Families Concerned With TennCare Cuts

BLOUNTVILLE, Tenn. – David Hooker stood behind his disabled son on the family’s front porch Monday with a mixture of anger and sadness in his reddened eyes.

He was among the members of two families with disabled children who gathered to express their concerns over TennCare cuts to state-funded in-home, private-duty nursing care.

David and Brenda Hooker’s 24-year-old son, Jonathan, sat in a wheelchair, unable to speak, though watching and listening, and from time to time tapping the letters on an oversized keyboard in an attempt to have his say.

“According to the letter we got from TennCare, Jonathan lost his 24/7 care Sunday night,” David Hooker said while pointing at the letter.

Now, his son will receive 30 hours of licensed professional nursing care a week, plus 10 hours of care from a nurse not qualified to perform tasks such as inserting feeding tubes, giving medication or providing physical therapy, according to his licensed practical nurse, Donna McMillion.

TennCare made these and other cuts for fiscal 2008-09 in an attempt to reduce costs, which have been rising for years. TennCare also cut $4 million in emergency medical services funding statewide, although it is being asked to find a way to reinstate that money after the cuts were brought to the attention of state legislators.

TennCare spokeswoman Marilyn Wilson said Monday the cuts to in-home medical services cannot be helped and affect less than 10 percent of patients across the state who receive the care.

In 2000, TennCare’s budget for in-home nursing services was about $18 million. That grew to $243 million in fiscal year 2007-08.

Wilson said TennCare would have had to ask the state for more than $300 million just to maintain the same level of service for one year.

The Hookers, along with other Tennessee families and representatives from the advocacy group, Tennessee Healthcare Campaign, will be in Nashville today to explain their plight to the state’s TennCare Oversight Committee.

They hope to convince the committee that families need more time to adjust to the changes.

“It seems like all TennCare’s been doing is looking at numbers,” said Greg Williams, the campaign’s regional organizer. “They’re not putting a human face on it.” 

At 17, Jonathan Hooker suffered a severe brain injury in an automobile accident. He is cognizant and can signal with his right hand. But he requires a feeding tube to survive and one-on-one care most of the time.

Under TennCare’s new policy, the state agency “will ONLY cover PDN [ private duty nursing] services for adults age 21 or older IF: You are ventilator dependent, OR, you have a functioning tracheotomy AND need certain other kinds of nursing care too.”

He is not ventilator-dependent and is not on a tracheotomy. But he is fed through a feeding tube where medication must also be administered. He also has seizures and must be monitored during the night to keep his throat clear.

“I question their decision,” said David Hooker. “If he has to be put into a facility, he would regress tremendously. We want him to have the best quality of life that he can possibly have. Our doctor hesitated to order this [change]. He told us Jonathan needs more coverage.” 

Daryl Salyer was among those discussing possible options Monday on the Hooker’s porch.

He also will make the trip to Nashville today.

Two of his four boys have muscular dystrophy and also will be affected by the cuts. His son, Ben, 21, has been on doctor-ordered around-the-clock care. But that will soon stop, according to a recent TennCare notice.

“My boy will never get to …,” Salyer said as he began to cry.

Others on the porch wept with him.

“I’ve worked and lived in this state all my life,” he continued. “I’ve paid my taxes. And even though the around-the-clock care was ordered, we didn’t want to abuse the system, so we cut it to 12 hours a day. The company our nurse works for didn’t even know this was coming. I had to tell her.”

Adults over 21 who are not ventilator-dependent or have a functioning tracheotomy could still receive up to 35 hours of help per week, of which no more than 27 could be filled by a skilled nurse, said Wilson, the TennCare spokeswoman.

The changes took effect Sept. 8 for any new requests for services. Sept. 8 also was the first day that TennCare mailed individualized notices to members receiving home health or private-duty nursing services in excess of the new coverage policy, Wilson added.

“Those letters are individualized for each member and provide detail about the amount of home health or private-duty nursing services TennCare will pay for that person going forward,” she said. “Less than 1,000 TennCare members are seeing a reduction in the amount of home health or private-duty nursing services they were receiving. More than 10,000 members are currently receiving care in their homes within the coverage policy.”

TennCare Website
http://www.state.tn.us/tenncare/
Contact TennCare
http://www.state.tn.us/tenncare/quick-contactus.html
Private Duty Nursing Care Cutbacks
http://www.tenncare.org/actions_alerts/alerts/2008_08_19_nursing_cut.html
TennCare Cuts Round-the-clock Home Nursing Care
http://www.tricities.com/tri/news/local/article/tenncare_cuts_round_the_clock_home_nursing_care/13297/

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