Hospital bills.

[Sheryl]

H.pylori is not the only cause of ulcers. The OP's occurred after a serious infection, probably sepsis, and may be what is referred to as a "stress ulcer". Certain medications, like warfarin (which he is apparently on), NSAIDs and aspirin, can also be responsible.

 

Regardless of cause, a massive GI bleed (possibly with perforation of the ulcer) is an entirely different situation than normal ulcer disease with small amounts of blood loss. It leads to shock (and did in his case from the sounds of it) and that in turn can cause multi organ failure.

 

The OP is lucky to have survived.

 

OP: there are alternative drugs to warfarin that are easier to maintain a proper level of. NHS doesn't use them as first choice because they are much more expensive but given your history of ulcers and a  life threatening GI bleed, you should push this issue with them. I think your history would justify using the newer, more expensive options.

 

[defib]

Just to say my ulcer as Sheryl pointed out, was not caused by H.pylori. Also the first bleed was massive, the toilet bowl was just full of blood! (sorry for that thought!) They said at Bumrangrad Hospital that the bleed was from an artery behind the ulcer. The second bleed saw me back in intensive care straight away, luckily I was still in the hospital. The bleeding was as bad, very embarrassing indeed in the hospital bed! I am lucky to have survived I know. As for warnings of what was to happen, I never had any really, except some indigestion now and again.

[Cletus]

Private thai hospitals bashing. I think that's not fare. And scaring for someone without experience who just happen to read this forum.

[defib]

For the record, I am not Thai hospital bashing. But people visiting or living in Thailand should have full health insurance, or decent travel insurance. Care at Bumrangrad Hospital is excellent. 

[TommyUK1960]

I was chatting to an old guy in the pharmacy and I asked what's them marks on your wrists? He told me he had been in hospital handcuffed to the bed until his bill had been paid.

These hospitals will go to any lengths to get the money.

[canopus1969]

9 hours ago, TommyUK1960 said:

I was chatting to an old guy in the pharmacy and I asked what's them marks on your wrists? He told me he had been in hospital handcuffed to the bed until his bill had been paid.

These hospitals will go to any lengths to get the money.

Maybe what they do in Wales  - but not in Thailand 

[phetchy]

Any ideas about what would happen in a really, really worst case scenario? (which is looming)

I’ve gleaned some useful information from the previous posts here, but a number of the suggestions will not apply to my friend’s situation.  He’s 89 and for the last few years his general health and mobility have been in gradual decline commensurate with someone of his age.  This decline has accelerated in the last year or so and a month ago he had a fall resulting in a broken collar bone.  He’s been in hospital (Pattaya Memorial) ever since, accruing a hefty and ever increasing bill.  He’s been able to pay it from his savings up till now.  The hospital says that because of his age, frailty, worsening condition and the fact that he lives alone and has no-one at all to look after him, there is no immediate prospect of him being discharged.

In the event of his savings in Thailand and the UK being completely exhausted (in a few months at most), what will ultimately happen?  The options suggested in earlier posts, although helpful, don’t really apply. 

Repatriation – he is in a really bad way and without question is unable to travel on a plane, and in any case there is no-one in the UK that can look after him.  He would also have no funds to pay for care.

Transfer to a government hospital – He’s been in one before and although the cost is a lot less, it will only postpone the time that his money runs out.  

Crowd funding – he wouldn’t be able to organize that himself and has no-one to do it on his behalf.

So the worst scenario is that he is in a hospital (private or government) in a very poor state with no chance of being discharged, his money runs out with no prospect of any more from any other source, he’s too sick to go back to the UK and the British Embassy cannot help.  I realise that the ultimatum is that if you have no money, the hospital will not provide further treatment and expect you to leave when the bill is settled.  My question is what happens in reality?  If the hospital eventually realise that however much they try, there is no chance of the bill being paid and there is nowhere that they can move the patient to, what will they actually do?  This situation must have arisen before surely?

I’d be grateful for any advice.       

[giddyup]

I'd imagine there would be no other option than return him to the UK where he would be placed in some kind of aged care facility, but I guess if he's unable to fly that presents a big problem. A very sad state of affairs to find yourself in at that advanced age.

