ARChoices | Delta Digital News Service

New DHS Program Cuts Hours for Disabled Citizens

Posted on June 19, 2017 by Kimberely A. Blackburn

by Kimberely Blackburn
Delta Digital News Service

JONESBORO – A new program implemented by Arkansas Department of Human Services resulted in cuts of home health care hours for many in the disabled community of the state.

Legal Aid of Arkansas won a temporary restraining order on behalf of many who suffered a cut in hours in February. DHS appealed and won a postponement of the original court date of July 2017. The suit is expected to go to court in 2018.

The suit states Arkansas DHS did not notify those enrolled in the ARChoices waiver program of upcoming changes. This lawsuit came after winning a suit filed in federal court against DHS.

James Dukes speaks about a video he directed that highlights the impact of the 4,000 cuts. Legal Aid of Arkansas is traveling the state meeting citizens to help explain the cut in hours imposed by Arkansas DHS. (Photo by Kimberely Blackburn)

Kevin De Liban, attorney with Legal Aid of Arkansas, said the lawsuit came after several clients contacted him after DHS drastically cut their hours. These cuts resulted from a new program called ARPath. The program uses an algorithm developed at the University of Michigan to determine a category each patient would fall into. DHS assigned each category a pre-determined number of hours assigned that cannot be changed by a health care professional.

Brandi Hinkle, deputy director of communication for Arkansas DHS, said, “ARPath was implemented to provide a more objective review of client needs to ensure that all beneficiaries receive a consistent, medically appropriate level of care.”

She said DHS developed the categories after studying a large number of individuals with similar diagnoses. DHS used this study to best determine home health care hours. Hinkle said DHS commits itself with helping individuals maintain a high quality of life.

De Liban said the lawsuit was filed due to the violation of the Administration Procedures Act, which governs state agencies. According to the Act, state agencies must publish any proposed changes and allow for public comment. After the period for public comment closes, they must consider comments and re-evaluate the proposed change.

Hinkle said DHS follows an extensive procedure for changes to all programs and clients have the right to appeal after their assessment. De Liban said DHS did not adequately inform the public of the change. He said DHS published a notice of rulemaking online and in newspapers of record, but included no mention of the algorithm. The notice did include a link to the entire 242-page document, but De Liban said the notice mentioned the algorithm only six times and did not include it on the page that listed the major changes.

The Effects

Dan Watson acts as the primary caregiver of his 32-year-old son Andrew. He said they learned of the new program with they asked for a re-assessment. Watson said his son’s condition worsened, but the new program resulted in a reduction of hours. He said the nurse ran the program with all the worst answers and it still resulted in the same number of hours. He said his concern lies in what will happen to Andrew in the future.

Dorothy Vaughn suffered a spinal stroke, which involved a blood vessel bleeding out into her spinal cord. She said paralyzation occurred within a matter of hours. DHS cut Vaughn’s hours by 21 hours per week. She said her family works and her son cannot turn her due to his back surgery. She said she suffered a stage-four pressure sore due to her lying on her back each night, a result of the reduction of hours.

Vaughan said she remained in a nursing home for three weeks after having part of her tailbone removed in treatment for the pressure sore. She said she needs the additional home health care hours to help her get on top of the pressure sore and become productive again. As it stands, Vaughan said her end result will be a nursing home.

Shannon Brumley suffered a spinal-cord injury 16 years ago as a result of a motorcycle accident. His mother remains his primary caregiver.

Brumley said emotional health plays a big part in one’s physical health. He said being in a nursing home would affect his emotional state greatly directly. He said he wishes DHS could live his life for a week. If possible, he said it would change its mind.

Tammy Dobbs of Cherokee Village explain how the cuts in her home health care affects her life in a video directed by James Dukes. Legal Aid of Arkansas produced this video to show the impact of the cuts caused by the new program implemented by Arkansas DHS. (Video courtesy of Legal Aid of Arkansas)

The Future

Arkansas DHS appealed the state lawsuit and De Liban said it could take until 2018 for the case to go to court. In the meantime, those enrolled in this program can protect themselves. Hinkle said all enrollees have 30 days to appeal their assessment. She added anyone who appeals within 10 days has the right to keep all their hours until the hearing.

