Even if it does, the HMO's obligation is not simply contractual. A contract, like law, is the least we have to do. Difficult questions of HMO resource allocation and policy are not answerable with this case. Home care expenses are enormous and vary widely from vendor to vendor. Limiting services when such obvious need exists reflects poorly on managed care as a whole, and on individual systems in particular.
Poor service comes back to bite such systems in advanced markets.
The family's burden in high-tech home care is daunting and unfair. The real difficulty in training home caregivers is the emotional impact of such treatment on them, the family and its life. Finally, the Family and Medical Leave Act now provides limited job protection for the husband, but the leave is unpaid and brief. Of course, there is no school leave for the patient's daughter. The tragedy of medicine is that illness happens, and the magic is that people somehow cope.