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Thread: Having difficulty finding an LPN for sci home care

  1. #1

    Having difficulty finding an LPN for sci home care

    I am new to your website and have found it very interesting to hear how other people deal with sci situations. My husband is a c5-6 quad for 21+ years. He is pretty independent onces he's up and in his motorized chair. He doesn't drive, though, so when the weather is not warm (doesn't tolerate cold very well), he can be housebound for weeks at a time.

    For most of those years, we've had LPN nursing 4-6 hours per day. This was paid for by insurance in the early years, but more recently covered through Medicaid. We hire our own nurses, using only Medicaid providers. We've been fortunate to be able to find and keep reliable LPNs over the years. This has allowed me to work full time, missing very little time from work except when the nurse can't make it (sick, kids are sick, snowstorms etc).

    Well our luck changed at the end of June when our nurse left to take a job in a hospital for the insurance coverage and more $$. We have been unable to find another LPN, either privately (newpaper ad) or through an agency. My employer has been very accommodating allowing me to work from home a few hours in the morning so that I can continue as a full time employee. I am only in the office 25-30 hours per week, because I've become the full time caregiver for my husband.

    We've been doing everything we can think of to try to find another nurse, but have run out of ideas. My husband has called all the Medicaid providers in our area, and we've not had any luck in hiring someone. All agencies in the area have also been called many times and they've been of no help. We've interviewed a few nurses, and even tried a few out, but they didn't work out. We need to stick with an LPN or RN because of his bowel and bladder care. Also, we don't want to switch to HHA or PCA for fear that Medicaid will no longer approve his need for LPN or RN. (I don't know if this is true.) What is also making it difficult is the pay for an LPN in our county (Nassau) is 21.60 per hour. In the county just to our east (Suffolk), the pay is $4 more per hour. In Queens, it $2 more per hour.

    Any suggestions or ideas would be appreciated. Thanks!

  2. #2
    This is just a shot in the dark here - but could you talk to Medicaid and ask if they will make an exception to the 'LPN - BP rule'? If there are no LPN's available, a PCA could be trained to do the program; perhaps having one put through a training program at a rehab center. It would be cheaper for Medicaid in the long run if they would approve this, as PCA salaries are less than LPN ones.

    _____________
    If we have no peace, it is because we have forgotten that we belong to each other. - Mother Teresa

  3. #3
    Have you contacted the LI Center for Independent Living?

    Maybe you can provide room/board to a student attending college in the area? Call the college Office of Disabled Services (i.e Hofstra, Adelphi)

    *Vote for Change 2004*

  4. #4
    I don't know the regulations for NY state, does anyone else? In my state you can hire anyone to do PCA level care (not just LVNs or RNs) under our Medicaid waiver program (IHSS). This includes bowel and bladder care, suctioning, etc. etc. You of course must train them yourself, but often this is better than an RN or LVN anyway (who tend to be kind of bossy in my experience!!!). The nursing shortage is only worsening access to home care through an agency, and generally you still have to train an agency RN or LVN as they will not know SCI care.

    We have found having several part time people better than a 6-8 hour shift, as this allows your PCAs to have other jobs that give benefits (such as working as an aide in a nursing home or for a HHA). No matter what you pay, no benefits is difficult for any employee. They have families and get sick too.

    Your ILC should be able to help you with options based on what is allowed in your state. You can find your ILC at this URL: www.ilusa.com

    This is also an excellent resource on PCA care:
    http://www.wa-ilsc.org/toc2ack.html

    (KLD)

  5. #5
    Thanks for your suggestion. By the way what is the LPN-BP rule? I haven't heard of that before.

  6. #6
    SCI Nurse: Thanks, we'll contact our Independent Living Center. Over the years, we've always had to train our nurses in SCI care. Only once or twice did we have someone with SCI experience. We did check with the local branch of Social Service office who places PCA's and were told they can't do bowel care or urinary cath; however, we'll check further. Sometimes their information isn't the most accurate.

  7. #7
    In some states agencies and hospitals may not assign bowel care or catheterization or similar "invasive" procedures to nurses aides, and require the use of LVNs/LPNs or RNs for this type of care. A PCA that you hire outside any agency is generally allowed to do this. It is a licensing and liability issue primarily.

    (KLD)

  8. #8
    Senior Member Norm's Avatar
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    Many years ago I had LPNs for 4 hours a day. The turn over rate was killing me so I went to 6 hours & still no one stuck. Finally I went 8 hours a day now I've had a nurse for 13 years. Try that. I kept losing nurses to other job because they all wanted 8 hour jobs.

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