[uhuh]

27 minutes ago, phetchy said:

  If the hospital eventually realise that however much they try, there is no chance of the bill being paid and there is nowhere that they can move the patient to, what will they actually do?   

They will transfer him to Banglamung hospital or Chonburi hospital. 

It may be that he gets minimal treatment there  and dies quickly.

[giddyup]

On 8/28/2018 at 1:18 AM, defib said:

For the record, I am not Thai hospital bashing. But people visiting or living in Thailand should have full health insurance, or decent travel insurance. Care at Bumrangrad Hospital is excellent. 

If you are over a certain age medical insurance is almost impossible to get. At 76 the cost for me would be prohibitive.

[puukao]

feel bad for the OP, but keep your spirits up and i wish you the best.  yea, i'm sure it's best to transfer now if possible.....

[Sheryl]

7 hours ago, phetchy said:

Any ideas about what would happen in a really, really worst case scenario? (which is looming)

I’ve gleaned some useful information from the previous posts here, but a number of the suggestions will not apply to my friend’s situation.  He’s 89 and for the last few years his general health and mobility have been in gradual decline commensurate with someone of his age.  This decline has accelerated in the last year or so and a month ago he had a fall resulting in a broken collar bone.  He’s been in hospital (Pattaya Memorial) ever since, accruing a hefty and ever increasing bill.  He’s been able to pay it from his savings up till now.  The hospital says that because of his age, frailty, worsening condition and the fact that he lives alone and has no-one at all to look after him, there is no immediate prospect of him being discharged.

In the event of his savings in Thailand and the UK being completely exhausted (in a few months at most), what will ultimately happen?  The options suggested in earlier posts, although helpful, don’t really apply. 

Repatriation – he is in a really bad way and without question is unable to travel on a plane, and in any case there is no-one in the UK that can look after him.  He would also have no funds to pay for care.

Transfer to a government hospital – He’s been in one before and although the cost is a lot less, it will only postpone the time that his money runs out.  

Crowd funding – he wouldn’t be able to organize that himself and has no-one to do it on his behalf.

So the worst scenario is that he is in a hospital (private or government) in a very poor state with no chance of being discharged, his money runs out with no prospect of any more from any other source, he’s too sick to go back to the UK and the British Embassy cannot help.  I realise that the ultimatum is that if you have no money, the hospital will not provide further treatment and expect you to leave when the bill is settled.  My question is what happens in reality?  If the hospital eventually realise that however much they try, there is no chance of the bill being paid and there is nowhere that they can move the patient to, what will they actually do?  This situation must have arisen before surely?

I’d be grateful for any advice.       

 

What they will actually do is make him sign an agreement to repay them, possibly in monthly installments and if he fails to do so they can lodge a complaint with the police which  may result in his being arrested and/or deported.  I know people who had to leave Thailand and cannot return for this reason. 

 

And then they will transfer him to a government hospital.

 

The price difference between where he is now and a government hospital is about 3-4 fold, a shame he did not go to a government hospital to begin with but even now, it will certainly let his remaining funds go much further. Transfer ASAP.

 

Age, frailty and living alone are nto valid reasons to stay in the hospital, there are better and less expensive options e.g. a nursing home or hire caretakers to look after him in the home.

 

When you say his condition is "worsening", what exactly is the problem? Sounds like something more than the original fracture?

 

Try to get a handle on what his condition is and whether it in fact requires hospital care vs. he is just too old and weak to look after himself, if it is the latter then look into the options just mentioned.

 

If there is something else going on, like say a pneumonia,  better ask him how he feels about life support and whether he has an advance directive or would like to make one. In fact, ask him this regardless as it is very important. 89 years or not, the hospital will resucitate him and place him on a ventilator when the time comes - -at huge cost and suffering - unless he executes such a document.

 

The hospital should have a social worker. Find out where this person's office is and go talk to her, explaining that he is running out of funds, lives alone etc. Hospital social worker can help with things like nursing home placement and home care.

 

 

[Sheryl]

Off topic/unhelpful posts have been removed along with replies to them.

