Tuesday, Sept. 5, 2006 | 7:20 a.m.
For the past 10 years, Bryan Young's family has lived nearby as the youngster has remained bedridden in nursing homes, nearly comatose after he almost drowned.
Bryan can't speak or smile when they visit, but he can hear and see them in a distorted way, nurses say. Still, he's making progress, considering his heart had stopped beating for nearly 35 minutes after he fell into a pool when he was 2. He is able to move a little, which gives hope to his father, David Young.
Bryan lives in a private care facility with 15 other severely disabled children - victims of accidents, drug-addicted mothers or genetic mutations. It is the only facility of its type in Nevada that takes Medicaid.
However, families are now bracing for the possibility that the facility will close its pediatric wing because the operator says he is taking a financial beating.
The state's compensation is not enough to pay the costs of liability insurance and health care for the 16 children, said Chris Vito, chief executive of TLC Care Center.
The company sent notices to families on July 17 saying it was going to close the pediatric wing of its facility in 30 days.
"No one likes to make decisions, but that's what I'm here for," Vito said.
The facility, situated in Green Valley, also cares for 150 elderly residents in a profitable nursing home that will remain open.
The loss of the children's wing means the young patients will either have to return to their homes or be relocated to care centers out of state.
Parents are bitter about TLC's decision.
"These are handicapped children, and we need someone with half a heart who doesn't care about the God Almighty dollar bill," David Young says.
If Young sounds frustrated, it is because he has been through this drill before. His son had been cared for at a different facility previously, but it too closed its pediatric wing. The family is not eager to move the 12-year-old a third time.
Legally, TLC cannot evict the patients until new accommodations are found for them; so TLC and Medicaid officials are scrambling to find new homes or a last-minute solution.
One of those may be a significant increase in Medicaid reimbursements - something that TLC had not requested until a meeting with family members on Aug. 23.
The meeting riled parents and grandparents, even though Vito tried to describe the situation from his perspective. He distributed a two-sheet list of expenses and reimbursements showing that the children's unit is spending twice as much money as it earns from Medicaid.
TLC's owner, Leslie Dunn, a developer who built the Galleria at Sunset mall, opened TLC 2 1/2 years ago. TLC started losing money so quickly that Dunn had to reach into his own pocket to cover expenses, Vito said.
Looking back, Vito - who was an initial investor with Dunn - says a pediatric center should not have been built in the first place. Low reimbursement rates and exorbitant cost of liability insurance made it unprofitable. A 28-bed pediatrics wing was closed in fall 2004.
Charles Duarte, administrator for the Medicaid division of health care financing and policy, said he understands why TLC is looking to backtrack.
"Having children adds a level of liability," he said. "I understand what they're going through There is fear of an unforeseeable event. When an adult is injured in a nursing facility, they report to the appropriate authorities. When a child is injured, they do the same thing - only the police show up."
Although Medicaid had asked TLC to formally request higher funding, Vito said that a former management team never did. By the time he took over in March and did a cost analysis, he did not think higher reimbursement rates would make up for high insurance premiums.
A decision by Medicaid on reimbursement increases is expected any day.
A second solution was offered by a nonprofit organization that provides at-home nursing care for disabled children. Positively Kids offered to lease the pediatrics wing at TLC and manage the children's care itself. But the two sides could not agree on financial terms.
Jack Bishop, the grandfather of 12-year-old Taylor Nicole Bishop, blames both the facility and Medicaid for the closure of the pediatric wing.
"I can't understand how the state can sit and watch all of what's going on and let all these families get broken up," he said.
Until about two years ago, Taylor lived at her grandparents' home. But after stomach surgeries made it hard for Bishop to pick up his granddaughter, she was moved to TLC.
"We go see her every day and do her laundry and feed her supper," Bishop said. That dedication makes them a rarity; nurses say most children don't have regular visitors.
Taylor has a genetic condition called microcephaly, which keeps her brain stem from growing. Her grandparents took custody of her at 2 years old. Bishop can still work - he does contract plumbing - but tearfully had to give her over to the nurses after his own surgery.
"I'm not going to give her up," Bishop said. "She's been in my life since she was 2."
Of TLC's financial quandary, he said: "I don't understand the reasoning, why they opened two years ago without investigating (the costs) first."
Families of the children at TLC, unsure what will happen, are braced for a worst-case scenario .
Said David Young: "I'd literally have to make him a ward of the state I don't have money or resources to pay for 24-hour care."
archive
