BALTIMORE – Evelyn Burrell feels like her Baltimore home is an obstacle course. The 86-year-old former teacher suffers from congestive heart failure, high blood pressure and osteoarthritis, ailments she says make the most basic activities, such as getting into bed and going to the bathroom, an ordeal.
“My knees hurt all the time,” she said. “If I had help to get into bed it wouldn’t hurt so much . . .if I had help, my knees wouldn’t buckle.” To get the level of health care services she says she needs but can’t afford on her own, Burrell joined six other elderly citizens in filing a lawsuit Wednesday against the Maryland Department of Health and Mental Hygiene, the agency that oversees the state’s Medicaid program.
The lawsuit alleges that DHMH illegally refused to provide Burrell and the other seniors with the critical long-term nursing services to which they are entitled under state and federal Medicaid laws.
The lawsuit was filed in Baltimore City Circuit Court on behalf of the seven seniors by American Association for Retired Persons and Maryland Legal Aid Bureau, Inc., a non-profit organization that provides free legal services to low-income people.
According to Joseph DeMattos Jr., the director of AARP Maryland, Burrell and the other plaintiffs in the case are a just a sample of 70,000 people throughout the state who they say are too frail to take care of themselves but too poor to afford the necessary nursing services.
“What is at stake is the eligibility for Medicaid’s long-term care services,” Demattos said at a press conference. “These are frail and sick older Marylanders who need the help to which they are entitled.”
On any given day, about 16,000 seniors receive state Medicaid assistance to help them meet the cost of nursing home care or equivalent care at home, according to Susan Tucker, the executive director of the Office of Health Services at DHMH. She said the average annual cost per person receiving nursing services is about $68,000.
However, Tucker said she could not comment on the suit itself.
The dispute, according to DeMattos, hinges on the standards DHMH uses to determine which elderly, low-income residents can receive nursing facility services, whether in a nursing home or while living in their own homes or assisted living facilities.
He says a lower level of care provided by Medicaid, known as “personal care services,” is not sufficient to meet the needs of many seniors who like Burrell are physically impaired or suffer from loss of mental function from stroke and Alzheimer’s Disease.
The lawsuit states that a DHMH regulation stipulates that Medicaid recipients must have a condition so severe that they must be “under the supervision of licensed health care professionals” before they can receive the higher level of care. DeMattos said this wording allows the agency to refuse the more extensive services to people who are unable to take care of themselves but aren’t so bad off that they need constant supervision from a doctor or a nurse.
“Just because a loved one does not require constant supervision from a doctor or a nurse does not mean that he does not need or deserve other health-related help,” he said.
Maryland receives part of its Medicaid funding from the federal government and is required to follow federal guidelines in providing Medicaid services to state residents.
The attorneys representing the seven elderly plaintiffs said that Maryland is one of the most restrictive states in the country in setting the standards for receiving nursing facilities care under Medicaid.
“They are interpreting it in the most extremely limiting way possible,” said Regan Bailey, an attorney for Maryland Legal Aid Bureau, Inc.
Evelyn Burrell, who attended the press conference yesterday in a wheelchair, hopes the lawsuit will force the state to giver her more help. “I can’t take a bath by myself,” she said. “I must have health-related services, but the say I don’t need it.”