Caring Across Generations: Post from New CAG Intern Josh Edwards
Tuesday, January 3, 2012 at 12:28PM
Jill's Story
by Josh Edwards
Jill’s admittance to the hospital was preceded by a diagnosis of a decubitus ulcer, which is damage caused by pressure or friction, on her lumbar spine. Jill is a 17 year-old girl who has suffered from Myelodysplasia (spina bifida) since birth. Beth is an occupational therapist who has worked with Jill’s insurance to assist her in getting a much needed new mattress that will supply continuous airflow. Jill currently uses a standard mattress with a gel overlay. The mattress is estimated to be 10 years old, while the gel overlay, over years of use, has succumbed to an unsupportive split down the middle offering Jill negligible support.
Beth, along with a mattress representative from a company dealing exclusively with supportive equipment for spinal conditions, has requested from Medicare a new mattress––the one that supplies continuous airflow. Medicare refused to cover the $9,000 expense to supply Jill with an indispensable medical need, but offered to rent the mattress for one month. After refusing to accept Medicare’s offer, Beth and the mattress representative along with Jill’s physician wrote a compelling letter detailing Jill’s condition, her current sleeping arrangement, and the need for this equipment to avert additional bed sores.
Within a short time, Medicare revised their decision, allowing a rental mattress for two months instead of just one, rather than spend $9,000 for years of quality use. Why? The reason they cited was a mattress of this sophistication cannot be resold. Per Medicare’s policy, a standard mattress can be bought and resold every five years under their coverage policy, but because Jill would require a specialized mattress, Medicare will not approve purchase.
People with spinal cord injuries like Jill’s cannot feel the damage being done, while a person without such an injury could simply adjust their posture. Consequently, after Jill has surgery to repair the skin, she will be bed-ridden with spotty support for several weeks, unaware if any movements she makes could be damaging her skin. Yet Medicare holds firm in their decision not to cover the cost of the mattress for Jill.
Through my internship for the Caring Across Generations campaign, I am starting to learn more about the improvements we need to make to our health care system. Like Jill, many individuals with disabilities are unable to receive the care they need – whether that’s in the form of hours of home care, or specialized equipment that would significantly improve quality of life. I look forward to sharing more blogs in the future as I learn more about the state of healthcare in America.
Reader Comments (4)
Oh, her life is so inspiring and a reminder to all to take good care of our health. -Sarah-
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