A potential second tragedy is looming for Michigan auto accident survivors with brain and spinal cord injuries.
On July 1, Michigan's new auto insurance law makes deep cuts in payments to providers of long-term care for these and future survivors. Many care providers are expected to close by then, or not long after. And in many cases, alternate care is simply unavailable. That could leave hundreds of people, especially those dependent on ventilator support, facing severe consequences -- including a heightened risk of death.
Kelley Miller is one of these most vulnerable accident survivors.
She was once an assembly line worker at General Motors’ Delta Township plant. But on July 31, 2011, Miller’s old life disappeared in an instant.
"It could happen to anybody at any time," said Miller. "It was simply on the expressway, and he decided to get off the exit at the last minute, and I jerked the wheel and rolled."
Miller suffered a C2 and C3 spinal cord injury. She is paralyzed from the shoulders down and needs a ventilator to breathe. Miller said adjusting to her new life was extremely difficult. A nightmare, really. But she’s really glad she didn’t just give up during those early dark days.
Today, one of Miller's greatest pleasures is finding rustic treasures at antique stores and auctions to make her home a visual delight.
"I’ve been living a good life, to the fullest, at my own home ... (with) my husband, children and grandchildren, and I get out in the community a lot, so I’ve made the best of it for sure," she said.
Miller’s good life was possible because of the lifetime care benefit of Michigan’s old auto insurance law. Her insurance company paid for her surgeries, built a home for her to live in, and pays for her nurses. Miller’s 24/7 nursing care alone costs the insurance company more than $11,000 a week.
RN Shara Curry has been doing shifts in Miller’s home for the past ten years. She manages catheters, wound prevention, bowel and tracheostomy care, range of motion exercises, and that all important ventilator.
"She cannot take one breath, without ventilator support," said Curry. "So it’s very important, without the ventilator she would have brain damage after about two minutes."
"It could happen to anybody at any time. It was simply on the expressway, and he decided to get off the exit at the last minute, and I jerked the wheel and rolled." Kelley Miller, survivor of a 2011 car accident that left her paralyzed from the shoulders down
Miller now faces the prospect of a second tragedy. Michigan’s new auto insurance law slashes payments for long-term rehab, home care and residential programs for car crash victims by 45% on July 1. Her current provider could go out of business, with no other that could afford to take its place. She doesn't know where she will go if she has to leave her home due to lack of adequate care. And her nurses and aides could soon be looking for new jobs.
Tom Constand is president of the Brain Injury Association of Michigan. He said these cuts will usher back problems the state struggled to solve 48 years ago, including a lack of good and timely health care for crash survivors.
It’s why Republican Governor Bill Milliken signed the Auto Insurance No Fault Act in 1973 in the first place. Constand keeps a letter Milliken wrote in praise of the Act in his office. He quotes from some of it.
"Seriously injured persons are provided optimal medical care that enables them to achieve maximum recovery," he reads. "Injured parties and families have the lifetime medical coverage needed so that they can avoid the threat of bankruptcy due to medical costs, and or the shifting of these costs to the state’s Medicaid program."
But that’s what we’re going back to, he said. Basic nursing home care instead of home and specialized residential program care. Short-term instead of long-term rehab. Medical bankruptcies. And shifting costs to Medicaid.
Bob Mlynarek is a co-owner of 1st Call Home Health Care, the company that provides Kelley Miller’s care. He said his business won’t survive long on a 45% cut in reimbursements.
"But we have decided to remain open for three months and we expect to lose about $50,000 a month," he said.
Mlynarek hopes that in that time, the state Legislature is forced to confront the crisis that has been set in motion, and addresses what he calls a humanitarian crisis, as thousands of people -- including hundreds of ventilator dependent car crash survivors -- lose their current care.
Mlynarak and other officials say there’s almost no place for vent-dependent survivors to go. Many residential treatment centers with vent programs plan to close or downsize. Regular nursing homes and adult foster care homes are simply unequipped to handle their intensive medical needs. And there’s a mere handful of open beds at the state’s 12 skilled nursing homes that are certified to care for ventilator dependent patients.
"People will die. It will happen. You cannot take the high acuity level and the care that they need and put them into a system that was not designed to treat them." Bob Mlynarek, co-owner of 1st Call Home Health Care
"People will die," Mlynarek said flatly. "It will happen. You cannot take the high acuity level and the care that they need and put them into a system that was not designed to treat them."
As the deadline approaches, case managers, survivors and families are desperately trying to find a facility that has a bed and can handle the scope of their injuries. Insurance companies and other advocates for the new law say providers were overcharging, because they need more money to operate than what Medicare and Medicaid pay.
But Chad Tuttle said it’s inherently costly to provide good long-term care for traumatic injuries. Tuttle is senior vice president of Hospital Operations at Spectrum Health, which has several long term rehab, home, and residential programs for accident victims.
"Our collective neurorehab business has been a break-even business for us," he said.
Soon, if the payment cuts go into effect, it will be a money-losing business.
Tuttle said Spectrum Health is trying to get insurance companies to negotiate with it, so the high quality care it provides can remain in place, but otherwise, Spectrum accident survivor patients will have to be shifted to lower levels of care and Spectrum Health-owned nursing homes. Spectrum does own a specialty nursing home that can care for residents currently in Spectrum’s adult foster care homes, but does not have a ventilator dependent unit if those receiving in-home care need to transition into a facility.
Across the state, other hospital officials agree that options for vent-dependent survivors are extremely limited. Widespread closures of long-term treatment facilities and home care will throw the entire care system for accident survivors into disarray.
Some families may decide they have no other choice but to try to replace the services of trained professionals themselves -- trying to manage complex medical needs such as managing tracheostomies, catheters, and bowel care, preventing wounds, as well as manually bagging loved ones when the ventilator malfunctions.
"It becomes very risky for them," said Tuttle, who shares the concerns. "Their loved ones will probably try to step in and help to fill the gap to the degree that they can, they’ll try to cobble together other care options, but the reality is the first thing that goes wrong, folks likely will end up going to the ER."
"The reality is the first thing that goes wrong, folks likely will end up going to the ER." Chad Tuttle, Senior Vice President for Hospital Operations at Spectrum Health
And from there, once they’re stabilized? There’s no plan. Will hospitals send them back home to repeat the cycle? Let them live in the hospital for long periods?
Tina Gross is CEO of Sparrow Specialty Hospital, an acute care hospital in Lansing. She said the expected rolling closures of long-term care providers for accident victims will affect future seriously injured accident victims, too, even those who paid for lifetime medical PIP benefits on their auto insurance policies.
"It’s going to be very concerning for discharge planning," said Gross. "We work with a lot of different organizations for patients to continue their rehab and their next level of care after they are at a specialty hospital. However, if they are declining to take these patients, then what? Where do they go?"
There is a way to prevent much of what’s about to happen. Democrat-sponsored Senate Bill 314 and House Bill 4486 would leave most of the state’s new auto insurance law in place, but would amend it to provide enough reimbursement to keep providers who care for accident survivors in business.
But the bills are languishing in the Senate Committee on Insurance and Banking and the House Committee on Insurance.
None of the Republican members of the committees responded to our inquiries. Nor did the Insurance Alliance of Michigan. Nor did Detroit’s Democratic Mayor Mike Duggan, who was a powerful champion for the auto insurance changes. Nor did Michigan’s Democratic Governor Gretchen Whitmer, who signed the changes into law.
This story was produced through the New York & Michigan Solutions Journalism Collaborative, a partnership of news organizations and universities dedicated to rigorous and compelling reporting about successful responses to social problems. The group is supported by the Solutions Journalism Network.
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