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Care for survivors of catastrophic car accidents in other states is typically very poor. Michigan could soon be among the worst.

Emma Winowiecki/Michigan Radio

Michigan's best-in-the-nation care for catastrophically injured auto accident survivors is coming to an end.

The state's new auto no-fault law is forcing care providers to close, or turn patients away.

Some Michigan Radio listeners have asked how other states care for severely injured auto accident survivors.

The answer is grim.

Experts say many survivors with spinal cord injuries and traumatic brain injuries in other states end up in nursing homes that are ill equipped to handle their extensive needs for care - and those are the lucky ones.

Safe at home for now - but maybe not for long

The family of Dennis Robison knows, based on first-hand experience, how inadequate nursing home care can be for someone who suffers severe injuries from a car accident.

Robison, a Mt. Morris resident whose accident happened in 1978, now gets one-on-one care at his home, 24/7. Home care aides do the daytime shifts and his mother, Virginia Robison - at 87 years old - has the night shift.

She said she can clean him in his bed if he makes a mess overnight, so it doesn't matter that she's a little "wobbly."

"I could probably try and put him in a chair," she said pragmatically. "But I worry about it. If I fall, we both fall and get hurt."

The situation is safe for Dennis right now. But there are huge worries for the family due to the new auto no fault law. What if he loses what he has now?

A nursing home stay that nearly led to death

Right after her son's accident, Robison said Dennis had to go to a nursing home, because his wheelchair wouldn't fit in the house without structural changes to the home. He almost died in the nursing home.

"When we brought him home, he weighed 90 pounds, and he cried constantly."
Virginia Robison, speaking about what happened to her son, Dennis, after his catastrophic car accident

Dennis Robison's caregiver of 36 years, Tom McKay, said nursing homes are not the right place for accident survivors with brain injuries.

"They would just put the food in front of Dennis," he said of the care he received at the facility. "Well, Dennis is blind. And at the time, he did not reach out for anything. So they’d put food in front of him, and he’d either swipe it off onto the floor, or he just didn’t eat."

McKay said Dennis was also just wheeled into the hall by the nurses station and left there, all day sometimes, since the home didn't have enough staff to sit with him in the TV room while he listened to the shows.

McKay can't bear to think he'd have to go back to a place like that.

"He would lose so much happiness and so much progress if he went to a nursing home. It would just - it would be the end of him, pretty much."
Tom McKay, caregiver for an auto accident survivor with TBI for 36 years

That could still happen to him, though, if his family can't negotiate high enough payments from his insurance company to maintain his home care. The new no fault law allows insurance companies to cut pay for caregivers by nearly half — well below the cost of providing the care.

High-quality rehabilitation found no where else in the nation thanks to the old no fault

Robison's current high level of care is, or was, not unusual in Michigan. He gets help bathing, dressing, and eating, two hours a day of physical therapy to stretch his limbs and prevent them from becoming spastic, along with outings for social and mental stimulation. The insurance company paid for the installation of a whirlpool bath for physical therapy and to help manage his pain.

In addition to home care, Michigan's old auto no fault system enabled the development of other care options for catastrophically injured survivors too, like residential rehab centers, where they can live and obtain evidence-based therapies to realize their full, post-accident potential.

Such care was paid for by the Michigan Catastrophic Claims Association. Every insured driver in the state paid into the MCCA's fund to cover catastrophic injuries over a set amount. This year, the amount is $600,000. Insurance companies pay for care under that amount, and the fund pays for care over the amount. The fee goes up and down from year to year, depending on the fund's projected expenses and things like investment income.

The annual fee ranged from a low of $0 to a high of $220. Experts say nowhere else in the entire country is such an insurance product available. For those unlucky enough to need it, it provided for high-quality, lifetime care. The fund still exists - but drivers who pay for lifetime medical coverage on their policies will be increasingly unlikely to find a long term care industry in existence, should they need it.

