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Thread: Bowel program..Skilled nursing or non-skilled

  1. #1

    Bowel program..Skilled nursing or non-skilled

    I have long been told from the time of my accident the bowel program is a non-skilled procedure because its easily shown or taught and it is long term ongoing care or custodial care. From 1979 when I became a S.C.I. crushing C5-6-7 the R.I.C. taught family and friends.Over the years Rehab Centers,Doctors,Visiting Nurses Association,Voc.Rehab and CDC+ programs as well as Medicare told me this.
    The program that told me recently after over a decade on the program was CDC+, Which ironically stands for Consumer Directed Care Plus. I was recently told by the CDC+ program thru Med-waiver that I now am required to hire skilled nursing, a LPN or RN for my bowel programs and when I asked if a LPN or RN is required for a hemorrhoid suppositories my Doctor prescribes for me twice a day, the answer was yes. When I ask why the answer is new rules for the CDC+. I was told from the time I entered the CDC+ over 12 yrs. ago by my case worker that you are not required to hire a RN or LPN and you can even hire family or friends.
    Under Medicare Medicaid and OSHA if find the same definition and criteria for determination of requiring skilled or non-skilled. A non-skilled procedure because its easily shown or taught and it is long term ongoing care or custodial care

  2. #2
    Because it includes the administration of medication, and "invasion of an internal body organ" (ie, insertion of the suppository and manual removal or dig stim) many states rate bowel care as a proceedure that cannot be delegated to a unlicensed person by a licensed person.

    This means that if you get your care provided by an agency where an RN assigns or supervises unlicensed staff to your care, it may not be done by an unlicensed person.

    In some states, the personal care attendant (PCA) waiver program is NOT provided through an agency, and the program supports the person with a disability hiring family, unlicensed PCAs (CNAs, HHAs, or any lay person) and the unlicensed person is considered an "extension" of the person receiving care, and is allowed to do any care that the person would be able to do themselves if able. This is the case in CA for example, with our IHSS program.

    How this is defined is set by the state or county which has authority over the program, and often by state legislation (which can be changed through political action). This varies by the state.

    If your program has recently changed, I would encourage you to talk with people at our local Independent Living Center (such as Access Chicago if you are still in the Chicagoland area), and also to people at ADAPT. They may be able to help you with some advocacy and also direct you to others who are working on getting such regulations or laws changed.

    (KLD)

  3. #3
    Ditto what SCI-Nurse said, the ADAPT link is appreciated.

    Medicaid rules vary by state, CMS only sets loose federal regulations the states must follow. In Colorado we waived the Nurse Practice Act for our 2 consumer directed programs, and are looking to extend the waiving of the Nurse Practice Act for services under the Community First Choice option in 2014.

    Your local Independent Living Center should be able to advise you on the rules for the program you're on in your state.

  4. #4
    Thank you very much for the help and the ADAPT link. I live in Florida and been on CDC+ here. I was actually recommend to this program for the reason of not requiring agencies or LPNs and this would give more care since I was to control a percentage of the budget they used to provide my care.I was told though my old aging adult waiver I had agencies and LPNs but if I chose the CDC+ program it did not require a LPN. After being on the CDC+ many years I was told this about 5 years ago and after rearranging everything we were told that it didn't require a LPN and the care remained the same. I contacted ILC and they gave me someone at DCF but still haven't found why it has been changed and what are their criteria for determination of skilled or not.

  5. #5
    Quote Originally Posted by SCI-Nurse View Post
    Because it includes the administration of medication, and "invasion of an internal body organ" (ie, insertion of the suppository and manual removal or dig stim) many states rate bowel care as a proceedure that cannot be delegated to a unlicensed person by a licensed person.

    This means that if you get your care provided by an agency where an RN assigns or supervises unlicensed staff to your care, it may not be done by an unlicensed person.

    In some states, the personal care attendant (PCA) waiver program is NOT provided through an agency, and the program supports the person with a disability hiring family, unlicensed PCAs (CNAs, HHAs, or any lay person) and the unlicensed person is considered an "extension" of the person receiving care, and is allowed to do any care that the person would be able to do themselves if able. This is the case in CA for example, with our IHSS program.

    How this is defined is set by the state or county which has authority over the program, and often by state legislation (which can be changed through political action). This varies by the state.

    If your program has recently changed, I would encourage you to talk with people at our local Independent Living Center (such as Access Chicago if you are still in the Chicagoland area), and also to people at ADAPT. They may be able to help you with some advocacy and also direct you to others who are working on getting such regulations or laws changed.

    (KLD)
    In OR we have an independent choices program that allows the client to hire own unlicensed or whatever... that is one of the ways the State puts some distance between us workers and the clients and also empowers the clients able to manage own life.

  6. #6
    Senior Member Van Quad's Avatar
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    Quote Originally Posted by ZenBiker View Post
    In OR we have an independent choices program that allows the client to hire own unlicensed or whatever... that is one of the ways the State puts some distance between us workers and the clients and also empowers the clients able to manage own life.
    Same as British Columbia. Independent funding is empowering, and much cheaper for the taxpayer. Cascadia rocks

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