People receiving home care benefits from Managed Long Term Care plans (MLTCs) must know their rights and must know how to pursue the MLTC plans to give them the appropriate amount of services. All plans have a grievance process. Most often, this process does not resolve the issue as it is the plan who denied you services evaluating the complaint. However, you can and SHOULD take it to the next level. Fair hearings are heard at the State level and plans have to comply with decision – usually made in favor of the patient. This NYT story – where the children are taking turns caring for Mom at night – is heartbreaking. That MLTC plan should and could provide overnight care to this patient. Most caregivers work full time and also have their own families to contend with. Placing the burden of care on them is not a viable long term plan – they will burn out. Then their loved one winds up in a nursing home – when more home care services could have prevented this.
