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  • Kristin McNealus, DPT, MBA

Navigating a Difficult Situation

As you can guess, Cathy exhausted her health insurance, but also lost her private insurance when she was unable to return to work. She was able to get MediCaid, which allowed her to be accepted to a long term subacute facility. If you said you would take your mother home, did you consider the costs that would be associate with this decision?

Cathy can never be alone… can you pay someone  to care for her while you are at work? Or would you quit your job? Can you do that?? Medicaid is changing regularly, and may not cover 100% of the medication, may not cover tube feeding (food can be blended for the G tube), may not cover diapers or pads, and may not cover medical equipment such as a chair for bathing or a mechanical lift to get Cathy out of bed.

This is understandably more than most families can take on, so many people are placed in a facility. Ideally, these people would get regular rehabilitation to help them get more mobile so they could eventually get out of the facility and live with family. However, more often than not, these people receive limited therapy services, and some facilities will not get people out of bed every day. Why is this? Well, obviously it is more work. But it is not because the staff is lazy. There are a number of factors; first, the reimbursement has decreased over the years that keeping the facility open and functioning is getting more difficult. Staff is cut to a bear minimum, and not being paid for the extra work. The facility is fined for people who fall, so they want to limit that risk by keeping them in bed. And if people discharge, there may be a fear that the next occupant will have a lower reimbursement.

The system is set up poorly. Even with an understanding of the system, it is difficult to navigate, and difficult to advocate for yourself or a loved one. Obviously, as a therapist, I think that spending the money early on for more therapy will help reduce long term costs, and this would behoove the health plans to consider. They look at an annual budget, and do not look long term. How do we fight for change? I’m open to suggestions.

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