Antero Pallaroso (left) with Carmen Pallaroso (middle) and Lillian Gleason, RN (right)
Mr. Pallaroso is representative of those elderly who are in the highest needs category, and he is being cared for at home by his daughter, Carmen, who quit her job to do this. In 2004, Mr. Pallaroso was admitted to the hospital for pneumonia/Chronic Obstructive Pulmonary Disease and came home from the hospital with a tracheostomy and feeding tube. A patient of Visiting Nurse Lillian Gleason for over a year, he has been diagnosed with Alzheimer's and is very vulnerable to further pneumonia.
- Costs of Care
- Medicaid pays for the costs -- $8,000/month -- for Visiting Nurse Service once a week and part time help by two home care aides, plus supplies, equipment, etc.
Nurse Gleason's Comments
Here, Lillian Gleason, RN, talks about the extraordinary care Mr. Pallaroso is receiving from his daughter, Carmen, and the costs of care for keeping someone like him at home.
What do you think when you see Mr. Pallaroso? Why is he at home?
When I first went in, I didn't understand what was really happening there, because the daughter is taking care of him to the point where she's really not taking care of herself most of the time. She's almost given all of herself to his care. I thought to myself, "Well, she doesn't get much back, so how does she keep doing that? How does she keep regenerating herself?"
And then after a few visits, he started to get a little stronger -- maybe it was because I did educate her along the way on how she could do things differently. We got him a little stronger now.
So now I see that when he is awake they have this bond between them that is so strong. And she gets a lot from him, even though, to me, he looks like he's just kind of laying there. He looks at her, and he tries to talk to her, and he's very, very focused on her when she's talking to him.
“… He looks at her, and he tries to talk to her, and he's very, very focused on her when she's talking to him. So I can see what motivates her to keep on going, to go all those sleepless nights.”
Lillian Gleason, RN
So I can see what motivates her to keep on going, to go all those sleepless nights. I can totally understand what she's doing. He's not functioning like he used to, but there's still that love there that she has for him. She would really be at a loss without him. She'd miss him so much.
So there are all kinds of motivators that make people do what they need to do to take care of someone that ill.
Without Carmen's care, what would happen to her dad?
The care that she gives him is really expert care. She hasn't had medical training but she's learned everything about his care, to the nth degree. So she knows how to take care of all of the equipment that he has. She knows how to feed him. She knows how to take care of his skin, how to take care of his trachea. And she knows when something's up, and something looks funny, so she'll call on us to come help her.
I would say, probably once he got the trach and the feeding tube, he probably would have started to deteriorate pretty quickly if she hadn't gotten him home so that she could concentrate on him.
But think about it. I mean, it's a one-to-one, caregiver-patient relationship, 24 hours a day, seven days a week. You can't get that in any institution. He just never would have been taken care of that way. And it's not through the fault of the institutions. [It's] just not possible in our world to have that kind of care in an institution.
How does she work and have a life?
Believe it or not, she doesn't have enough to do at home so she volunteers her time at the hospital. She doesn't work. She relies on insurance to take care of everything for her father. Yet she's so generous. She wants to make me lunch when I go there. I have to stop her from doing that.
And she doesn't really go out socially very much at all, because she's worried about him having trouble breathing. So she goes out, max, two hours at a time. And she's always calling in to see how he's doing. And then she goes to Mt. Sinai Hospital for two or three hours in the day, so she can make beds and take care of other people. And that's how she lives. She's incredible, actually. She's very giving person.
The costs of care, to keep somebody at home?
It's very expensive. Every time a nurse visits, it's about $135, just to have them walk in the door, whether it takes an hour, 15 minutes, or two hours. Then the physical therapy is another big expense. The home health aides cost around $25 an hour. And if you extrapolate that times 24 times seven, it can really get very expensive.
But the overhead of a hospital and rehab and nursing home are sometimes even more expensive. So it just depends. And if a person is living in the apartment that they've had for 50 years, and their rent is really low, it might be the best option.
They're not wealthy, but spending their savings? Is there a range of economics for families and the caregiving?
Very much so. I have people who live in the projects and who are on Medicaid, and then I have people who are living on Park Avenue and can afford to pay for some of their care or a lot of their care. So there is a very wide spectrum.
And it's tough for everybody, because even if you have Medicaid paying for home care, there are other expenses to be met. And then sometimes when you have insurance, it's even worse, because the insurance company doesn't want to pay for certain things, but yet you have money so you're not eligible for Medicaid. And so then you get stuck in a bind.
I have one patient who has private insurance that he pays for, Medicare and Medicaid. And my agency still has to buy supplies to take care of his wounds, because all the insurance companies point at each other and say, "Well, if that guy's in, I'm not paying for it. And if that guy's here, I'm not paying for it." So what do you do? You can't just say, "Well, we're not going to dress your wound today because we don't have the supplies." We have to take care of it.
What's ahead for Mr. Pallaroso?
He's most vulnerable to lung problems because his breathing is already so compromised. He takes air directly into his lungs through that tube. Any kind of bacteria or anything that gets in there, or if he swallows or breathes some fluid into his lungs, he could get pneumonia. If somebody comes around with a cold, gives it to him, he could get worse than a cold. So probably for him, he will at some point succumb to a lung illness. Something will happen there.
But he gets all this great care, so he could go on for a while. His heart is strong.