Filling in the gaps

janelle deesNurse Janelle Dees (here with another wound care patient) was one of a large team of caregivers and social services staff who helped resolve Brown's life-threatening conditions and took steps to help lift his spirits as well.

Day 6: Emory Johns Creek Hospital

Arnold Brown arrived at Emory Johns Creek Hospital's emergency department by police car, after Georgia Adult Protective Services reported concerns about his health and safety at home.

For more than two years since his stroke, his wife had been doing her best to care for him, but she had serious issues of her own. Brown was not in good shape. His thinking was confused, his body weak. He had a large, painful bedsore and a staph infection (MRSA) resistant to most antibiotics. Adult Protective Services would not allow him to return home. Soon there was no home he could have gone to, with utilities shut down, furniture on the street, and his wife dealing with her own exacerbated problems and completely out of his life.

Emory Johns Creek's infectious disease specialists quickly got the staph infection under control. Under the care of the wound care team, the bedsore began to shrink. Other general health issues also resolved. The more difficult work was tracking down documents that had scattered to the wind after Brown's stroke and his wife's eviction. Friends from his religious community said the Caribbean native had become a citizen in the 1970s and served in the U.S. military. The Veterans Administration paid for his initial hospital stay, but a small minority of soldiers serve with green cards, and documentation of citizenship has to come from the State Department. Unable to get results on their own, hospital administrators paid for a state-appointed financial conservator to try, but she was unsuccessful.

The VA stopped paying his costs when hospitalization was deemed no longer medically necessary. His doctors agreed, but where would he go? Without proof of citizenship, he was ineligible for Medicaid or Medicare, and no long-term care facility would accept him without some kind of reimbursement. Brown had become the hospital's responsibility, both physically and financially. With the exception of the short period covered by the VA, Emory Johns Creek covered all costs of his hospitalization for more than a year. Last spring, the hospital made arrangements—and agreed to pay the cost—for him to be cared for at Budd Terrace, Emory Healthcare's 250-bed facility for skilled nursing care. There he continues to get care, still without reimbursement, and new caregivers have joined his adoptive family.

As Brown's stay stretched on, staff adopted him as family, taking him outside for fresh air, cutting his hair, and bringing him audio books.