KNOXVILLE, Tenn. (WATE) – For nearly a year, a blind woman who lives alone has been trying to receive home care services from TennCare, but has been turned down, twice.
In a report, TennCare says the young woman has “no significant functional deficit.”
The state’s division of TennCare offers what is called the CHOICES Program – a service set up either for seniors or adults with disabilities so they can live at home and don’t have to go to a nursing facility.
The blind woman who called us would like a caregiver to visit a few times a week, but, following an evaluation, TennCare writes she doesn’t qualify for assistance.
For the last 11 months, Janet has lived alone. She’s been blind since birth. Her mother has dementia and moved an hour away for care. Janet’s dad died 20 years. Her only outside communication is through her computer. With the exception of an aunt, she has no family members living nearby. Janet says her mom and dad sheltered her for most of her life.
“They just wanted me to stay a child,” she says of her parents.
She reads Braille and attended the Tennessee School for the Blind. At 45, she has never worked, lives on a fixed income and receives some TennCare benefits.
Earlier this year, she applied for Home Care and Health community-based services through the CHOICES program; she’d like to approve a caregiver for two or three days a week to assist her at home.
“I can do some things, but a blind person can’t sweep, can’t mop. We can’t really cook for ourselves. I can’t do my own laundry. I can’t make my own bed,” she says, adding that a caregiver could make a difference so that, “I wouldn’t be as lonely as I am. I would have help.”
Her aunt who lives nearby tries her best to be there for Janet, but it’s getting harder with her own failing health.
“It is hard because I can’t always be here when she needs me. When she calls, I try my best to come,” says Janet’s aunt, Linda Bradley.
Because she lives alone, Janet asked we not reveal her last name or where she lives.
The steep steps in front of her mother’s house are difficult to navigate and they keep her home-bound. Five months ago, a friend wrote a handwritten letter to TennCare requesting CHOICES home care services for Janet.
“I was told I can’t get help because I can dress, bathe and feed myself,” Janet says.
Bradley adds, “She needs help. She needs help from someone. You would think that they would consider that.”
Not giving up her fight, the state sent a nurse to evaluate Janet’s activities of daily living. We read the nurse’s evaluation presented to the state:
“You are able to do all of those activities of daily living by yourself without help from anyone else most days of the week.”
Janet was devastated.
“Getting turned down like this is, it’s bad enough that I don’t have my mom anymore. I miss her,” she says. “But when I’m told you don’t qualify because of this and this, it makes me angry and really depressed.”
In early October, Janet requested a hearing before TennCare’s Office of General Counsel. We returned to her home because within the last 10 days, she received a package from TennCare.
The state sent more than 90 pages of legal documents and reports — none of it in Braille — in preparation for Janet’s hearing later in November.
That mid-November hearing is scheduled to be a conference call.
Documents say representing TennCare will be the state’s lead Clinical Nurse. Janet has no one representing her.
“I’ll really need to have someone here that can talk to this judge because… I don’t know what I’m going to say to him because it doesn’t seem like I’ve said anything to them so far has mattered,” she says.
We wrote to TennCare regarding Janet’s case.
In its response, the state says an independent third party confirmed Janet has “no significant functional deficits” and does not qualify for the CHOICES program.
“Ah, well, I’m blind. That, that makes it hard to function… I think they should look me in the eye and tell me that I don’t qualify,” saying she’ll also request an in-person hearing.
Despite her request, Janet had yet to hear any word about an in-person hearing. TennCare has stringent rules it must follow as it evaluates people like Janet who apply for assistance under the CHOICES program.
She did not qualify under the state’s pre-admission evaluation formula, but without any legal representation, without being able to understand the documents, because they’re not in Braille, Janet has a rough road ahead of her.
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