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Thread: Independent living after SCI

  1. #11
    He needs to get in shape...but, as you say, it's going to take him a while. And he needs to want to do it himself. I mean, is it just me, or is it ridiculous that he can't bend over to pick something up off the floor with an L1 injury?

  2. #12
    I know you mean well, but I would be totally mortified if a caregiver was discussing my private care details on a public forum.

  3. #13
    I think I'm not including any identifying information. At least I hope no one is going to be reading this and say "Oh yeah! That's Frank! I know that guy."

    I think his gut gets in the way of picking stuff up from the floor, at least doing it without falling out of the chair. He has what appears to be a 32" jaw style reacher, which he attempts to use but with little success.

    Thank God, he's not humongously, morbidly obese, however he is probably your typical 60 something fat, weak American guy, which means very limited to begin with physically even with no SCI. I don't mean to ridicule anyone, however this man does bicep curls with one or two pound weights.

  4. #14
    What's actually happening with the money is this. Medicare is providing him with an aide 4 hours a day 5 days a week. And I think that has to be a single 4 hour shift. So that means no coverage in evening or two mornings a week.

    The family pays me $600 plus room and board so figure I cost them $700. I am an HHA, so I'm signing up with a local agency and in a few days I will become his Medicare paid HHA and I'll deduct what Medicare pays me, probably $200, from my salary leaving them with $500 out of pocket per week.

    They could probably manage without me and pay privately for an HHA from an agency two mornings per week. That would probably be 8 hours times $15 per hour or $120. In the evenings, his wife might, and this is a fairly strong "might", manage to put him to bed safely on her own.

    So it comes out that to have me hang around all the time is costing them about $380 per week total.

    I guess I'm not sure if it's really worth it or for how long it will be. The consensus here seems to be to fire me now and save the money to build some ramps or modify the bathroom. Correct?

  5. #15
    Rarely do people on these forums hire their PCAs through an agency. Many hire privately, so the 4 hour minimum shift is a moot point for them. If they can find someone who is willing to work a 2 hour shift, then they can hire them. I am amazed that Medicare is actually paying for attendant care for this man. That wouldn't happen in my state.


  6. #16
    Isn't background checking a problem if you hire privately? Also, I know one very popular local caregiver who is paid privately by families and she charges $15 per hour.

  7. #17
    When I was managing my mother's PCAs, we hired privately (ads on Craig's List) and I had a friend who was a private investigator do the background checks. Not that hard to do, and cost me less than $100. I only did them on people I screened and wanted to offer the job. We paid starting at $12/hr. (in the Los Angeles metropolitin area). You will find that many people pay privately from $10-18, which is much cheaper than what an agency charges (remember the person working for the agency only gets part of the fee paid to the agency). I can also tell horror stories about people hired through agencies who supposedly had background checks done, but turned out to be thieves and worse.


  8. #18
    Here in New York State, to be hired by an agency as an HHA, you have to be fingerprinted. The NYSDOH runs that through an FBI database which will come back with a rap sheet listing any time law enforcement in the US took that person's prints. I don't think that a private person can run that type of check. However only certain felonies will disqualify you. Also, only if you got caught.

    One thing I've been surprised by: in the New York City area, my impression is that only about 10% of HHA's are American born, only 25% speak English fluently and 10% speak no English. I wonder if that's true elsewhere. I've never seen such a high concentration of new immigrants in any profession.

    Which brings me to background checks. If he got off the boat from Haiti or Russia three years ago, then the FBI can only check those three years. Back in his country, he might be a convicted bank robber.

  9. #19
    My father has a similar injury, and was injured at age 65.

    I agree with others that at his level of injury, he could be quite independent.

    HOWEVER, I am worried that the person you are caring for is in for a very hard time. His age and his poor general health (overweight/not in good shape) will make his rehab much harder. My father was able to mostly dress himself, transfer well with a sliding board (and sometimes without) and cath independently, manage bowels independently when he left rehab, and was extremely driven and worked hard at therapy. And even with this, his rehab for the next 1-2 years was brutal. You cannot underestimate the impact of pain, depression, sleep problems... and in an older person, many of the medicines we use for these problems can cause fatigue/confusion that cause more problems. You have to be driven, with a lot of support to get through this process.... well, you don't have to be, but it certainly helps. And for someone in their 60's or older at time of injury, it is important or a downward decline can happen easily.

    I have seen that it is a bit different when you are injured in your 60's/70's compared with your 20's etc... The doctors/therapists often treat you differently (and give up on your more....). And the complication rate for people in their 60's+ is much higher than younger folks after SCI, and they are rehospitalized more often. You also haven't mentioned if he had any other injuries with his SCI, like a traumatic brain injury or other things that are also impairing his recovery. Those are common. And of course, most will develop depression, which can worsen pain, make you more tired, and discourage you from therapy. I hope he has good doctors following him.

    The most important thing you can do right now is encourage him to continue rehab aggressively. Transferring on his own, cathing on his own, dressing on his own are things he should be working on every day - both in therapy and at home. You can assist him with a routine that will keep him healthy... helping him prepare healthy foods during the day so he doesn't gain more weight, getting him into a routine of cathing/remembering to take his meds/learning to check his OWN skin/ doing pressure reliefs/exercising etc... so that he can manage himself more independently. Watching for signs of a UTI (which are common in the early days) will be helpful too.

    Good luck.
    Last edited by hlh; 06-17-2014 at 10:38 AM.

  10. #20
    Thank you very much. He is working hard on getting into shape and lose weight, become more independent, etc. I think his only injury was the broken spine; maybe a few ribs too, I'm not sure.

    Sleeping and depression to some degree are problems; but I think he's in a denial/bargaining stage right now.

    And again, this isn't your college athlete who fell off a cliff. He wasnt in good shape to begin with and of course we aren't getting younger.

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