Medicaid Managed Care - U.S. Senate Special Committee on Aging

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problems; a rare blood disorder; and a clotting disorder. She has a history of
problems with decubitus ulcers, which are commonly known as pressure sores. She
needs help in performing some Instrumental Activities of Daily Living (lADLs).
She can ambulate using artificial legs, but only with great difficulty.
Needs: This individual needs the services of several specialists, including a urologist,
neurologist, orthopedist, internist, hematologist, and a gastroenterologist. She also
requires periodic urological lab tests, assistive technology for prosthetics and a
manual wheelchair, and routine health screening. Service coordination is essential
for this person due to the complex interactions of her disability, Spina Bifdta, and
the chronic health conditions that are not related to her disability but that greatly
impact her health.
Profile 3: This person is a 45 year old male with quadriplegia who has severely limited
wheelchair sitting time as a result of a history of decubitus ulcers. He has chronic
muscle spacisity and urinary tract infections (UTI). He cannot perform Activities
of Daily Living (ADLs) or Instrumental Activities of Daily Living (lADLs) without -
assistance. One kidney ceased functioning due to a series of UTIs several years
ago and was surgically removed.
Needs: This person needs prescription medications to manage spacisity and UTI. This
must be supported by ongoing lab tests to identify UTI and to monitor kidney and
liver function to detect drug related side effects such as liver damage. He needs to
be regularly evaluated by a physical medicine specialist and a urology specialist.
His general health care should be monitored by an internist or other physician
knowledgeable about the unique impacts of spinal cord injury upon major body
systems, especially the urological system. He requires ongoing physical therapy to
maintain functional abilities and personal assistance with both ADLs and IADLs.
His assistive technology needs include a powered wheelchair; various seat
cushioning and positioning systems; and arm splints. Routine health screening and
service coordination is required.
Profile 4: This individual is a 29 year old woman with Cerebral Palsy who walks with a limp
but without mobility assistance. She has no speech difficulties. She wants to have
children when the time is right. She was recently rejected by a managed care
provider due to Cerebral Palsy. As she ages, the effort that it takes for her to walk
will age her joints and tendons more rapidly than normal. Eventually she will
require some assistive technology with mobility, such as a scooter, causing a
reduction in the amount of exercise she gets. This will require a modification in her
diet, her physical therapy, and her exercise regime.
Needs: This person requires routine health screening and on-going physical therapy to
maintain her good health. When she is ready to have children, she will need
United Cerebral Palsy Associations Page 2 of 9