At age 25, John has the mental capacity of a small child. He requires total care and constant suctioning to keep his airways clear. At first, he was receiving enough nursing care for his mother, Evelyn, to work. But then TennCare changed the nursing maximum to 35 hours per week, which would leave John without suctioning for long stretches and put him at risk of choking. So, when John’s care was reduced, Evelyn had to miss work in order to care for John. Evelyn appealed, asking for more nursing hours. TJC found a pro bono attorney named Leslie Muse to represent the family. TJC helped train Leslie in techniques for winning TennCare appeals. After a long hearing, the judge agreed with Evelyn and John’s doctors that his needs make constant care medically necessary. Because of Evelyn advocacy, John is now receiving the care he needs to safely live at home.
Photo Credit: Mark Mosrie