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

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MRS. M. IS A RETIRED TEACHER LIVING ALONE ON HER TEACHER'S PENSION.
SHE LIVES AT HOME WITH A DIAGNOSIS OF CANCER OF THE BOWEL WITH A
COLOSTOMY, DIABETES AND DEMENTIA. SHE TAKES A TOTAL OF SIX
MEDICATIONS TWICE DAILY. BECAUSE OF HER DEMENTIA, SHE CANNOT BE
LEFT ALONE. MRS. M. IS DISORIENTED TO PERSON, TIME AND PLACE. SHE
DEMONSTRATES IMPAIRED JUDGMENT BY LEAVING POTS ON THE STOVE FOR
LONG PERIODS OF TIME UNTIL THEY BURN. SHE DEMONSTRATES BEHAVIOR
PROBLEMS SUCH AS SUSPICIOUSNESS, WANDERING, SLEEP DISTURBANCES
AND HALLUCINATIONS. SHE REQUIRES ASSISTANCE WITH BATHING AND
CUEING FOR DRESSING. SHE IS UNABLE TO PERFORM ANY OF HER
HOUSEHOLD MANAGEMENT SUCH AS COOKING, CLEANING, MONEY
MANAGEMENT, ETC. SHE IS UNAWARE OF HER OWN HEALTH STATUS AND
SHE CANNOT MANAGE THE MEDICATIONS APPROPRIATELY. MRS. M.'S CARE
PLAN IS QUITE COMPLEX. SHE UTILIZES 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 SEVEN DAYS A WEEK. MRS. M. GOES TO AN ADULT DAY
CARE CENTER TWICE A WEEK ON TUESDAY AND THURSDAY AND
THROUGHOUT THE WEEK, MONDAY THROUGH SUNDAY, THERE IS A
HOMEMAKER/COMPANIONiTHAT 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.
IN MRS. M.'S CASE, THERE IS A NEED FOR MULTIPLE SERVtCE PROVIDERS TO
SUPPORT HER CARE AT HOME. THE COMPLEXITY OF ASSESSING,
COORDINATING AND MONITORING HER NEEDS AND MULTIPLE SERVICES