Thanks to all of you who have emailed me with suggestions to help Curt and Bynthia Gates.

Here’s an update and a few clarifications:

• The patient is approved for 35 hours of weekly Home Care under Medicare. The problem is NOT that insurance will not cover the service he needs. The problem is GETTING IT.
• His biggest need is for a PCA (Personal Care Attendant) to help with bathing, etc., however, intermittent nursing (even 15 minutes per month) must be deemed necessary in order for Medicare to cover the 35 weekly hours of Home care. He certainly qualifies for at least 15 minutes of skilled nursing a month since he has an ostomy and open wounds on his feet!
• The above determination requires an assessment by a nurse who then orders PT/OT and a home health aide.
  • Unfortunately, the nurse never showed up for the scheduled assessment. As a result, Curt can’t get any help at all – either skilled home health or a PCA.
• So far, 9 Home health agencies have declined to come evaluate him because “his needs are too great” or he has “no likelihood of improvement.”
  • This in itself is worrisome, because the “Jimmo settlement” makes it clear that under Medicare, skilled nursing services can’t be denied on the basis of rehabilitation potential.
  • Unfortunately, the Jimmo settlement does not seem to stop home health agencies from deciding NOT to see a patient on the basis of rehabilitation potential.
  • The Gates have contacted the Department of Health who put them in touch with the Minnesota Office of the Ombudsman for Long Term Care. Complaints have been filed against home health agencies. However, complaints do not help get Curtis any actual home health CARE.
• Bynthia, who was previously on the Bethel University faculty, has reached out to the Nursing, Kinesiology (PT/OT) and Social Work departments, as well as to former PT students. There has been no response to these requests for help.

For a long time I’ve been convinced that the missing link in the field of wound care was a broad understanding of the patient experience. More than 3 months after hospital discharge, this patient is at home on a ventilator with open wounds on his feet, and no skilled home health or personal care services to provide so much as a bath. Next time you think you have problems, think about that.

Although I’d like to fix a lot of injustices in the world, I’d be happy to start with finding 35 hours a week of skilled home health (and a bath) for this one patient. I’ll publicly thank anyone who can provide that care, or make it happen.

 —Caroline

Caroline Fife, M.D.

Dr. Fife is a world renowned wound care physician dedicated to improving patient outcomes through quality driven care. Please visit my blog at CarolineFifeMD.com and my Youtube channel at https://www.youtube.com/c/carolinefifemd/videos