Gladys Threlkeld waits patiently in her arm chair, a sweet smile on her face. Her daughter-in-law runs a comb through her soft white curls.
"She's having a good day today," said Ree Thelkeld, helping Gladys carefully rise from the chair.
Some days she is able to nimbly move around with the aid of a walker.
Others, she is barely mobile until late in the afternoon.
The 94-year-old was diagnosed with dementia and Alzheimer's several years ago and now lives in the Garden Place, a secure unit at Carillon Assisted Living on Charles Road.
Ree said knowing her mother-in-law is safe and well cared for has brought her peace of mind.
That peace of mind was recently shattered, however, when funding cuts threatened that quality of care.
Funding cut
Federal funding for personal care services, which covers assistance for bathing, dressing, eating, mobility and toileting, was drastically reduced by the state.
It's just the latest issue for the state's Medicaid program, which has been marred by $1.4 billion in overspending in the past three years. State representatives continued to debate this week whether the state should adopt a 100-percent federally funded Medicaid program.
Keith Ensey, Carillon Assisted Living's regional director of operations, said that beginning Jan. 1, hours for those personal care services were cut from a maximum of 161 to 80 per month.
That 161 hours equals an additional $2,082 per month the facility receives to care for patients in the secure unit, said Rebecca Johnson, adult services lead social worker at Cleveland County Department of Social Services.
"Most of these families cannot pay an additional $1,000 per month for their loved ones to remain in their current placement," she said.
She said 61 percent of Medicaid residents in the county have been impacted by the changes, some with hours cut and others denied personal care services altogether.
'No matter which way you go, it's not good'
Shortly before Christmas, Ree said she was stunned to receive a letter informing her that a nurse completed an assessment on Gladys, a Medicaid recipient, and determined that she could perform daily living tasks independently.
Some patients, such as Gladys, were deemed capable of independently performing daily tasks and her family was told that care would no longer be funded.
"We had two weeks," Ree said. "I was very confused. I didn't understand what process they used or what assessment tools they used."
After receiving the letter, Ree said she called Carolinas Center for Medical Excellence, the independent assessment entity the state contracts with to perform the assessments, and spoke with a nurse.
"She encouraged me to go through the appeals process," Ree said.
She filled out an appeal form and faxed it to two different offices, as instructed.
Remediation was the next step.
A teleconference was scheduled with a CCME nurse representing the assessment team and Ree said she was able to give her argument, point by point, on why her mother-in-law needed more hours of personal care services.
By the end of the phone call, Ree said she was offered 68 hours of PCS care out of the maximum of 80.
But with her mother-in-law's health in decline, she said Gladys will only require more care as time goes by.
"No matter which way you go, it's not good," Ree said.
'It's a terrible feeling'
Although there are days when Gladys can feed and dress herself, Ree said she needs constant supervision and prompting to complete those daily living tasks.
When she refused the 68 hours, Ree said she got a certified letter in January letting her know a court hearing had been scheduled for Wednesday.
"There will be a judge, a nurse representative and anyone who wants to be involved on this end," she said.
It, too, will be conducted via teleconference.
"Everybody's at their mercy right now," Ree said. "It's a terrible feeling."
Ree said she is a retired nurse but, even with a medical background, she would not be able to safely care for Gladys.
"We will never move her," Ree said. "The care here is so good."
'We're confident the state will come through'
While families are in the process of appealing the results of the assessments, emergency funds are in place to continue to provide care for patients at the same level prior to the changes. Those funds are slated to run out in June.
"Right now, we're confident the state will come through," Ensey said. "We're following along closely with the appeals process and making sure the General Assembly fixes this issue. I think everyone wants to help."
Ensey said there is an effort, by families and health care providers, to make sure the N.C. General Assembly is focused on the issue.
He said 6,000 letters were sent to federal, state and local officials asking them to focus on the problem.
"I think the key is to generate the focus on that and let them know how important this is to the public," Ensey said. "I don't know what could be more pressing than the care of our seniors."
Currently, Ensey said, the reimbursement for the care of Alzheimer's and dementia patients is lower than what is spent to care for them.
While Ree waits for the court hearing to be held, she has written a letter to Gov. Pat McCrory explaining her plight and how the cuts have impacted her family.
She said the only response she received was from the N.C. Department of Health and Human Services explaining how to appeal the decision.
'We are working very hard with the General Assembly'
In the interim, before any final decisions have been made, Ree said her mother-in-law's care is still being funded at 161 hours.
Johnson said the Department of Social Services wasn't aware of the changes until recently.
Johnson said some facilities are billing the families for the additional amount of money that is no longer funded.
In the worst-case scenario, Johnson said, the facilities' options include billing the family, discharging the resident into the community or sending them to a nursing home, which will cost the state more than double what current assisted living facilities charge.
She said if a mediation is lost, such as in the Threlkelds' case, DSS has to certify that there are no other housing options in the community. If no housing is found, the facility can bill the state for transition funds until June 30.
Ensey said Carillon Assisted Living has 36 Medicaid residents in the secured unit.
"Funding runs out at the end of June," Ensey said. "We are working very hard with the General Assembly."
If the denials are upheld following the appeals process, that funding could be lost as early as this month.
"We just don't see how the General Assembly can not act with the impending loss," Ensey said.
Attempts to contact N.C. Rep. Tim Moore, R-District 111, and N.C. Rep. Kelly Hastings, R-District 110, for comment were unsuccessful.
Carol Whisnant, executive director of Carillon Assisted Living, said she hopes the Wednesday court hearing will result in another assessment being performed on Gladys.
Whisnant said Gladys was never assessed as an Alzheimer's resident but simply as an assisted living resident while she was still in a Gaston County facility.
If the judge decides to award the family the previously determined 68 hours, Whisnant said the family will have to come up with the remaining funds for Gladys' care from out of pocket.
"I don't know if there are any other options," she said. "We're hoping another assessment will be completed based on the fact she's an Alzheimer's resident."
Reach Rebecca Clark at 704-669-3344 or rclark@shelbystar.com. The Associated Press contributed to this report.