PA is stopping agency attendants from doing bowel care.

[forestranger52]

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.

[trekker6]

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?

[SCI-Nurse]

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)

[nrf]

Originally Posted by forestranger52

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.

[LaMemChose]

Colostomy?

[cheesecake]

Originally Posted by LaMemChose

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.

[LaMemChose]

Originally Posted by cheesecake

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?

[ffindley]

Sorry to hear about this. That really sucks! I think NC must have the same law as I can't get the two agencies in my county to send anyone as they say a nurse is required and all they seem to have are CNA's. I'm really worried about being in the same situation as you are in. Good luck! You might try getting your local senators/representatives involved to change the law.

[Sue Pendleton]

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.

Originally Posted by SCI-Nurse

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)

[smashms]

been that way in NY also for years i know a couple of people who have aids all day long one has a nurse and the other has concumer directed choices which is basically she is hiring and firing but the company is paying them. so she gets away with having them change her colostomy bag and emptying her sp bag, she i think has a nurse come in every month to change the sp cath though.