In nursing home, Medicaid and a family's struggle

June 28--What they hoped would be a two-week struggle has turned into an ordeal lasting well over a year.

Sitting in a small break room at Hillview Terrace Health and Rehab Center earlier this month, Walter May said his wife, Cheryl, who suffered from breathing problems for the previous few years, had open-heart surgery last year to remove a blockage. But Cheryl developed a MRSA staph infection. Her condition deteriorated.

"They assured us her lungs were strong enough and her kidneys were strong enough," Walter said. "Her lungs collapsed and her kidneys quit. I don't know if it was the infection or not, but her original problem was a breathing problem."

Recovery has been slow. Cheryl was on her back for "eight or nine months," Walter said. She requires dialysis three times a week. The other days of the week, she works on rehabilitation, "trying to get back on her feet, trying to get strength up."

Medicaid pays for what has been a long stay for Cheryl at Hillview. The program covers about 70 percent of those in the facility, said Bobby Stephenson, Hillview's administrator.

"One thing is Medicare and managed care plans are only short-term," Stephenson said. "Without the Medicaid system, we would not be able to get people with the level of care they need."

According to the Alabama Medicaid Agency, three of every four individuals in the state's nursing homes receive coverage. Medicaid's nursing home funding is not an area that can be cut should legislators decide to reduce Medicaid funding in a special session, said Dr. Don Williamson, overseeing a transition of the Medicaid delivery system.

But Medicaid's importance to nursing homes underlines its major role in Alabama's health system, where 20 percent of state residents are covered by the program.

Unlike decades past, most of those who enter nursing homes are dealing with major illnesses. "Most of our patients tend to be very sick," Stephenson said, saying congestive heart failure, pulmonary disease, and stroke were the most frequent conditions.

Long-term care is critical for Cheryl's recovery, said Walter May. It's also critical for the May family. The couple are raising four great-grandchildren -- ages 4 to 12 -- as their parents are unable to take care of them. One child is autistic; two have attention deficit hyperactivity disorder. Walter May, who said they "don't take assistance" for their kids, said he cannot care for his wife at home.

"If she didn't have (long-term) care, I would have to have her at home, which would be an impossibility because of things she's not ready to do yet," he said.

Medicaid is also critical for nursing homes around the state. Hillview, on Perry Hill Road, has been recognized for the quality of its care, and Stephenson said maintaining those levels requires Medicaid support.

"Labor is where we spend our money," he said. "Hands-on care, we need that ... we're maybe the second-most regulated industry out there, maybe two or three out there. You make sure people are being taken care of."

Hillview stays in touch with their residents' loved ones. "They have monitored Cheryl and they call every day, they tell me everything they're going to do with her," May said.

The family hopes to get Cheryl home soon. The couple celebrated their 50th wedding anniversary earlier this month. Walter May, who gets about four hours of sleep a night, has given up gardening, and jokes that he's lost 15 pounds since Cheryl has dealt with her illness.

"Without Medicaid, we'd fall through the cracks," he said.

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