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Thread: PA is stopping agency attendants from doing bowel care.

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  1. #1
    Senior Member forestranger52's Avatar
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    PA is stopping agency attendants from doing bowel care.

    Today I received a call from my attendant care provider, agency provided PCA's will no longer do or help with bowel programs of any type. No supositories or emeneeze, nothing.

    Somehow consumer model PCA's are allowed, you hire/ you fire. This is illogical to me, why one, not the other. Consumer model never worked for me because attendants would quit at anytime, usually on weekends. I have been left in bed in the mornings will a full night bag ready to explode and no one comming and meds due. They have no one to answer too and never report they worked here.

    At least the agency had on-call attendants to fill in when PCA's disapeared.

    This may be the end for me. Rural folks are really screwed unless they have a large caring family. I am by myself, I moved back where I worked because no one in my family was any help. All they did is complain about any little thing.
    Last edited by forestranger52; 08-06-2012 at 06:27 PM.
    C 5/6 Comp.
    No Tri's or hand function.

    Far better it is to try mighty things, to win glorious triumphs, even though checkered by failure. Than to take rank with those poor spirits who neither enjoy much or suffer much, because they live in the grey twilight that knows neither victory or defeat.

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  2. #2
    Senior Member trekker6's Avatar
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    That sucks, is there a backup you can set up if they quit on the weekends or will the pcas continue the bowel care knowing that you are stuck?
    "Would you rather reduce deficits and interest rates by raising revenue from those who are not now paying their fair share, or would you rather accept larger budget deficits, higher interest rates, and higher unemployment? And I think I know your answer." Ronald Reagan"

  3. #3
    Yes, unfortunately in many states, only licensed nurses are allowed to do bowel care which includes dig stim, manual removal, or any administration of rectal medication (enemas, suppositories, lidocaine jelly, etc.). This is due to state law and scope of practice regulations that prevents a RN (ie, the head of the home health agency, charge nurse, staff RN, etc.) from delegating any activity to an UAP (unlicensed assistive personnel: HHA, CNA, etc.) which includes "invasion of an internal body organ". This means it also prevents delegation of catheterization or cath changes, tracheal suctioning, administration of tube feedings, administration of injections, etc. etc.

    When you employ non-agency or non-RN supervised PCAs, and they are your (not the agency's) employees, most states allow you to direct the PCA to do any activity which you would normally do for yourself if you were able. This gets around the issue above of having the activity delegated by an RN or LVN.

    Does your state allow you to obtain PCAs from a non-agency source? While it may not be as easy to find these types of folks in your area, with the economy the way it is, in my area I have had no problems finding applicants. Of course with the low wages paid by programs like In Home Supportive Services (IHSS) in CA, this can be a challenge.

    The alternative is for the state to authorize the agency to send RNs or LVNs to do the care that the state requires be done only by licensed staff. Have you talked to your local ILC about these changes and what they are doing to lobby or advocate for this in your area?

    (KLD)

  4. #4
    Super Moderator Sue Pendleton's Avatar
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    I would find out if this also applies to hospitals especially rehab hospitals in your State. The normal for in hospital care is a tech (HHA, CNA, MCT) works under the direct supervision of an RN. We all know that isn't true so make the State prove that an RN is in the room when any of these procedures are done by anyone but an RN.

    In the meantime, anyway a live in would work? There are people who love the more rural areas.

    Quote Originally Posted by SCI-Nurse View Post
    Yes, unfortunately in many states, only licensed nurses are allowed to do bowel care which includes dig stim, manual removal, or any administration of rectal medication (enemas, suppositories, lidocaine jelly, etc.). This is due to state law and scope of practice regulations that prevents a RN (ie, the head of the home health agency, charge nurse, staff RN, etc.) from delegating any activity to an UAP (unlicensed assistive personnel: HHA, CNA, etc.) which includes "invasion of an internal body organ". This means it also prevents delegation of catheterization or cath changes, tracheal suctioning, administration of tube feedings, administration of injections, etc. etc.

    When you employ non-agency or non-RN supervised PCAs, and they are your (not the agency's) employees, most states allow you to direct the PCA to do any activity which you would normally do for yourself if you were able. This gets around the issue above of having the activity delegated by an RN or LVN.

