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Thread: Aide expectations - Am I being unreasonable?

  1. #41
    Quote Originally Posted by SCI-Nurse
    We also have a twice annual PCA training program (40 hours) that prepares those interested in working as PCAs in the basics, and we can then refer our clients to these trained PCAs as potential employees. Too few rehab programs offer anything like this, and it had always been a dream of mine to create one....which we did when I helped opened our program. The first 5 years it was a grant-funded program...now it is part of our regularly funded and staffed programs.

    (KLD)
    That is a brilliant idea!

  2. #42
    About that CNA training thing...Rules for working in a nursing home and home health care are way different. In a nursing home a CNA can NEVER do anything ADL care. In home health care, a CNA can cath, do bowel programs and much more.
    That is simply not true. CNAs who work in nursing homes help with ADLs all the time. This includes dressing, grooming, hygiene, feeding, transfers, wheelchair mobility, etc. All of these are ADLs (activities of daily living), and it will be rare in a nursing home and anyone BUT a CNA will do them. It is common that CNAs in nursing homes (or hospitals) are not allowed to give any medications, including suppositories, do bowel care, catheterizations, tube feedings or suctioning.

    In many states, CA included, nurses aides who work in the home, through an agency (who must be certified as a HHA = home health aide) are also NOT allowed to do caths, bowel care, tube feedings or any other procedures that "invade an internal body organ", nor can they administer medications. This is common in many states.

    A PCA = personal care attendant (privately hired, not necessarily certified as either a CNA or HHA, not working through an agency), in many states, has no restrictions at all in what they do, as long as it is something that the employer would be able to do themselves if they were able. This does include caths, bowel care, wound dressings, suctioning, tube feeding, etc. etc.

    It is the state, usually through the board of registered nurses or the legislature that establishes these rules, rarely just the agency.

    (KLD)

  3. #43
    Marm's paid her dues.

    If I had to pay somebody to do something, I would definitely want them to do what I requested. It's pretty demeaning to have a low level employee refuse, on your dime, to do what they were hired to do. They're gonna stand there, with the clock ticking, and tell you what you need? It's one of those "I'm not paying you to think" situations. If the funding is coming from the government, that is unfortunately another kettle of fish. I still wouldn't like an employee telling me no, but I might have fewer options.

    I am in favor of everybody doing as much as they can, if for no other reason than being stranded is just that much worse if you've let your shirt-changing skills slide. The time for building those skills is post-injury, before you return to work and your busy life. Nobody needs to spend 30 minutes putting on a shirt before work, or even before church or brunch on a weekend.

    I just can't see what would qualify a PCA to tell you no.

  4. #44
    Quote Originally Posted by SCI-Nurse
    That is simply not true. CNAs who work in nursing homes help with ADLs all the time. This includes dressing, grooming, hygiene, feeding, transfers, wheelchair mobility, etc. All of these are ADLs (activities of daily living), and it will be rare in a nursing home and anyone BUT a CNA will do them. It is common that CNAs in nursing homes (or hospitals) are not allowed to give any medications, including suppositories, do bowel care, catheterizations, tube feedings or suctioning.

    In many states, CA included, nurses aides who work in the home, through an agency (who must be certified as a HHA = home health aide) are also NOT allowed to do caths, bowel care, tube feedings or any other procedures that "invade an internal body organ", nor can they administer medications. This is common in many states.

    A PCA = personal care attendant (privately hired, not necessarily certified as either a CNA or HHA, not working through an agency), in many states, has no restrictions at all in what they do, as long as it is something that the employer would be able to do themselves if they were able. This does include caths, bowel care, wound dressings, suctioning, tube feeding, etc. etc.

    It is the state, usually through the board of registered nurses or the legislature that establishes these rules, rarely just the agency.

    (KLD)

    I'm sorry, I forgot to write BUT in the sentence. That in a nursing home you Can't do anything BUT adl's! And in home care you get checked off by the RN to cath. I've always done BP's in home care...suppositories and dig. stim. We also give meds that the RN has already put in the pill box. I live in Michigan so the rules might be different here. I also think the rules change when anything is funded by medicare.

  5. #45
    No, it has nothing to do with Medicare. It has to do with state law. In CA an RN could loose their license for assigning or teaching an aide to do caths, bowel care, dressing changes, suctioning or any other procedure that "invades an internal body organ". This is why we never use agency, but instead use private PCAs. Agencies require only an RN or LVN do these procedures to be compliant with state law.

    (KLD)

  6. #46
    I guess the rules are different in different states. My original point was that I do what is asked of me, and that I wouldn't tell a client no.

  7. #47
    Senior Member
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    Quote Originally Posted by SCI-Nurse
    Sure it is. Tons of people (SCI and AB) hire people to do those things for them. Many PCAs contract to do those things as well. If you can afford it, why not?

    We teach a PCA course twice annually. What we teach (and repeat over and over) is that the amount of assistance the PCA provides is what is mutually negotiated with the employer ahead of time, or renegotiated during employment (in the contract). This is using the independent living model rather than the medical or rehabilitation model. Again, this person is hired to follow your direction and assist you. They are not there to tell you what to do. You establish your own priorities, not them.

    If you would rather spend your available energy playing with your dog (or your kids) rather than struggling to put your slacks on yourself (and then get up exhausted), that is your decision....not theirs. Of course it is important to do what you can for yourself, but if that results in you being too tired (or too late) to get to work or school or do other meaningful activities, that is not to your advantage either.

    (KLD)
    The nurse is absolutely correct, and I have hired pcas for 23 years now. Longest was with me 16 years. You are hiring her as a aid, to assist you in what you see fit. Usually to avoid problems, you should cover what you expect, and what generally are the duties of the job before you hire her. That generally can avoid problems that may occur. If she/he continues to tell you what b you can do yourself, let her know politely you will be compensating her from now on with just the tasks she completes.

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