JOANNE: LAST NOVEMBER ADAM RECEIVED AN UNEXPECTED LETTER.
IT WAS ABOUT HIS WIFE, CHRISTINA.
CHRISTINA HAS LATE STAGE ALZHEIMER'S DISEASE, SHE CAN'T WALK OR TALK, IT'S DIFFICULT FOR
HER TO EAT OR SIP JUICE WITHOUT ASSISTANCE.
THE LETTER WAS FROM SAN DIEGO HOSPICE.
IT WAS NOTIFICATION THAT AFTER RECEIVING HOSPICE CARE FOR THE PAST SIX YEARS CHRISTINA WAS
BEING DISCHARGED BECAUSE SHE WAS NO LONGER DYING.
>> >>: IT WAS REALLY INTERESTING.
IT WOULD HAVE BEEN FUNNY IF IT WERE NOT SO DRAMATIC.
>> >>JOANNE: NINE DAYS PRIOR TO RECEIVING THAT LETTER CHRISTINA LOST HER ABILITY TO
WALK.
THE DISEASE WAS FORGING AHEAD.
THE IRONY OF THE LETTER WAS NOT LAST ON ADAM.
HE WITNESSED HIS WIFE SLOW DECLINE FROM A STRONG AND VITAL WOMAN TO A WHISPER OF HER
PAST SELF.
>> >>: THE HOSPICE SAID ESSENTIALLY THAT SHE IS NO LONGER TERMINAL.
I COULDN'T UNDERSTAND THAT BECAUSE ONCE A PERSON IS TERMINAL, IT'S TERMINAL UNTIL THE
END.
>> >>JOANNE: AFTER SIX YEARS OF RECEIVING WEEKLY VISITS FROM A TEAM OF NURSES AND HEALTH
AIDS, CHRISTINA WAS CUT OFF FROM THE GOVERNMENT PAID SERVICE AS SAN DIEGO HOSPICE, ONE OF
THE OLDEST AND MOST RESPECTED HOSPICES IN THE COUNTRY, SCRAMBLED TO DISCHARGING PATIENTS
WHO MAY NOT HAVE BEEN ELIGIBLE FOR CARE.
THERE WERE MORE PATIENTS DISCHARGED IN HER NURSING HOME, HUNDREDS MORE ACROSS THE COUNTY.
IN TOTAL SAN DIEGO HOSPICE REDUCED ITS PATIENT POPULATION FROM 1,000 TO JUST 400 LATE LAST
YEAR, AS IT TRIED TO GET AHEAD OF A MEDICARE AUDIT AND FEDERAL INVESTIGATION QUESTIONING
WHETHER THE PEOPLE THEY WERE CARING FOR WERE ACTUALLY DYING.
WEATHER IT WAS A MATTER OF COMPLIANCE, FINANCES OR SOME COMBINATION OF THE TWO THAT LEAD TO
THE DEMISE OF THE SAN DIEGO HOSPICE IS STILL UNCLEAR.
THE EXPERIENCE HAS LEFT ADAM QUESTIONING THE RATIONALE OF THE SYSTEM AND THE INTEGRITY
OF THE INSTITUTION.
BECAUSE WHAT IS CLEAR TO ADAM EACH DAY THAT PASSES BRINGS HIM CLOSER TO SAYING GOODBYE
TO CHRISTINA.
ADAM AND CHRISTINA FIRST MET AT A JUNIOR COLLEGE IN GERMANY, BOTH HAD BEEN BORN IN POLAND,
BOTH HAND LANDED IN GERMANY AS REFUGEES WITH THEIR FAMILY.
ADAM DIDN'T KNOW WHETHER HE STOOD A CHANCE WITH THE YOUNG WOMAN WHO ALREADY SEEMED SO
POISED AND READY TO TAKE ON THE WORLD.
SCHOOL ENDED AND SO DID THEIR BRIEF ROMANCE, BUT THEY WOULD MEET AGAIN, THIS TIME IN CHICAGO
AS YOUNG IMMIGRANTS.
ADAM FINALLY PROPOSED AND THE TWO WERE MARRIED.
THAT WAS IN DECEMBERﾊ1956.
THE NEXT SEVERAL DECADES BROUGHT WITH IT A MOVE TO SAN DIEGO, NEW CAREERS AND A DOT DAUGHTER.
>> >>: LIFE WAS VERY NICE IN CALIFORNIA.
>> >>JOANNE: UNTIL 2003, CHRISTINA WAS DIAGNOSED WITH ALZHEIMER'S DISEASE.
>> >>: IT WAS ABSOLUTELY NO INDICATION THAT CHRISTINA WAS THREATENED BY A DISEASE.
ESPECIALLY A MENTAL DISEASE.
