Medical Home Meeting: November 13, 2013

Our November meeting began with Denise Guilbeault, LICSW explaining the Medical Review Team.  In Massachusetts, the admission of a child into any of the three pediatric nursing facilities needs to be reviewed.  The Medical Review Team is composed of medical and human service agency representatives.  In order to qualify for long term placement, the child must have two discrete daily nursing care needs and developmental function scores of less than 12 months.  Short term respite care is available for families.  The nursing requirements are the same as long term placement, but the developmental profile is slightly higher, under 24 months.  Approval for respite care allows for up to 90 days at the facility.  As expected, summers and  holidays are the busiest time for respite requests.  MassHealth is the primary payor of respite services.

There is a real gap of services in Western MA; these pediatric nursing facilities are located in Billerica, Groton and Plymouth, MA.  Right now, there are about 25 beds available for respite care.  Without respite, families do suffer.

The initial application is very difficult, due to paperwork requirements.  Once the child is approved, the annual review is quite a bit easier.   The Medical Review Team offers a list of alternate community-based programs to families whose child does not qualify for admission to a pediatric nursing facility.  Many children will qualify for temporary placement after discharge from a hospital stay.  Hospitals develop the discharge plans, but the pediatric nursing facilities make the final decision on whether to admit a child or not.  Again, these services are located in Eastern MA.  For children having surgery in Boston, this is a viable option.

Next up:  Charles DiFazio, attorney with Sam’s food stores in Connecticut, spoke about Sam’s Children, Inc.

Sam’s Children is a small charity seeking to help families facing the chronic illness of a child.  This charity provides funding for diverse expenses associated with caring for children with medical conditions.  Sam’s Children tries to provide support within one week of the family’s request.  One example of support was the purchase of a generator for a family after the tornado in 2011.  The grant is given to the vendor, not the family.  This is a one-time opportunity to help families, and should not be seen as a source of on-going support.

Sam’s Children also donates food to the Ronald McDonald House.  Shriner’s Hospital and other area hospitals send referrals for funding to Sam’s Children.  Referrals come from doctors, nurses, social workers and other health care professionals.  The referral must explain the need to the charity board and give justification for funding.  The service area for Sam’s Children is Connecticut, Massachusetts and Rhode Island.  The charity is looking into providing services for New York families.

Several attendees at the Medical Home Work Group meeting spoke enthusiastically and warmly about the work done by Sam’s Children.