Success Stories

Aetna Better Health of New York and Ms. M

Ms. M, an 80-year-old, Creole-speaking woman, is a FIDA member living alone in her private home. She has a Level of Care (LOC) score of 16, which placed her under supportive care. She receives Personal Care Aide (PCA) services for four hours, five days a week and three hours the other two days (Monday-Saturday). Every Sunday Ms. M attends church services.

Ms. M enrolled in Aetna´s Better Health of New York FIDA Plan in August 1, 2015. It was reported at that time that that she had multiple diagnoses of osteo arthritis, age-related osteoporosis, hypertension, gastro-esophageal reflux disease, hyperlipidemia, chronic pain, type 2 diabetes, and problems with mobility and incontinence.

On November 25, 2015, Ms. M called her Care Manager (CM) because she was having issues with her boiler and had no heat in her home. Her CM inquired if she had contacted any repairmen to come check the boiler for her. Ms. M replied that she had and was told the boiler had to be replaced, but that the estimated cost for a new boiler would be over $6,000, a price Ms. M was shocked by and definitely could not afford. Her CM encouraged Ms. M to stay with her daughter until the boiler got fixed, but Ms. M had received no help from her family in the past and refused to leave her house. Instead she set up a space heater in one room of her home.

Her CM immediately took actions to assist Ms. M with applying for a grant toward a new boiler. From November 25 - December 29, 2015, Ms. M´s CM spent her holiday season working tirelessly to secure heat for her home. She made numerous calls to Ms. M and checked up on her to make sure she was ok. She asked her many times to seek another place to live temporarily that had heat (which Ms. M refused every time).

Her CM also contacted the case manager at the NYC Human Resources HEAP Department, plumbing companies, and family members. Throughout the process, she was ignored by Ms. M´s family members (as Ms. M assured her she would be). In addition she encountered issues that could have potentially put Ms. M´s case at risk of being rejected because the December 24th deadline to submit all necessary documents was in danger of passing.

On December 23rd, Ms. M´s CM was able to collect all the requested documents, and immediately forwarded them to the HEAP case manager for review. On December 29th, a new boiler arrived and within the same week she once again had heat going throughout her whole home, rather than living in one small room barely warmed by a space heater.

The approval for the grant in getting a new boiler took a little over a month to resolve. In the end, Ms. M received a new boiler from the NYC Human Resources HEAP. She was so grateful, she exclaimed, "I am so happy to have heat in my home," and went on to praise her CM by saying, "I will never stop praying for you for what you did for me. You´re more than a daughter to me than my own daughter. I will continue praying for you even in my dying bed."