De Liban said anyone who loses at the hearing will be required to pay the state for the cost of the extra hours. However, he said DHS cannot garnish any Social Security or Medicaid benefits. He said he also suggests each one logs all hours in which care received, what they do, and what they cannot do for themself.

De Liban said his main concern involves the lack of thought DHS made on how its actions would affect many enrolled in their program. He said anytime you make a decision that will greatly affect those vulnerable, great thought must be made.

“You definitely should get the opinions of the people who are going to be affected by the program,” he said.

Vaughn said although her concern remains her future, others’ futures concern her more. Before her recent health decline, she volunteered at schools with special-needs children.

“My heart breaks for the possibility of this affecting children,” Vaughan said.

Health

DeltaYou: Bradley Ledgerwood’s Fight

Posted on December 20, 2016 by jiayueliao

by Jiayue Liao
Delta Digital News Service

CASH, ARKANSAS — Though confined to a wheelchair for 34 years, Bradley “Brad” Ledgerwood continues fighting for his personal rights.

Ledgerwood was born with cerebral palsy, which keeps him from independently standing, walking, taking care of his personal hygiene and feeding himself. The only parts of his body he can move by himself are his hands, but they have a limited range of movement.

“I can’t do anything by myself,” Ledgerwood said.

Ledgerwood lives in Cash, a very small town with fewer than 400 residents and no hospitals.

When Ledgerwood joined the ARChoices program in 2002, he was approved for 56 hours per week of in-home personal care Medicaid services, which was the maximum allowed. In January 2016, the Arkansas Department of Human Services introduced a new system for setting the maximum number of hours for ARChoices’ participants. The new system relies on computer algorithms rather than caregiver discretion.

LISTEN: Bradley Ledgerwood explains the difference in his care hours.

The Arkansas Department of Human Services twice cut Ledgerwood’s in-home personal care services from 56 hours per week down to 32 hours per week since he’s not on a respirator, according to the Ledgerwood family. Although two appeals have kept services at 56 hours a week, Ledgerwood must undergo another evaluation in January 2017.

He said the slash of personal care services would take his life away.

“I can’t drive, so if I want to go anywhere, I have to ask my mom to take me there,” Ledgerwood said.

David and Ann Ledgerwood kneel for a picture with Bradley at Paragould’s Lincoln Day Dinner. Bradley Ledgerwood will start his third term as alderman for Cash in January. (photo by Alice Mellow, courtesy of the Ledgerwood family)

When DHS first cut Ledgerwood’s hours, his mother had to quit her job to take care of him. If a life-threatening emergency happened, she might not be able to make it back in time from Jonesboro — an approximate 30-minute one-way commute.

Ann Ledgerwood said the system changed the service hours without reasoning other than a computer system that only allots so much time.

“We just know the last two years, his hours have been cut from 56 to 32 with no improvement,” she said.

Critics note a recent ruling only makes DHS explain to ARChoices’ participants why their allocated hours will be cut, and claim hours are being cut even more drastically. But testimony from the professor who invented the algorithm suggests the state’s software may be faulty and DHS does not understand the tool it uses.

“If you going to do a program, you are knowing how it works,” Ledgerwood said. “Nobody in state government knows how the computer program works.”

His father, David, notes technology may not always be the answer.

“I have a love/hate relationship with technology,” he said. “Algorithms do work, but there’s a human element that has to be there.”

Since DHS started using the new system in January 2016, 47 percent of participants in ARChoices have seen a reduction in service hours, according to a Nov. 6 Jonesboro Sun article.

“I feel like the people in government are just wanting to make a name for themselves … the ones who are supporting the cuts are just wanting to make a name for themselves and I don’t think they care about people,” Ledgerwood said.