SHE WASﾊ HER MIND WAS VERY ACTIVE AND, UM, SHE WAS RATHER BRILLIANT PERSON.
CHRISTINA REMAINED IN HOSPICE UNTIL SHE WAS DISCHARGED ALMOST EXACTLY SIX YEARS AFTER
BEING ACCEPTED.
WHETHER SHE WAS EVER ELIGIBLE FOR CARE WHEN SHE WAS FIRST REFERRED BACK IN NOVEMBERﾊ2006,
AND WHETHER SAN DIEGO HOSPICE EVER PROPERLY RECERTIFIED HER TO REMAIN IN CARE, IS AT THE
HEART OF WHY THE HOSPICE IS BEING INVESTIGATED BY THE FEDERAL GOVERNMENT.
>> >>: EVEN THEN SHE WAS NOT IN A BAD CONDITION.
>> >>JOANNE: HOSPICE IS UNDER SCRUTINY NATIONWIDE, THE FEDERAL GOVERNMENT WANTS TO KNOW WHAT'S
BEHIND ITS SORE S COST. 13ﾊBILLION DOLLARS IN 2010, FOUR TIMES WHAT IT WAS A YEAR AGO.
ADD UP THE COST FOR CHRISTINA'S CARE TOTALS MORE THAN 300,000 DOLLARS.
THAT'S FOR ONE PERSON.
DR.ﾊDORIS HOWL FOUNDED THE HOSPICE IN THE 70S.
SHE SAYS SHE KNEW TAKING ON TOO MANY ALZHEIMER'S PATIENTS FOR TOO LONG WAS CAUSEINGA PROBLEM
WITH MEDICARE.
>> >>: I'M SURE WE ADMITTED ALZHEIMER'S PATIENTS THAT HAD OTHER DISEASES WE COULD TREAT AND
MAKE THEIR LIFE MORE COMFORTABLE.
BUT IT'S HARD TO THROW THEM OUT.
>> >>JOANNE: SHE SAYS MEDICARE WARNED THEM ABOUT THE PROBLEM BEFORE.
>> >>: WE LOOKED AT THEM AND SAID DO YOU WANT US TO AT 12:00ﾊP.M.
ON SIX MONTHS SAY TO THE PATIENT YOUR NO LONGER ELIGIBLE?
>> >>JOANNE: FORM EMPLOYEES WHO SPOKE TO THE KPBS AND INEWS SOURCE INVESTIGATIONS DESK
SAY THE HOSPICE ACCEPTED ALMOST ALL PATIENTS WHO CAME TO THEM FOR HELP, AT TIMES STRETCHING
ELIGIBILITY REQUIREMENTS.
THEY DIDN'T WANT TO BE NAMED FOR FEAR OF PROSECUTION FOR MEDICARE FRAUD, BUT THEY SAY THERE WAS
AN UNWRITTEN POLICY TO FIND A WAY TO SAY YES.
ONE DOCTOR TOLD US THE INTENTIONS WERE REALLY GOOD.
WE SAW ALL THE SUFFERING AND PAIN.
PEOPLE WHO COULDN'T GET INTO COMMUNITY RESOURCES, IT COULD HAVE BEEN OVER REACHED.
ADAM SPENDS FOUR AFTERNOONS EVERY WEEK WITH HIS WIFE IN THE NURSING HOME.
HE SPEAKS SOFTLY TO HER IN POLISH.
SHE IS LOSING THE ABILITY TO SWALLOW, THE FINAL STAGE OF ALZHEIMER'S.
HER DOCTOR ONCE AGAIN RECOMMENDED HOSPICE CARE.
CHRISTINA WAS ACCEPTED INTO CARE BY ANOTHER HOSPICE PROVIDER.
>> >>: SHE MAY DIE WITHIN WEEKS.
OR SHE MAY LIVE MORE THAN SIX MONTHS.
THERE IS NO WAY TO TELL.
>> >>JOANNE: ADAM IS WRITING CHRISTINA'S BIOGRAPHY AND COMPILING HER MANY ESSAYS AND POEMS INTO
A BOOK.
HE WANTS PEOPLE TO KNOW WHO HIS WIFE WAS.
SURVIVER OF WAR, ACTIVIST IN THE POLISH AMERICAN COMMUNITY, STUDENT OF HISTORY, SOMEONE WHO
LIKED TO TAKE LONG WALKS AROUND MIRAMAR LAKE BUT WAS COMFORTABLE TRAVELING TO TURKEY ON
AN ALONE MISSION TO LEARN MORE ABOUT HER FATHER, MOTHER, AND GRAND MOTHER COMMITTED TO RAISING
STRONG WOMEN.
>> >>: IF NOTHING ELSE, I WOULD LIKE OUR FRIENDS IN THE COMMUNITY TO REMEMBER HER.