Michigan was the envy of brain injury specialists in other states

"What we used to say is if you do have a traumatic brain injury, make sure it happens in Michigan," said Wendy Waldman, president of the Brain Injury Association of Indiana. "It was being funny in a kind of dark way, but it was true."

Waldman said in Michigan, brain injuries have been treated as the lifelong chronic conditions they are, with the right care, at the right time, for more than 40 years.

"Without that kind of care, they can end up incarcerated, they can end up homeless, they can end up in a facility they don't belong in — and very much isolated and alone," she said.

Waldman said Indiana cobbles together what it can for survivors, but there is not a single long-term residential care facility in the state. And she said it's very difficult for families of survivors to find out about the rehab treatments, and it's even more difficult to find ways to pay for them. Waiting lists for Medicaid waivers to get care are long, she says, and not everyone qualifies.

Now, in Michigan, as the state's providers close, options for severely injured survivors are also becoming extremely limited, especially if they don't have family to care for them.

There's always hospitals, for temporary, emergency care. Then, a scramble. If they're lucky, they may find a placement in a nursing home.

"You will not get rehabilitation, you will not get cognitive stimulation. You will get three meals and a change of sheets. And that happens all over the country."
Susan Connors, Executive Director of the Brain Injury Association of America, speaking of typical nursing home care for severely injured auto accident patients in other states.

Susan Connors is Executive Director of the Brain Injury Association of America. She says even nursing home care may be unavailable, though. Hundreds of patients with brain injuries and spinal cord injuries have lost their home care in the state, and she says there simply aren't enough beds in skilled nursing homes in Michigan to handle high-needs patients.

"What makes anybody thinks that there's spaces available in skilled nursing facilities?" Connors asks. "Last I checked, there were more than 700 people in Michigan who had lost their care. Where are all those people going? Psych hospitals....jail....homeless.....mortuary."

Even for those who do find a bed in a nursing home, the staff to patient ratio there may be one direct care worker to 20 patients, and one nurse to 50, rather than the one-to-one staffing level they had before.

Experts say some people are likely to die as a result of the changes. But no state agency is tracking what happens to the survivors after they lose their care.

Connors doesn’t sugar coat what she sees happening in Michigan as vulnerable patients are stripped of care. She said it’s immoral.

"And it didn’t have to happen," she said.

"Honestly, it didn’t have to happen. Any one of those policy makers could have taken a look at any of the other states and understood how fantastic a system you had in Michigan and how awful it is elsewhere."
Susan Connors, Executive Director, Brain Injury Association of America

Fear and uncertainty for more than 18,000 people getting care from the MCCA fund

Now many survivors are fighting a losing battle to keep at least some of their former care, because insurance companies have the new law on their side.

Virginia Robison said her son's insurance company initially proposed cutting his caregivers' pay to $8.00 an hour. That's $1.65 below minimum wage. Tom McKay said if it comes down to that, he couldn't survive on such low wages.

And after 36 years, he'd dread having to say goodbye to Dennis.

"You know, he’s a part of my life," McKay said, his voice trembling. "It's pretty hard. I don’t know what I’d do. I'd move on, I guess, and hopefully still be a part of his life."

Meanwhile, the jury is still out on whether the law delivered significant auto insurance savings, but so far, it looks like politicians who supported the law may have over-promised, and under-delivered.

According to the Consumer Federation of America, the average insurance premium in Michigan is second or third highest in the nation - exactly where it was ranked prior to the passage of the new no fault law in 2019.

And Detroit still has the highest premiums of any city in the nation.

The law is taking Michigan on a plunge to the bottom - where it could end up one of the worst places to survive a catastrophic accident - instead of the best.

Tracy Samilton covers energy and transportation, including the auto industry and the business response to climate change for Michigan Public. She began her career at Michigan Public as an intern, where she was promptly “bitten by the radio bug,” and never recovered.
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