Rocky Mount, N.C. — The state Department of Health and Human Services has considered cutting or eliminating private nursing care for 48 of its most needy patients since June as part of an evaluation of services.

Private-duty nurses serve 440 patients statewide, including scores of infants and young children. Many of the patients are paralyzed, use ventilators and are fed through tubes.

Fifteen of those patients are getting fewer hours of nursing as part of the on-going review. Some of them have seen their health improve and their need for nursing decrease. In six cases, patients saw their service cut after a hearing or mediation.

State officials say cuts to the program are designed to improve effectiveness and not solely to save money.

"You know, we only have so many dollars to spend, and we owe it to the taxpayers and everyone else to spend the dollars wisely," DHHS Secretary Lanier Cansler said.

The Association for Home and Hospice Care of North Carolina recently released a video to raise awareness and prevent cuts to the program. The group worries some patients may end up institutionalized if families can't get as much help from a private-duty nurse.

"We want to make sure that we are supporting those caregivers in our community and our state to be able to keep their loved ones at home," Kathy Smith said.

Kelli Crist said she couldn't handle the needs of her 20-month-old daughter, Chloe Garris, without help from private-duty nurses.

"They are life-savers. They are my angels," Crist said.

Chloe was born with a rare genetic defect known as Goldenhar Syndrome. Her ear, jaw and soft palate didn't develop completely, so she had a tracheotomy to help her breathe and uses a feeding tube to eat.

The toddler needs to be watched constantly.

"You definitely have to be very strong, and if you're not, you will break," Crist said. "You can't do that because it's not about you anymore. It's about the child."

A nurse helps care for Chloe 12 hours a day, usually overnight so Crist can sleep.

DHHS wanted to cut the hours for Chloe's nursing in half, Crist said, but officials agreed not to reduce the number of hours after discussing the case with Chloe's physician. Still, her case will come up for review again next month.