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Case Study: Quadriplegic Sues for In-Home Care

Updated: Dec 17, 2018

Karen Vaughn, a 60-year old Indiana resident, has lived with quadriplegia since 1976. She requires assistance with almost all activities of daily living, including bathing, eating, and brushing her teeth. Between 1981 and 2016, Karen lived in her own apartment while receiving in-home health care through Medicaid. In January 2016, she was hospitalized with pneumonia.

Once she recovered, she tried to return home but could not find a home health care provider. She was unable to find a provider for two reasons: (1) the reimbursement rate offered by the state to home health care providers was too low and (2) Medicaid required that certain tasks (like the ones Karen needed) be performed by nurses. Karen was unable to find any nurses that would provide skilled care at the state’s reimbursement rate.

Despite being cleared medically, Karen remained hospitalized for 11 months and was then moved to a nursing home 60 miles away from her friends and family. Once there, she developed a bed sore that required surgery, which had never happened in her own home. In her case, cost was not an issue- Karen had been approved for $395,000 a year  and in-home care is less expensive than a hospital or nursing home.

Karen sued under the Americans with Disabilities Act, the Rehabilitation Act, and the Medicaid Act. She argued that FSSA failed to provide her with medical assistance that she qualifies for, there by institutionalizing her against her will. Karen and her doctors contended that she did not require nurses or a skilled level of care in all areas. “Any lay person could be taught how to safely provide Ms. Vaughn’s care,” said one of her doctors.

U.S. District Court Judge Jane Magnus-Stinson ruled in Karen’s favor and ordered a remedy hearing to finalize her care. The judge found that FSSA’s administrative policy was too rigid:

Ms. Vaughn’s request that more of her services be provided by non-nursing staff would help to alleviate the effects of a nursing shortage…For all of these reasons, the court concludes that Ms. Vaughn has established that the accommodations she requests are reasonable.

SOURCE: The Journal Gazette “Woman OK To Get Care At Home” by Niki Kelly


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