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Personal Story Behind Now-Settled Class-Action Medicare Case

Earlier this month we shared information on a settlement in a major Medicare case that will change the way the federal program supports those who have chronic illnesses. The lawsuit was hailed as an important achievement by many who advocate for the rights of nursing home residents, including the Consumer Voice.

The basic disagreement in the lawsuit is whether Medicare is required to pay for certain long-term care for patients who have chronic illnesses. In the past, in order to qualify for support those patients must have shown some signs of long-term improvement. That meant that those who would likely not recover fully would not qualify for the long-term support. This clearly presented a troubling problem for those residents–often very ill–who usualy have few other options to receive the care that they need. However, thanks to this settlement, the Medicare rules are slated to change so that those who have chronic illnesses will be covered for things like home nursing services.

The Personal Story Behind the Case
Recently the VT Digger provided an in-depth story about one family at the heart of this case. The lawsuit was a “class-action,” meaning that while certain individual parties led the effort, the ruling would apply to others “similarly situated” even they were not named individually to the lawsuit.
According to the report, one of the lead plaintiffs in this case was a 70-year old woman who has suffered a serious string of medical setbacks. She is blind and diabetic. Her ilnesses have taken a leg, and she now only has one toe remaining. Yet, despite her clear need, she was denied at-home nursing support. That is when she decided to fight back. She explained in a recent interview after the settlement was reached, “Nobody ever promised people that worked all their life that they’d get what they wanted, whether it’s a new car or a new tractor. But if you need something to help you walk or to help you get around, you will get the necessities if you go after it. You just can’t sit there and hope it will come walking through the door. You have to stand up for what’s right.”

Our attorneys are all too familiar with reality. So many community members who have earned certain benefits often have to fight simply to receive the care to which they are reasonably owed. That sometimes translates into family members of those individuals forced to stand up for the rights of their loved ones. Ideally there would be an understanding of the quality of care that all should receive, but we have yet to reach a point where fairness pervades at all times.

The Settlement
Fortuantely, due to the tireless advocacy of so many, including those personally affected by these issues, progress is being made. The main advance in this case was the axing of the “improvement” standard. While CMS officials did not concede that the improvement standard ever existed, it agreed to allow patients with chronic conditions who are deeemd stable (even though they need support) to receive at home nursing care. This represents a big win for advocates for seniors and those with disabilities. Those invovled say it will likely improve care for tens of thousands of community member who, currently may not be recieving the care that they need.

See Our Related Blog Posts:

Settlement in Medicare Payment Rules Case

Lawsuit in Death of NH Resident with Dementia