I just found out that DSHS will only pay for 14 hours of care a day for my edss level 8 MS client. Is this legal ? In the 3 weeks I've been her night caregiver and put her to bed she literally can't even move an inch. I when I took this job was not aware that I was only getting paid 57 of the 85+ hours her day care giver wasn't there. I understand her fear of being stranded in bed alone. Is it legal for DSHS to refuse to pay for care when shes at her most vulnerable?
The Care Tool Assessment asks about the level of assistance a person has needed in the last 7 days. Which can cause some issues if the client is not completely honest (many people have the tendency to cover up or hide how much help they really need), or if they had a really good week, their assessment might not be reflecting their true day-to-day needs. If she is new to the COPES program, her hours are based off of that initial assessment done by the DSHS social worker. In WA state, what happens is the DSHS social worker does the assessment, gets together the care plan, gets services started and then hands the case over to a contracted agency for someone else to be the long-term case manager. The new case manager will do a "30-day" visit, which is just a quick visit to introduce themselves to the client and to see how the care plan is working out. The client can request a new assessment to be done if they feel the initial care plan didn't give them enough hours. It would be important to have care givers at the assessment who can help answer questions in case she is not a very good "self-reporter."
When it all boils down, COPES will never offer 24-hour in-home care. However, if the assessment finds she does indeed need 24-hour care, she may qualify for an Adult Family Home (AFH) or Assisted Living Facility (ALF), or she can apply for a skilled nursing facility (nursing homes are through a different program than COPES, so need a new application). In this case, rather than an approved number of hours per day, the CARE Tool determines a "daily rate," which is the amount the state will pay to the facility for that person, per day. The individual must also pay a "participation" to the facility, which is pretty much their entire income, and they get to keep $62.79. If the person is married, there are some additional considerations taken into account in regard to income. Anyway, the facility will look at the person's participation and the state's daily rate to decide if they can take the person. Care is very expensive, and the facilities are usually losing money by taking someone on Medicaid. Not all AFH/ALF's accept Medicaid, or if they do, most will only take someone if they move in and pay privately for an agreed-upon amount of time, usually 2 years. Which, unfortunately, people on Medicaid can't afford. Keep in mind that the facilities that do accept Medicaid are being inundated with Medicaid applicants all the time, so finding a place can be very hard.
Sorry for the long-winded answer, but I figure more information is better than not enough! There's more information on the COPES program on the Washington Law Help website. Rather than calling APS right away, I'd suggest first helping your client advocate for herself if possible, and calling her case manager to see if they can increase hours.
When you write "confine", do you mean just allowing her to sleep there or strapping her down, or using bed rails or something similar?
If I understand the situation, you're paid for 14 hours of care so that would leave this woman alone for another 10. But you're the night caregiver, so that suggests she would be alone and "confined" during the day? But she has a day care giver... Am I interpreting this correctly?
One problem I occasionally have is country locations sometimes have ants etc. I don't want a lot of spray in my Mother's room, so have to be very inventive. Disabled persons not only need good care, but you have to constantly assess the situation from a legal and ethical view. I am noticing with my Mom and other family members, they are getting really pushy about no aggressive measures and pushing Hospice when they don't quite know what setting appropriate for loved one. I hope this was just poor judgment with specific discharge planners and not a trend. This is very troubling!
7x14=88 hours. You cover 57 hours (paid by whom?).
That leaves 23 hours uncovered. So you want DSHS to cover more hours? They will tell you that it is cheaper for them to move her to a facility.
I'm going to guess she is refusing to go.
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