CASE SUMMARY - NURSING CARE

Michael

Michael is a 7 year old boy with spastic diplegia with left hip dislocation and right hip subluxation.  Michael lived at home with his mother, Gina, and older brother.  Gina called the MLPP because she had concerns with respect to Michael’s home nursing care.  Gina informed the MLPP attorney that while she requested 30 hours/week of a private duty nurse and 20 hours/week of a home health aide, the nursing agency was only providing 10 hours/week.

The MLPP attorney did an immediate intake and investigation.  Upon further review, the MLPP attorney determined that since Michael was on Medicaid he rightfully qualified for 30 hours/week of a private duty nurse, as well as 20 hours/week of a home health aide.  The MLPP attorney spoke with the managed care company responsible for his health care, as well as with the contracted nursing agency.  The nursing agency initially declared that they were unable to provide the full requested hours, due to a nursing shortage, however, after several phone-conference negotiation sessions with both the nursing agency and the managed care company, a settlement was reached that was able to meet Gina’s request for additional hours.

Gina is now receiving additional hours of care for Michael, giving her the ability to properly address her son’s special health care needs.