    Does your state allow you to obtain PCAs from a non-agency source? While it may not be as easy to find these types of folks in your area, with the economy the way it is, in my area I have had no problems finding applicants. Of course with the low wages paid by programs like In Home Supportive Services (IHSS) in CA, this can be a challenge.

    The alternative is for the state to authorize the agency to send RNs or LVNs to do the care that the state requires be done only by licensed staff. Have you talked to your local ILC about these changes and what they are doing to lobby or advocate for this in your area?

    (KLD)
    Courage doesn't always roar. Sometimes courage is the quiet voice at the end of the day saying, "I will try again tomorrow."

    Disclaimer: Answers, suggestions, and/or comments do not constitute medical advice expressed or implied and are based solely on my experiences as a SCI patient. Please consult your attending physician for medical advise and treatment. In the event of a medical emergency please call 911.

  5. #5
    Quote Originally Posted by Sue Pendleton View Post
    I would find out if this also applies to hospitals especially rehab hospitals in your State. The normal for in hospital care is a tech (HHA, CNA, MCT) works under the direct supervision of an RN. We all know that isn't true so make the State prove that an RN is in the room when any of these procedures are done by anyone but an RN.

    In the meantime, anyway a live in would work? There are people who love the more rural areas.
    Sue, in my state, the rehab centers (and nursing homes, assisted living facilities, etc.) are not any different than the acute care hospitals or licensed home health agencies. CNAs or other UAPs are NOT allowed to do invasive procedures. For this reason, many rehab centers no longer employ CNAs, but use LVNs instead, or the RN has to do these procedures themselves. I remember when we had to stop our CNAs from doing intermittent cath and bowel care when I worked in the private sector...and that was around 1986. It did not matter if the RN was in the room or not. By law, the RN is in charge, and so if they assign a CNA to perform a procedure in violation of these regulations, the RN risks loosing their license, regardless if the RN is present or not.(KLD)

  6. #6
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    Quote Originally Posted by forestranger52 View Post
    Today I received a call from my attendant care provider, agency provided PCA's will no longer do or help with bowel programs of any type. No supositories or emeneeze, nothing.

    Somehow consumer model PCA's are allowed, you hire/ you fire. This is illogical to me, why one, not the other. Consumer model never worked for me because attendants would quit at anytime, usually on weekends. I have been left in bed in the mornings will a full night bag ready to explode and no one comming and meds due. They have no one to answer too and never report they worked here.

    At least the agency had on-call attendants to fill in when PCA's disapeared.

    This may be the end for me. Rural folks are really screwed unless they have a large caring family. I am by myself, I moved back where I worked because no one in my family was any help. All they did is complain about any little thing.
    It's been the rule in PA for over 4 years.

  7. #7
    Colostomy?

  8. #8
    Quote Originally Posted by LaMemChose View Post
    Colostomy?
    Really bad when a surgical procedure has to be considered because of state mandates on what a PCA can and can not do. Colostomy is a good option for many but I hate that lack of access to an appropriate bowel program/ care would drive the decision process.
    Every day I wake up is a good one

  9. #9
    Quote Originally Posted by cheesecake View Post
    Really bad when a surgical procedure has to be considered because of state mandates on what a PCA can and can not do. Colostomy is a good option for many but I hate that lack of access to an appropriate bowel program/ care would drive the decision process.
    Absolutely. i was aware of why it would be a horrid choice when I wrote it, but to remain indy, what are other options?

  10. #10
    Quote Originally Posted by LaMemChose View Post
    Absolutely. i was aware of why it would be a horrid choice when I wrote it, but to remain indy, what are other options?
    LAMEM~ My reply was rhetorical, I absolutely knew why you posted what you did.

    For many on these boards their colostomy freed them to be fully independent. Many have posted openly about their decisions and have no regrets.

    I do find it bothersome however that health care mandates either an RN or family to do the care but generally will not pay for the RN visits for bowel care. Few are independently wealthy to lift the cost.

    When will health care and insurance catch up with improved survival rate, increased life expectancy and the right to choose?

    Foreststranger, if it were me, I would explore all options. Are you a veteran with a service related injury?
    Every day I wake up is a good one

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