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105-year-old veteran faced untimely discharge from care home until last minute inquiries

The Press Democrat - 5/12/2024

May 11—Debbie Little and Robert Lownes were at their father's Windsor home early Saturday to prepare it for his return. They were harried, rushed, anxious. The 105-year-old World War II Army veteran was to be discharged the next day from the skilled nursing facility in Santa Rosa where he'd been rehabilitating from an April 18 fall.

It was too early, said Little, 70, who was told Thursday that her father, Manuel "Mike" Lownes, had to leave the Park View Post Acute facility at 11 a.m. Sunday. She just needed a bit more time.

The medical bed and wheelchair the facility had ordered for them weren't to arrive until Monday. The U.S. Department of Veterans Affairs only provides 16 hours a week of in-home care for her father, though she'd been fighting for more than three months to increase that benefit.

"I'm not asking to put him in there for another two weeks. I just want a couple of days. That's all I want," said Little.

She'd filed an appeal late Thursday with the federal Center for Medicare and Medicaid Services that — as she understood it — asked Park View to delay the discharge and for Medicare to cover the cost of the additional stay.

She learned Friday afternoon her appeal had been denied. Now as she and Robert cleaned up his living room and set up his television, her dad was due to come home anyway — an example of how easy it is to slide through the gaps of an imperfect system of care for the nation's elderly and infirm.

The elder Lownes, who served as a medical orderly, has Social Security and VA pensions, and a pension from his time as a plumber with Healdsburg's water department, Little said. After rent and utilities he has less than $1,000 a month left for food and other expenses. It wouldn't go far toward securing additional in-home care support, she said, not at the $40 an hour or more she'd been quoted by professional caregiving services.

"We can't do it alone," she said.

"Call someone else'

Little, her brother and their father felt lost in limbo.

They'd called elected representatives, the federal Department of Veterans Affairs, and Sonoma County's Veterans Service Office. They had gotten nowhere. And they couldn't convince Park View administrators or social workers to keep the senior Lownes until a better plan was in place.

"Everybody says call someone else," Little said.

Rep. Mike Thompson's office had gotten in touch but then referred them to Rep. Jared Huffman's office, as Lownes lives in his district. Friday afternoon, after the appeal was denied, Huffman's office called Park View administrators to urge them to delay Lownes' discharge.

But Little had heard nothing since. The VA wasn't budging on the 16 hours a week limit. The Veterans Service Office hadn't been able to help. American Legion officials had tried but exhausted their efforts.

"I was like, 'I'll put my credit card down and buy him a handicapped hotel room, whatever," but, you know, obviously he needs more extended care than that," said Mark Kirby, Commander of American Legion Post 21 in Santa Rosa. "It'd be a nice gesture or whatever, but it doesn't help the situation."

Little and her brother were worn by worry.

How would their father — still vital in may ways, stubborn, particular, insistent on his own way, but so weakened by age — get around his mobile home without falling like he had before. Just climbing the five stairs to his front door was going to be a challenge. He weighed about 175 pounds. Little is a slight woman, and her brother Robert, at 81, has terrible arthritis.

"I just felt like this was just a real short time to tell somebody, 'Oh, he's getting discharged Sunday. You got one day to take care of business,' Little said. "I mean, I've been taking care of business all this time. Been trying to fight for more hours, and that's what he needs, you know? And I keep getting doors shut in my face."

Still, she said, she would bring him home from Park View if she had to.

"I would take a bullet for my dad," she said. "We're just going to have to do it on a wing and a prayer."

"I'll be here with you, too," said Little's cousin Nancy Cordova, 69, of Windsor. Manuel Lownes is her uncle. "I'll help you because it's going to take more than just you guys to get him up."

"I was just imagining all day, the stairs, who's going to catch him when he falls?" Cordova said.

'Triggered some things'

Desperate, Cordova on Friday called The Press Democrat.

A reporter made a round of calls Friday evening seeking comment from officials with the Veterans Affairs department and the county's Veterans Service Office and from Thompson and Huffman's office.

Saturday morning at 11:15 a.m., Paul Dunaway, director of the Adult and Aging Division at the county's Department of Human Services, called back, saying, "some things have been triggered to provide some assistance to this guy."

He urged Lownes' family to call the county's Aging and Disability Resource Hub to get routed into a system that could potentially lead to help qualifying for more professional in-home caregiver support, and other assistance, such as medically tailored meals and home modifications.

But the line wouldn't be open again until Monday, he said.

Until then, Dunaway said, "My No. 1 recommendation is they need to continue working with this facility if they don't feel like they have the resources in place to keep him safe. I would sincerely hope that they do not discharge this gentleman into an unsafe situation."

Two hours later, Dunaway called a reporter again. His office, he said, had talked to the county's Long Term Care Ombudsman, Crista Barnett Nelson, executive director of Senior Advocacy Services. She was on her way to Park View.

At the front desk, Barnett Nelson said: "This is not a safe discharge. You cannot send him home. I will hold you accountable."

She would refer the case to the state Department of Public Health, which oversees skilled nursing facilities, she said.

"And he doesn't have the bed and wheelchair," she added. "You were supposed to order the items. They're not arriving. How can you possibly justify sending him home?"

The admissions staffer called her supervisor, who called Park View's executive director.

Shortly before 3 p.m., a nurse approached Lownes' bedside, where Barnett Nelson was waiting.

"You're not going anywhere," said the nurse, who gave her name only as Paula. "You're going to stay until Monday when they figure everything out for you."

"Oh, OK, Lownes said. "As long as the hospital agrees with them (his children), it's fine. It's when they don't agree that there's a problem."

Later, outside the facility, Barnett Nelson called Little.

"So, he's not going to be discharged tomorrow," Barnett Nelson said.

"He's not?" said Little.

"No."

Oh, my God," said Little, starting to cry.

"What we're going to do is make sure that on Monday, we're going to work with the facility and then work with a care transition team and also with you, and see what we can do to ensure that all the systems start moving. You know, he needs more care hours. I believe we can make that happen pretty quickly. And we'll make sure before he goes home he has his equipment and ideally get approved for more hours."

"Oh, my God that's so wonderful," said Little.

After hanging up the phone, Barnett Nelson said The Press Democrat's inquiries turned the direction in Lownes' and his family's favor.

"You guys moved the needle. At the end of the day, it shouldn't require that; like, our systems should work." she said. "I am confident there's a lot of people who go home because they don't know what else to do. The nursing home is telling them they have to leave."

"This stuff is really hard," Barnett Nelson said. "It's just so tough because they don't know to call the ombudsman. They don't know that we're the people that will help them with this. So, you know, by this time, she's trying to navigate this alone, which is just heartbreaking because that's what we do for her.

"The challenge is that I don't know how often they fall through the cracks, because you don't know," she said.

Undoubtedly, many without people in their corner do, she said.

"The best advocates are the ones who don't give up," Barnett Nelson said. "This is exactly what Manuel's family did for him. They reached out and they kept reaching out to every avenue they knew of until they got to the right place. That tenacity is exactly what is needed."

Getting help with aging and disability

To get help navigating the complex system of support for adults and those who are aging, call Sonoma County's Aging and Disability Resource Hub 707-565-INFO.

To reach Senior Advocacy Services and the county's long term care ombudsman, call 707-526-4108.

You can reach Staff Writer Jeremy Hay at 707-387-2960 or jeremy.hay@pressdemocrat.com. On X (Twitter) @jeremyhay

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