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Thread: Relative as a PCA?

  1. #11
    I don't see how this is in conflict with the independent living movement. People have always (and always will) rely on family members to help provide their care.

    In states where this is allowed under their attendant care funding programs (very consistent with the IL movement) why should the family member not be paid? Many times they must cut back on work hours or even quit their jobs to do this. It certainly is better in many cases than depending on PCAs/HHAs from agencies who are much more expensive, and often lazy, incompetent, and who often rob you blind. In addition, in many states HHAs are not allowed to do caths or bowel care (and wound care) so this means you have to have an RN/LVN, which the state or Medicare certainly does not fund for the hours you need if you need assistance with this. Some can get funding through Medicare, but only if you are totally homebound (never leave your home). What is consistent with the IL movement about this?

    Some states are worried about abuse and fraud in a system like this, but of course in CA we resolve this by having IHSS social workers (AKA "IHSS Nazis") make unannounced visits to your home to see what your PCA is doing and if they are actually on-duty when you say they are. In addition, you can only get funding when this same social worker (not a nurse or doctor) does an in-home evaluation of your needs and decides how many hours you will get each month. Not a great system, but the system we have to work with.

    You may want to look into information about the importance of PCA funding (family or stranger) vs. state payment for nursing home care (the only alternative for many in the USA) on the www.adapt.org website.

    (KLD)

  2. #12
    Quote Originally Posted by SCI-Nurse
    I don't see how this is in conflict with the independent living movement. People have always (and always will) rely on family members to help provide their care.

    In states where this is allowed under their attendant care funding programs (very consistent with the IL movement) why should the family member not be paid? Many times they must cut back on work hours or even quit their jobs to do this. It certainly is better in many cases than depending on PCAs/HHAs from agencies who are much more expensive, and often lazy, incompetent, and who often rob you blind. In addition, in many states HHAs are not allowed to do caths or bowel care (and wound care) so this means you have to have an RN/LVN, which the state or Medicare certainly does not fund for the hours you need if you need assistance with this. Some can get funding through Medicare, but only if you are totally homebound (never leave your home). What is consistent with the IL movement about this?

    Some states are worried about abuse and fraud in a system like this, but of course in CA we resolve this by having IHSS social workers (AKA "IHSS Nazis") make unannounced visits to your home to see what your PCA is doing and if they are actually on-duty when you say they are. In addition, you can only get funding when this same social worker (not a nurse or doctor) does an in-home evaluation of your needs and decides how many hours you will get each month. Not a great system, but the system we have to work with.

    You may want to look into information about the importance of PCA funding (family or stranger) vs. state payment for nursing home care (the only alternative for many in the USA) on the www.adapt.org website.

    (KLD)
    Thanks KLD. Hope to discuss this matter with colleagues

  3. #13
    Does anyone know the rules in Mississipp? I've looked everywhere and can't find the answer. I am a stepmom that is a fulltime caregiver to my step son. I would love to get a little $ for what I am doing since I am not able to work a full time job any longer. Any help would be appreciated.

  4. #14
    Senior Member taj2002's Avatar
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    Quote Originally Posted by SCI-Nurse
    Some can get funding through Medicare, but only if you are totally homebound (never leave your home).

    (KLD)
    KLD:

    I do not agree with your statement about the Medicare “Homebound” definition. Medicare has issued more flexible guidelines. One of the criteria for the chronically disabled to receive home health services paid for by Medicare is that the recipient be confined to his or her home, meaning that leaving it to receive services would be a "considerable and taxing effort." The Medicare law also stipulates that absences from the home be of "infrequent and of short duration." The law does not require that a person “never leave the home”. The new instructions--from the Centers for Medicare & Medicaid Services (CMS) to home health agencies and the contractors that pay home health claims--make clear that chronically disabled individuals who otherwise qualify as homebound should not lose home health services because they leave their homes infrequently for short periods of time for special occasions, such as family reunions, graduations or funerals.

    I would never suggest that people stay home just to get Medicare home health services. But let’s say that you basically go out to church, doctor appointments, and other infrequent or short outings, then I would encourage you to try to get Medicare to pay any skilled services that you might have. In Indiana, the bowel program, trach suctioning, cathing, etc. are all skilled services. I have been successful in getting Medicare home health services for this care for my husband. For very high level quads, it might be an option.

    Trish

  5. #15
    In Louisiana the State Waiver Program for Disabled & Elderly will allow agencies (sitter agencies) to come sit and YES, they prefer relatives and friends to do the sitting versus them sending a total stranger in to do it. Of course you have to have the relatives and friends pass the agencie's background checks and drug screens and such. But once that's all done, you're ready to go!

    Only problem with this program is that I just got my approval for this service because the waiting line for these sitters in the home was 2 1/2 years for me. My brother has been in a nursing home waiting for this and I'm moving on it as we speak.

    I asked the same question in your post --- can my mother or myself be one of your paid sitters? They said - "SURE!, We prefer it that way. You just have to fill out application and meet our requirements to sit. They will only pay for so many hours per day, though. I'm told my brother, a C5-6 quad, will qualify for maximum hours (15 hours per day). That will be plenty. I will personally try to tend to the other 9 hours each day.

    Oops! Forgot one important thing - paid sitter cannot LIVE in same household w/patient.

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