Preserving an ICS Member’s Job and Independence

ICS member Scheria Keith needed a specialized, standing transfer device installed in her home in order to be discharged from a nursing home and to live independently in her community. The device is generally found only in hospitals and institutions.

As the first and only health home program in New York State with expertise serving people with physical disabilities, ICS staff knew exactly what was needed. They had to demonstrate to her insurer that the standing transfer device was essential to Scheria’s ability to live at home and maintain her independence. To ensure that Scheria was able to return home and to prevent her from losing her job, Stephanie and Elaine embarked on an extensive, months-long process that required ongoing communication with Scheria, her landlord, nursing home staff and providers, and the collection of detailed documentation to prove the medical necessity of the specialized device.

Providing disability competent care

For several months, Stephanie and Elaine worked rigorously and advocated for Scheria, highlighting how the standing transfer device was accessible in Scheria’s home, while proving—through trial and outcome—that other types of equipment could not support her.

Stephanie helped to collect pictures necessary to document that the home was accessible for the required device. Traditional equipment was also tested, Elaine said, but none worked for Scheria.

“We had to get information from her doctor, including a letter of medical necessity from her orthopedic doctor,” Stephanie said. “We also took pictures and measurements of her apartment to show that certain equipment would not be usable, or would not fit in the apartment. We had meetings—emails and phone calls were flying back and forth.”

Elaine noted the challenge of communicating with a variety of key players, and ensuring that outcomes were documented so that ICS could move the process along.

“There were so many pieces to put together in this case—this wasn’t a usual request,” Elaine said.

While focusing on gathering pertinent, supporting documentation, Stephanie and Elaine also had to keep in mind the well-being of Scheria, who was eager to return home after staying in a nursing home for months and as a result, was running the risk of losing her job.

“She was desperate to get home,” Stephanie said. “She wanted this to be done as quickly as possible.”

ICS secures specialized device

After months of compiling documentation and evidence to support Scheria’s need for her specialized device, ICS met all the required criteria and the transfer equipment was approved by Scheria’s insurer. Finally, Scheria was cleared to return home.

Elaine explained that upon approval, ICS then needed to then find a vendor who could supply the equipment to Scheria’s home.

“The only vendor willing to take the case was south of Buffalo,” Elaine said, noting that the vendor made the drive to deliver the equipment. “Time was of the essence. This is what ICS is meant to do. What would Scheria have done if this didn’t happen?”

Stephanie echoed those sentiments, noting that what mattered most was Scheria returning home, while receiving the care and service she needs.

“If she hadn’t been discharged, she would have potentially lost her job,” Stephanie said. “This was a time-sensitive issue that needed to be addressed. This is what our transition team does. We work to get people home and help them receive the services they need.

“It was quite the extensive process to have this equipment authorized,” Stephanie added. “We fought as hard as we could. We were thrilled we were able to get her home, back in her own community, and living as independently as possible.”