Aging, Poverty, and Illness

Mr. Chang is a 65-year-old widower who is diabetic with chronic kidney disease. He is supposed to receive dialysis three times a week but frequently misses his appointments due to not having transportation or not feeling well. His only hope for a cure is a kidney transplant, which Mr. Chang really wants. Mr. Chang is very frail with many health problems. He lives alone in a small garage apartment. The landlord is threatening to evict Mr. Chang because he is behind in his rent payments. Mr. Chang lives on a small pension and Medicare. His prescription costs are excessive and his Medicare Part D prescription plan requires large co-payments on the brand-name medications needed for his care A home health nurse used to transport Mr. Chang to dialysis occasionally, as Mr. Chang lives outside the township limits and is unable to access public transportation services. The clinic, which does not believe Mr. Chang is a candidate for a transplant, has revised its policies regarding home visits due to changes in reimbursement mechanisms. The home health nurse can no longer visit Mr. Chang unless there is a reimbursable need such as a dressing change; and for liability reasons, she can no longer transport Mr. Chang to dialysis.