For over forty, (40) years the personal injury protection benefits payable under Michigan’s auto no-fault law have been the subject of much discussion. Thousands of personal injury attorneys fight the insurers for more benefits while case managers help coordinate care for an estimated 900 new cases every year. The Michigan Catastrophic Claims Association acts as the financial fiduciary between paying for care and those providing it from medical practices to rehabilitation providers of various types to home care companies.
The law has also been the subject of much jealousy by those living in other states. Most do not have any mechanisms that will pay your medical benefits – that are reasonable and necessary – for life. Today there is an ongoing fight, led mostly by Republicans, to end the current no-fault system claiming it is being abused and has caused Michigan to have the highest insurance costs in the nation. Those on the other side including the Coalition to Protect Auto No-Fault argue there are billions of dollars available and insurance companies in the spirit of typical Wall Street merely want to pad their profits.
Who knows where this fight will eventually culminate. One thing for sure is that when you cannot get rid of something, the logical approach is to try and modify how it operates. Residential and commercial adult day health programs in combination with support from families, neighbors and other independent caregivers could be the force for cost reduction.
Think about it, when you hire a home care service bureau to come into the home of a catastrophically injured person at an average cost of $20.00 per hour the cost is $14,400.00 per month. Place them in certain higher end group homes and the nightly cost easily rises to between $400 and $1000.00 daily depending upon severity of injury so now we average $18,000.00 per month. None of this includes the cost to see medical practitioners for care associated with injuries sustained.
Let’s look at a way to save no-fault money with a different approach to care. Residential adult day services for the catastrophically injured average $1400.00 per month per attendee, a bit more when the person is a quadriplegic. Now let’s say he/she uses the adult day care for 44 hours per week with another 124 at home with a family member who is paid $14.00 per hour for those hours and you arrive at $7395.64. Throw in $1000.00 for transportation (although some centers provide it for much less for those attending daily) and you arrive at around $9000.00 per month, less than the cost of home care and life in a group home.
You do the math. If we save an average of $5000.00 per month or $60,000.00 per year per case by being what we call “clinically creative” its a win for everyone and massive dollars are saved.
Care First Group Living & In-Home Services, Inc. is now developing a program of this type in a residential structure for hte northern Oakland County Community. With over 2,000 square feet they will be able to serve Troy, Warren, Sterling Heights, Eastpointe and perhaps even Pontiac. More of these non-overwhelming programs are needed for those who find daily life with 100 people just too much.
Adult day services keep families together, promote stronger neighborhoods and with the right combination of services represent real care along the continuum. Many are being managed by devoted clinical professionals who are enriching the lives and the long-term care of those being served. Pressure wounds are being avoided, infections held off, depression managed with the right observation and socialization by dedicated direct care staff.
So if the powers that be in the insurance lobby really want money-saving change, our approach to how care is delivered should be among the primary considerations.
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