SD23 - The Needs of Machine-Dependent Individuals
Executive Summary: I. ORIGIN OF THE STUDY The impetus for this study originally came from the University of Virginia Hospital because of experiences with ventilator-dependent patients who "live" in the hospital for extended periods of time. The primary example of these patients at the University of Virginia is a twelve-year-old quadriplegic who has been residing in the University of Virginia Hospital for a number of years. This child was injured when struck by two cars and was transferred to UVA following a substantial period of hospitalization in a local hospital. This child is unable to return home and, at this time, placement In a long-term care facility is virtually impossible, because there are no facilities in Virginia which are both capable of handling the ventilator-dependent adolescent and providing the education and social services needed by this type of child. As a result of becoming familiar with this case and others like it, Senator Thomas J. Michie introduced Senate Joint Resolution No. 99, which created this study. SJR No. 99 called for a study of the needs of machine-dependent Individuals to be conducted by a joint subcommittee consisting of members of the Senate Committees on Education and Health and on Finance and the House Committees on Health, Welfare and Institutions and on Appropriations. The resolution directed the Joint Subcommittee to address the following issues: 1. What should the policy of the Commonwealth's teaching institutions and indigent programs, including Medicaid, be in relationship to these machine-dependent individuals? 2. Do the Commonwealth's criteria for Medicaid eligibility discriminate against providing care for these individuals in a less restrictive environment such as the home or community? And, if so, how can this problem be remedied without substantially increasing the cost of Medicaid to the Commonwealth? 3. Should the Commonwealth apply to the Health Care Finance Administration for a model waiver under Medicaid to provide care in the home and community for up to fifty machine-dependent Individuals? 4. Can appropriate delivery systems, other than acute care hospitals, be developed for these machine-dependent Individuals, especially children, which would be less costly to the Commonwealth and less restrictive for the individual? Senate Joint Resolution No. 99 required that the Joint Subcommittee complete its work in time to submit Its recommendations to the 1986 Session of the General Assembly. II. THE SCOPE OF THE STUDY Although the resolution addressed the needs of machine-dependent individuals, the Joint Subcommittee decided to limit its deliberations to the needs of ventilator-dependent patients. The Subcommittee noted that there are a number of other classes of machine-dependent patients with needs similar to those of the ventilator-dependent patient, such as oxygen-dependent patients, patients requiring parenteral nutrients, and end stage renal disease patients who require renal dialysis. However, the task of investigating the problems related to care of every class of machine-dependent patient appeared to be formidable and too comprehensive for a one-year study. Further, this study was initiated to address the specific needs of the ventilator-dependent patient. The Joint Subcommittee believes that if the problems related to care of the ventilator-dependent patient can be solved, these solutions will benefit other machine-dependent individuals. |
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