MANAGED LONG-TERM CARE (MLTC) PROBLEMS

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Article Retrieved from Gothamist:  https://gothamist.com/news/daughters-dementia-health-insurer-mothers-deaths

Two senior citizens with dementia were found dead after they wandered away from their homes in New York City last week. One was found on the shore of Newtown Creek in Queens, and the other in a grassy area near the cross Bronx expressway.

Their deaths have shined a light on a fast-growing, for-profit health-insurance company in charge of approving and arranging the long-term care they needed to live in their homes and be safe.

It has also exposed the plight of two daughters fighting to protect their aging mothers while navigating the state’s byzantine and costly Medicaid program.

Sue Veizaga’s saga began on February 15th. It was a freezing day in the midst of an otherwise mild winter. The temperature dipped to 15 degrees that night.

Veizaga was at home on the Upper East Side when her phone rang around 8PM. It was the sensor inside her mother’s Bronx apartment, set to alert her anytime 73-year-old Genoveva Madera went near the front door.

“The image I saw was her feeding the cat. You know just arranging the food,” she said.

Veizaga was constantly checking her phone to view the cameras she had placed throughout the older woman’s apartment. What she saw at that moment did not worry her.

“I put the phone down a second. I think I went to the bathroom or grabbed a glass of water,” she said.

But then the sensor went off again. This time, all Veizaga saw was Palomo, her mom’s white cat, waiting at the front door. Madera was gone.

Veizaga jumped in her car and headed to the home where she grew up, in the Mount Hope section of the Bronx. Before leaving, she called Yasmeen, her mother’s home attendant. Veizaga considered the woman an “angel”. She had been caring for her mother for nearly four years. But only for five hours a day.

Yasmeen rushed over to the apartment too. She got there first and found the door closed but unlocked. Madera’s keys and wallet were there. The lights were on and so was the TV. Veizaga flagged down some police officers and reported her mother missing, but she said they were not feeling her urgency.

“They let me jump in the car and we drove around,” she said. “But they were like, ”Are you sure? I have to call my supervisor,’ blah, blah, blah, blah.”

They issued a Silver Alert. Silver Alerts are like Amber Alerts, only the public is asked to look-out for an adult considered vulnerable instead of a child. The Office of Emergency Management said the number of silver alerts has shot up 73 percent in the last two years, from 89 in 2017 to 154 last year.

Veizaga said police did not provide her with flyers like they were supposed to, so she and her friends made their own and searched the streets. On Facebook, she wrote, “I’m living a nightmare right now. My mom who has Alzheimer’s left the house without a coat and just slippers.”

All she could do was wait. Detectives showed up two days later.

“When I looked through the peephole and I saw their faces,” she said. “I already knew it was something bad.”

At that moment, she had one final hope: “That maybe they found her in critical-condition and she was hanging on to life.”

Instead, the detectives said that her mother was found dead in some grass near an on-ramp to the Cross Bronx Expressway. Initial reports were that she froze to death.

Veizaga went there, lit some candles and put down a picture. Then she and her family prayed.

There are more than 250,000 people in the state who -- like Madera -- need long-term care, are on Medicaid and have a private insurance company that decides what services they get and from whom.

Madera’s insurance company was Centers Plan for Healthy Living. In just two years it has become the largest health insurance company in the state that manages long-term-care for people on Medicaid. Centers Plan is a for-profit company in a field of many non-profits.

Valerie Bogart, director of the Evelyn Frank Legal Resources Program for the New York Legal Assistance Group, said that companies get paid a flat rate per person each month, which creates an incentive to maximize profit by keeping costs down.

“The plans have a financial incentive not to authorize a lot of hours of care,” she said. “And it’s in their financial interest to offer fewer.”

February 15th was not the first time Madera wandered off. Last August, she was found near her old workplace in Harlem, by a woman whose own mother also had Alzheimer’s. She called the police. Veizaga considered herself lucky. Her mother came home safe. And she asked the insurance company to give Madera around the clock care.

“They granted me only one additional hour per day,” she said. “And so of course I was upset. I was like, ‘that’s not enough.’”

And so she asked for what’s called a medical review, when the company itself reconsiders their own decision.

“The additional hour they had given me — they took it away,” Veizaga said.

The pressure to curb spending is expected to increase as the state looks to Medicaid to save $2.5 billion this year. According to the state Department of Health, the cost of care for people like Madera quadrupled to $4.8 billion over the last six years. At the same time enrollment more than doubled.

Bogart said over-enrollment is not the main problem.

“How ‘bout looking at, are you paying plans that aren’t providing the services that they’re being paid to give?” she said, her voice rising.

In 2018, federal prosecutors and the state attorney general accused Centers Plan for Healthy LIving of doing just that — billing Medicaid for hundreds of people who received no services at all or services that were not covered by Medicaid. The company agreed to pay $1.65 million in restitution and fines.

When the company cut back that one extra hour for Madera, they told Veizaga she could appeal. Her lawyer advised her to make a log of her mother’s movements at night so that she could prove to the company her mother was “sundowning,” a symptom of Alzheimer’s.

“Your circadian rhythm gets all out of whack. And what happens is when the sun goes down, it sort of throws them into a confused, agitated state,” Veizaga explained.

Veizaga said her mother would pace up and down overnight, and go through drawers, and want to eat and go to the bathroom.

Along with the logs, she got a letter from her mom’s primary-care doctor that said her mom needed 24-hour care.

“Still they denied the appeal,” Veizaga said.

In Greenpoint, Brooklyn, Begonia Skidmore had been going through something similar. She also used cameras to monitor her mother from afar. Her mother also wandered once before and was found. The experience was also a wake-up call for her. She went to her mom’s neurologist for help.

“I got a letter from him saying that she needs 24-hour-care,” she said. “I’ve been working and trying to get her care for the last eight months.”

But the insurance company would only authorize six hours of care a day. Again, it was the Centers Plan for Healthy Living.

Still, Skidmore considered herself lucky. She felt relieved that she could take a break from worrying at least for those six hours. But then, three days into this new arrangement, she got a call at 10AM, on February 9th, two Sundays ago. It was the home attendant. There are conflicting stories about what happened, but the end result was that Skidmore’s mother was missing. She was last seen at her neighborhood Catholic church.

“I entrusted my loved one with you and this is what you do,” Skidmore said, racked with worry, 10 days into her mother’s disappearance. She thought up possible scenarios that gave her hope her mom was still alive.

“People are thinking she’s homeless. They’re staying away from her because she probably smells if she’s in the streets,” she said. “If not, my thing is she’s safe and sound in the hospital and somebody just didn’t inform the cops.”

The next day, hope was lost. 76-year-old Czeslawa Konefal was found dead on the shoreline of Newtown Creek under the Kosciuszko Bridge. In her grief, Skidmore declined further comment.

In a written statement, the insurance company said, “These two cases are under internal investigation and Centers Plan for Healthy Living is working with local New York City authorities to find how and why this happened”.

The company declined to answer further questions.

Last Friday, Sue Veizaga was at a funeral home planning her mother’s burial. The Bronx 6 train roared overhead as she flipped through pages of caskets and flowers. She picked out a white casket with pink lining and pink and purple flowers, in soft shades her mother loved. Veizaga said her mother was funny and sweet and loved to feed the stray cats that hung around her building. So when she went to pick out her burial plot, and a tiger-striped cat walked by, she saw it as a sign.

“She loved, loved, loved cats,” she said. “I was wondering if that was even kind of her saying, ‘Yeah, this is where I want to be.’”

Genoveva was buried last Saturday under a tree at a cemetery in Valhalla, about 25 miles north of her home.