Client Spotlight: Supporting a Mother’s Battle to Secure In-Home Care for Her Daughter
During the summer of 2015, Alyssa and her mother took a trip to California to celebrate college graduation. On the way home, Alyssa suffered a sudden cardiac arrest which resulted in a severe brain injury and left her completely dependent on caregivers to meet her most basic daily needs. For nearly a year after the injury, Alyssa’s private health insurance plan covered in-home nursing care which allowed her to remain at home, rather than moving into a nursing home away from her mother and everything familiar to her. When Alyssa’s mother received notice that her insurance would no longer cover that care, she applied for a Medicaid program (known as a Waiver) which, if approved, would allow Alyssa to continue receiving the supports and services she needed. Unfortunately, Alyssa’s Waiver application was denied based on the reviewer’s assessment that her needs were too great to allow her to be safely cared for at home.
However, Alyssa's mother knew how much progress her daughter had made with in-home nursing and that continuing that level of care would be best for her daughter. She filed an appeal to challenge the denial and called PHLP for help.
PHLP provided a point-by-point summary of advice for the hearing. We recommended that Alyssa’s doctor and nursing agency participate to communicate Alyssa’s positive changes over time. The judge saw that contrary to the assessment, Alyssa was not in a vegetative mental state, and he overturned the denial.
Alyssa’s mom expressed her gratitude to us, emphasizing the importance of PHLP’s guidance: “God was listening, and thanks to you, I came prepared and the only document I made reference to was of all of her improvements since she has been home, of which you advised me to do.”
Alyssa’s mom recently wrote to us to share her story.
"I was there fighting to keep my daughter home and argue with the State that my daughter would be better served at home, and I had all of the documentation to show how far she has come since she has been home.
"All doctors in the beginning told me to pray for a miracle, that they had no hope of recovery. Had I not taken my daughter home so she could be in a loving, nurturing and caring environment, they probably would have been right. My daughter would have been kept heavily medicated since no one really took the time to 'think' of a plan of care to help my daughter recover. They just focused on the ‘pain’ side, and not really trying to figure out why there was pain. It was my constant monitoring, asking of many questions, that eliminated many of the medications and brought her to where she is now, stable, awake, alert, and responding to stimuli. The Johns Hopkins doctors (who we waited 8 months on a list to see) are now telling me that they have hope of recovery.
"Never give up hope. Never stop fighting for what you believe is right... Everything has been a battle for me, but I have patience and never will I give up. Finally, things are starting to fall into place and I am getting the services and equipment that my daughter needs. If you can, please take your loved one home and care for them."