careful of those casual wishes. The bills have started coming in for my mom’s recent hospitalization. Her episode included a hasty trip in the ambulance, two days of observation, IV fluids, and many tests to determine why her blood pressure plummeted and why she was dehydrated. The sticker price for this treatment — which included no surgery, nor even a true admission since she was only “under observation” — was itemized at $40,000. I was astonished.

Thank goodness practically all of her costs were covered by her Part B provider, but the facts left me with a lot of questions about health care costs for elderly patients, especially those with dementia. According to the Health Care Cost and Utilization Project, “Inpatient hospital services account for a small share of health care utilization (7 percent) but constitute the largest share of total health care spending in the United States (29 percent in 2009).”

The study divided hospital stays by the cost per diagnosis. Dementia is not listed as an independent diagnosis. But people with dementia often have secondary diagnoses of other conditions that aggravate their health problems. According to HCUP, the five diagnoses with the highest hospital costs had approximately double the average cost per stay in 2010. The most expensive diagnoses were: septicemia, complication of device, acute myocardial infarction, respiratory failure, and intracranial injury.

The cost for these stays has been rising steadily. The HCUP study found that “inflation-adjusted costs for hospital stays grew 3.8 percent annually between 1997 and 2010.” Most of that growth (2.9%) was attributed to an increase in the intensity of services provided to patients.

So after studying my mother’s hospital expenses and the national statistics, here’s what I’ve learned about health care:

  • Make sure you have a good Part B provider. If you don’t feel you have sufficient coverage, do some research and make a change during the open enrollment period
  • If a hospital stay is necessary, ask questions about the tests and procedures ordered to make sure they will be covered
  • Even if you arrived at the hospital in an ambulance, don’t take an ambulance home; it was the one thing that doesn’t seem to be an allowable cost even though the hospital arranged it

Obviously, the best way to keep hospital costs down is to get good primary care and try to avoid emergency visits. But we are simple humans and that’s not always possible. So instead, let’s try to our best to be prepared.