Diagnosis: Stroke
Treatment: Increase Home Care/Personal Care (HHC) Personal Care Aide (PCA): Live-In to 24 Hours/Day (Split Shift)
The insurer denied an increase in HHC PCA: Live-In to 24 hours/day (split shift).
The denial is overturned.

The patient is an older adult female who underwent a follow-up clinical assessment utilizing the Department of Heath's Uniform Assessment System tool. Noted was some change of physical functioning since the previous assessment and change in abilities to perform physical functions such as bed mobility, bathing, personal hygiene, dressing upper and lower body, walking, eating, meal preparation, ordinary house work and medication management. The patient's memory is noted to be okay. She does have bladder incontinence. Cognitively, the patient is minimally impaired. She does have some memory problems; she usually understands verbal and nonverbal contact, however she has difficulty finding words or finishing thoughts but if given time, she can comprehend. The patient is forgetful of date. She is mostly wheelchair bound; a stroke affected the left side of her body and speech. The patient had an unsteady gait. The request is for an increase in home care/personal care HHC (home health care) personal care aide (PCA) from live-in per diem to 24 hours/day (split shift).

The proposed increase in home care/personal care HHC PCA: live-in to 24 hours/day (split shift) is medically necessary.

The patient is an older adult female who is wheelchair bound, with urinary incontinence and weakness in her left side of the body. The patient is unable to ambulate; she has lower extremity weakness and she cannot self-propel. The patient is completely dependent for all her activities of daily living. The patient requires assistant to get out of bed. The patient requires heavy verbal cues to direction to wheelchairs. The patient requires assistance to transfer to the toilet, and she needs help returning to bed. The request is for two providers; 12 hour shifts (split shift) for the aids is indicated.