[Orton Rd]

This forum would be so much poorer without the advice and info from Sheryl, just like to say thanks for all the work you put in

[jmd8800]

In Chiang Mai there is Mckean Hospital. https://www.chiangmaicitylife.com/citylife-articles/mckean-from-leper-asylum-to-rehabilitation-centre/

 

Is something like this available near the OP?

 

And yes Sheryl is to go to person for medical questions!!

[Sheryl]

13 hours ago, jmd8800 said:

In Chiang Mai there is Mckean Hospital. https://www.chiangmaicitylife.com/citylife-articles/mckean-from-leper-asylum-to-rehabilitation-centre/

 

Is something like this available near the OP?

 

 

McKean is quite unique in Thailand and nothing its equal elsewhere. However there certainly are nursing homes in the Pattaya area. which hospital social worker could advise one.

 

In Bangkok this one is good, and offers a wide range of care, from assisted living to skilled nursing

 

http://www.goldenyears.co.th/en/living-options/

[NancyL]

1 hour ago, Sheryl said:

McKean is quite unique in Thailand and nothing its equal elsewhere. However there certainly are nursing homes in the Pattaya area. which hospital social worker could advise one.

 

In Bangkok this one is good, and offers a wide range of care, from assisted living to skilled nursing

 

http://www.goldenyears.co.th/en/living-options/

People like the 89 year old man in Pattaya transfer into McKean from all over Thailand.  There are several gentlemen who had been living in Pattaya dependent on caregivers who found they weren't really very dependable, so they moved themselves into Dok Kaew, the assisted living portion of McKean.  Of course, they are much more independent than the 89 year old man who will undoubtedly need to make the trip to Chiang Mai in an ambulance, which has been done on numerous occasions. 

[Sheryl]

24 minutes ago, NancyL said:

People like the 89 year old man in Pattaya transfer into McKean from all over Thailand.  There are several gentlemen who had been living in Pattaya dependent on caregivers who found they weren't really very dependable, so they moved themselves into Dok Kaew, the assisted living portion of McKean.  Of course, they are much more independent than the 89 year old man who will undoubtedly need to make the trip to Chiang Mai in an ambulance, which has been done on numerous occasions. 

 

Good point and certainly worth considering for this man,  It is AFAIK the best facility of its type in Thailand, well able to cater to farangs and he would have the company of other farangs there.

 

Nancy how much does it cost?

[NancyL]

57 minutes ago, Sheryl said:

 

Good point and certainly worth considering for this man,  It is AFAIK the best facility of its type in Thailand, well able to cater to farangs and he would have the company of other farangs there.

 

Nancy how much does it cost?

The cost really depends on the level of care needed by the 89 year old man, for example if he needed someone to remain with him 24/7, needed daily dressing changes for pressure sores, if physical therapy was appropriate, etc.  They have ward rooms, private room and also what they call semi-private rooms, which I think is a misnomer, since those are really private rooms that share a toilet and kitchenette with another room.  In general, I've seen monthly charges of about 40,000 - 80,000 baht depending upon the type of room and level of care needed.

 

People living in Dok Kaew Assisted Living have lower charges, in the low 30s for someone who is semi-independent for a studio apartment, three meals, laundry and medication management to the mid-40s for someone who needs a higher level of supervision.  But Dok Kaew isn't a skilled nursing facility like McKean and it seems like the 89 year old man in Pattaya needs nursing care.

 

Frankly, I'm surprised that the hospital is keeping him as a patient if they say the only reason for keeping him is because he's frail, has mobility problems and no one to care for him at home.  Here in Chiang Mai, the private hospital social workers would be working hard to discharge someone like this either to McKean or one of the Thai nursing homes.  Several of them have foreign residents and do a good job, too, at a cheaper price than McKean, but without the social interaction with other English speakers available at McKean.

[KidoBkK]

I would like to share that hospital bill is negotiable. You may have to discuss with the doctor/head of nurse for cost containment avoid using unecessary items to lower the bill.
I support the idea to move away grom private hospital to government hospital if the cost of treatment is a serious concern. You may chose private room in government hospital or hiring private nurse and the overall bill will save more than 50%.

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