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

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ALL OF MRS. M.'S CARE IS COORDINATED BY A CARE MANAGER WITH A
SPECIALTY IN DEMENTIA CARE. SHE WORKS COLLABORATIVELY WITH MRS.
M.'S PRIMARY DOCTOR, NURSE, DAY CARE PROVIDER, HOMEMAKER,
COMPANION AND THE DRIVER OF THE MEALS-ON-WHEELS 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
(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 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. BECAUSE MRS. M. DOES NOT PRESENT-A NEED FOR SKILLED
SERVICES, SHE DOES NOT QUALIFY FOR MEDICARE COVERAGE. -THE IRONIC
SITUATION IN MRS. M.'S CASE, IS THAT THE MINIMAL PLAN OF CARE THAT SHE
IS RECEIVING IS NOT CURRENTLY RECOGNIZED AS, OR VALUED IN, OUR
MEDICARE SYSTEM. A HIGHER LEVEL OF CARE WILL NEED TO BE
IMPLEMENTED IF SHE DETERIORATES AND BECOMES MEDICARE ELIGIBLE.
SHOULD SHE NEED LONG TERM CARE (NURSING HOME) IT IS LIKELY SHE WILL
NEED TO ACCESS MEDICAID. THEREFORE, THERE IS NO METHOD OF
PAYMENT FOR THE "LOW TECH, HIGH TOUCH" CARE THAT MRS. M. REQUIRES.
IN SUMMARY, THE FOLLOWING REPRESENT THE BEST PRACTICE IN THE
CONTEXT OF MANAGING A FRAIL Ot9ER ADULT IN THE COMMUNITY:
1. IT IS CRUCIAL THAT THE PROVIDERS OF CARE HAVE A WORKING
KNOWLEDGE OF GERIATRICS AND THE CARE OF THOSE WITH