Few places to care for those with brain injury

People who like to party may not realize there can be something worse than dying of a drug overdose or alcohol poisoning. Not dying. Survivors sometimes emerge brain damaged, which can destroy their ability to work, speak, walk, eat or even breathe without help. As if that weren’t horrible enough, there is the question of where they will live, who will take care of them — and how well — for the remainder of their lives. Decades, perhaps.

“If you have money, there’s always an answer,” said Robert Almaraz, director of the Betty Clooney Center for brain-injury survivors, in Long Beach. “We’ve had clients whose families are quite wealthy. They buy condos for them and have fulltime attendants. But that’s the exception, not the rule.

“I get calls every day from people saying, ‘I have insurance!’ What do you have? ‘Medi-Cal.’ Well, you might as well not have insurance. It’s terrible. It’s very limited. It doesn’t pay for different therapies.”

For those people, the only option may be to enter one of the 98 nursing homes in California that take Medi-Cal. Twothirds of the 31,449 people who visited an emergency room for a brain injury in 2012 lacked private insurance, according to the Brain Injury Association of California, which says more than 350,000 Californians are afflicted.

One is John Gibson, 26, who survived an overdose in 2010 while a student at UC Berkeley. An only child, Gibson has been back in San Diego with his parents for five years. But the $253,000 they got from a legal settlement, which has paid for home care, is about to run out, leaving him reliant on MediCal. Gibson can’t walk or talk. He has a tube for nourishment and another in his trachea to remove secretions. It’s unclear how much he understands.

His mother, Madelyn Bennett, is outraged that the only option for her family is to place her son in a nursing home, where Medi-Cal won’t pay for the therapies that are now keeping his rigid body as limber as possible. Most galling, she said, is that the family paid $435 a day last year for everything from nurses to sterile gauze, or $160,000 a year, while the state says it would pay a nursing home $691 a day to care for someone in Gibson’s condition, about $252,000 a year.

“It would be less expensive to keep him here,” Bennett said.

The Department of Health Care Services, which administers Medi-Cal, declined to comment on Gibson’s case or cases involving people with similar medical needs in which home care is less expensive than a nursing home.

Bennett, Almaraz and other advocates want the state to require therapies for braindamaged people. Some suggest bringing their care under the Department of Developmental Services, which provides lifelong help — from transportation to adaptive devices — to the developmentally disabled.

“California is not paying attention to this,” Almaraz said, noting that the Veterans Administration is doing “a fantastic job,” but its services are not for “the regular Joe Schmo” who has a stroke or heart attack, or who drinks too much or overdoses — all of which can cause brain damage.

Almaraz said he’s seeing more young people than ever. He said they don’t realize brain damage can occur even with “stupid things like butt chugs,” which is an “enema where they pour in hard liquor.” Once brains are damaged, he said, it’s too late. “There’s no one to care for them.”

That’s just what Bennett is afraid of.