I am a social worker in a Medicare psychiatric partial hospital program in Louisiana. I have a 48 year old female client in our program who is currently living in a nursing home near our program. She is a displaced person from Hurricane Katrina. Her father lost a home in coastal Mississippi and their home in New Orleans was damaged.
Our client is medicaid and medicare eligible due to a serious mental illness (Schizoaffective Disorder). She also has ambulatory problems (she uses a walker) due to either a series of strokes or muscular dystrophy (diagnosis is inconclusive at this point).
My question is this; our client wants to live independently with PAS support in southern Mississippi near where her father is rebuilding his home. Are there sufficient PAS services available to adults with mental illness in Mississippi so that she could move there upon discharge from the nursing home and be eligible for services? She is currently a life long resident of Louisiana, but her father is selling the New Orleans home. She is also interdicted and her brother is curator. She is very stable at this point and we see no need for her to continue with nursing home care. She wants to live independently. Could you give me any information about the availability of PAS services and how to access them. I am familiar with services in Louisiana and I know that it is still rather difficult to access them and it usually requires a waiting period.
Dear Gentle Questioner,
Thank you for writing. The question you ask is complicated and even though you have asked about PAS, more assistance could be needed in order to best support this person. It looks like this individual may need ongoing medical specialists for the possible ALS and/or strokes. She looks to need assistance with daily activities. The level of physical assistance will depend on her functional abilities and/or the availability of assistive technology. Most states provide PAS including possible home modifications, through Medicaid Waiver programs. These programs serve people who are poor and also otherwise qualify for nursing facility or other institutional levels of assistance. State Medicaid programs also provide medical services and may also provide durable medical equipment such as wheelchairs, walkers and other medically necessary devices and appliances. I am assuming that she already has income through private and public sources such as Social Security.
Her initial needs could be met by a combination of services from Louisiana and Mississippi. In particular, she will need assistance with coordinating services during and after her move back to Mississippi. It looks like she will probably need mental health services, possibly ongoing community mental health services as well as knowledge about the availability of in-patient services, if needed. It looks like there is a need for more than just “PAS” as it is usually understood, but the person you write about still has a right to choose to be served in the most integrated setting regardless of the nature or severity of the disability.
This right also touches on the last issue you present which is her “curator” and having been “interdicted”. If I understand these terms, she has a guardian/conservator which means she has been found to be incompetent and is not in control of her own legal and financial affairs. Since a family member is assisting her in this arena, I assume that this will continue. However, if there are questions, you could try the State Agencies listed on the PAS Center website and also your local Social Security Agency.
While all of these issues may seem overwhelmingly complex, addressing them one at a time and having coordination support “on the ground” can make achieving the goal very doable.
First, check out Medicaid Waivers for Mississippi (I am assuming you are aware of any resources that may be available in Louisiana where you work.) In Mississippi, there looks to be three possible programs that could meet her needs. The first is an “Elderly and Disabled” Waiver, the second is called “Assisted Living (In addition to other factors, this program appears to have geographic restrictions.) and the third is called “Independent Living” Waiver. The “Spinal Cord / Traumatic Brain Injury” Waiver is not an option because functional limitations due to brain impairments caused by a stroke are not considered to be “traumatic”.
I called a colleague in Mississippi about PAS services and she thought, off of the top of her head, that the Independent Living Waiver might be the best option to explore because of the available services package and because there is no waiting list. You should also call the state program contact people listed on the website and ask them for information and about any questions you may have.
I also asked my colleague about community mental health services. She indicated that they are generally available without having to “wait” depending on where your resident actually ends up living. Besides community mental health, it looks like assistance with medical specialists might be a good idea. The question of whether this person has ALS or has had a stroke, and what needs might be expected to arise in the future depending on the diagnosis, may need to be addressed.
I also recommend you look at the Mississippi Agencies on Aging and the Mississippi Independent Living Centers for more information.
Yours truly,
Mike Oxford
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