******** – WestMass ElderCare,
I am very disappointed to hear that the new rate might be similar to only a small COLA increase. I had hoped that Senator Buoniconti would have been able to help get something approximating fair payment levels for the 24/7 caregivers are responsible for, considering their efforts save the State at least many thousands of dollars.
I had thought that medication not being an ADL was a bit odd, when in my particular situation it is definitely a (if not the) key component to health, and I wanted to attribute this difference to an oversight resulting from the tendency people have of thinking in terms of physical health. But the fact that ******* would not qualify for level 2 payments when so clearly it is level 2 care, explains why medication is not an ADL but an IADL. This reaffirms my suspicions that the new regulations were written to achieve a predetermined objective. That is, to minimize the short-term costs to MassHealth even though it may not be in the best interests of the insured and is unfair to care providers. It seems to me that inadequate payment levels could be seen by some as being discriminatory against non-physically disabled individuals, in that this will surely impact the availability of community based care providers.
The fact that you are unfamiliar with the terms I chose to use illustrates the concern I have regarding my making written reports. I am capable of making observations about behavior and deciding how to respond. As long as I can continue to relate this information to you, so that you can interpret and record the information using the proper terminology, then this is fine.
If MassHealth does not at this time intend to make fair payments that reflect the extent of care provided, then the matter of recording care in 15 minute time blocks so as to qualify that payment is moot.
A 'large print' version of the form will be of some help I suppose. I would prefer to have the cause treated rather than the symptom, but without additional income or insurance to cover the cost of corrective lenses, I guess this is the next best thing. Also, I have come to realize that for me to have the time to complete it without sacrificing time needed for other purposes, I will need someone to assume my responsibilities while I make entries. Because I am just now starting to get caught up on things that were set back by the insult and lack of consideration that MassHealth treated me to in the past, I am not inclined to suffer even more damage to what little time, effort and money I still have.
Where MassHealth did not provide the allowed 8 hours of Home Health Aide services per week for the benefit of the clients recovery, to give me some respite, or to allow me to acquire additional income, there should be no problem now that regulations require this form to be completed and I will need someone to temporarily assume care responsibilities for me to do so. The full 8 hours will not be necessary, 1 hr every other day should be adequate. This will most likely be problematic for a while, and could even be detrimental if not done tactfully. But I'm thinking maybe some personal hygiene care, hair, nails, grooming, etc. maybe some leg exercises, should be accepted and might even come to be welcomed. Please try to arrange for this as soon as possible so that it will be in place by the time I need to start filling out the form as per the new regulations.
Thanks ********
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********,
********'s on vacation so I'm responding to your latest email. I'm not sure that you're looking at the regulations that pertain to AFC. The laws used for AFC are 130 CMR 408.417. We, too, feel that medication should be considered and ADL and the statewide AFC Council is trying to address this. You're preaching to the converted here–we have little say in this whole thing.
The form that you need to fill out, although not our doing, should take no more than 5 minutes a day to complete out. It should be filled out once daily. It does not need to be filled out every 15 minutes (care provided in the PCM program is divided into 15 minute increments–but this does not apply to AFC). Perhaps when you look at the large print version it will make more sense.
I have said more than once that I feel ****** should be considered a Level II client because ******** requires so much patience and care. But the Level II regulations state clearly that a client must require "physical assistance with 3 of the ADL's described in 130CMR 408.417(B)(1) through(6) OR physical assistance with two of the activities described in 130 CMR 408.417 (B)(1) through (6) and management of behaviors that require caregiver intervention as described below:
As I see it, you provide actual hands on care for grooming (hair) but that is not considered an ADL in the new AFC regulations (although there is a move to change this). You also provide physical assistance with ambulation outdoors. Unfortunatley that is not quite enough to qualify for Level II. Since behavior can be used ******** would need 2 ADL's. If I'm wrong–that is if you actually provide hands on care with other ADL's we can look more closely at Level II.
As for a Personal Care Homemaker, AFC does not cover this. You are entitled to 2 weeks of vacation per year and possibly we could use that funding ($25.08/day) to pay for someone–although that has never been done before and we would have to check into this. However, you would have to find your own worker. We do not have "workers" at our disposal (unless the client is 60). In the past, ******** has refused respite (e.g. the DMH respite in Westfield). Do you think ******** would accept someone now?
I hope this is helpful. We'll be there on the 26th and discuss it further if you like.