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

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Mrs. M.'s care plan is quite complex. She uses a combination of
companions, adult day care, home health aides, meals-on-wheels,
and nursing services, all of which are coordinated through a care
manager. She receives care 7 days a week. Mrs. M. goes to an adult
day care center twice a week on Tuesdays and Thursdays, and
throughout the week, Monday through Sunday, there is a homemaker/companion
who visits Mrs. M. in the evenings to prepare
meals and to ensure that she has taken her evening medications.
Mrs. M.'s son spends the night in order to secure Mrs. M.'s safety
in the evening.
Mrs. M.'s care requires multiple service providers to support her
at home. The complexity of assessing, coordinating and monitoring
her needs and multiple services requires the skill of a highly
trained nurse or social worker. The care manager juggles the complex
issues to establish a plan of care to support both the client and
caregivers.
Mrs. M. requires providers with an adequate understanding of
geriatrics and dementia care. For example, on days that Mrs. M.
needs a bath, the home health aide is able to utilize the skills that
she has learned in her dementia training provided by the care
manager. She can decrease the client's agitation by approaching
Mrs. M. from the front and not scaring her and giving clearly stated
directions.
Mrs. M.'s plan of care consists of "low-tech, high-touch" service
such as companion, homemaker, and meals-on-wheels. All providers
of her care are oriented to basic dementia care in order to provide
an environment that is supportive, nonthreatening and medically
safe.
The care manager negotiates with providers to identify resources
to address the special needs of this population. For example, a registered
nurse with dementia training was selected. The nurse has
utilized her specific assessment techniques to try to understand
any underlying medical conditions that might be occurring.
Mrs. M.'s attendance at an adult day care center provides a wonderful
service to her. She is able to capitalize on her strengths, and
she is able to teach a class to some of the other participants at the
day center. The day care center Mrs. M. attends is exceptional and
provides an excellent example of a highly trained staff and the organization's
desire and commitment to provide dementia-capable
services. They exhibit high standards of practice and the flexibility
that is needed for someone like Mrs. M.
All of Mrs. M.'s care is coordinated by a care manager with a
specialty in dementia. She works collaboratively with Mrs. M.'s primary
doctor, nurse, day care provider, homemaker, companion, and
the meals-on-wheels driver, as well as the neighbor. Mrs. M. is unable
to act in her own best interest; therefore, her son was appointed
as conservator of person or guardian. Her son is an integral
member of the dementia care team that works together to support
Mrs. M.'s independence. The primary responsibility of the care
manager and the son is to assess, coordinate and monitor the plan
of care by coordinating and consulting with all team members on
a regular basis.
Managing someone like Mrs. M. is a challenge because securing
payment for services in our current system is almost impossible.