Managed Medical Assistance Story #1

A Better Health member is in a persistent vegetative state that resulted from an unexpected medical episode. This member had no previous medical issues prior to the episode that led to her vegetative state. The sudden complications and worsening of this member’s health caused an enormous strain on her mother who has assumed responsibility for her care. 

The health plan engaged a case manager to work with the mother after the member had several hospitalizations. During her most recent hospitalization, a move to a skilled nursing facility was suggested due to the member’s complex care needs, including ventilator maintenance. The mother, however, preferred to have her cared for in the home. 

Before she was discharged from the hospital, several interdisciplinary team meetings were held to determine the best solutions to assist this member in the home and prevent the need for further hospital admissions. The plan arranged for a physician to come to the member’s home, rather than continuing to have the member travel to a physician visit via a ventilator equipped ambulance ride, which was taxing for the member.  The visiting physician approved 24 hour a day nursing care, respiratory therapy, and home health.

The member’s mother has voiced relief from the caregiving burden she had prior to having this help. The mother is encouraged to see that the member is progressing and is responding to verbal stimuli and is becoming more active.