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We have to pay back the state for the PCA $$ we got while Chad was in the hospital

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  • We have to pay back the state for the PCA $$ we got while Chad was in the hospital

    Yes, you read that right. While Chad was sick and in the hospital, our PCA still worked - he came to the hospital and cathed Chad, bathed him, fed him breakfast, lunch and dinner - took some of the overnight shifts, etc. In fact, he probably worked MORE hours while Chad was in the hospital than while Chad is well. But when Chad was talking to his case manager for the state, he mentioned off handedly that he was recently in the hospital and his case manager then *immediately* demanded that we PAY BACK the state for the money that the state paid his PCA during the time he was in the hospital because *obviously* while Chad was in the hospital, his PCA just loafed around on vacation and did nothing.

    So, we have to come up with about $1000 to pay him. And the best part is that Chad of course was docked at work for the entire 2 months he was out of work related to this hospitalization and then pressure sores he got later, so we have no income from his job for 2 MONTHS!!! during that period. The thing is, if it wasn't for me being around, there is NO way Chad could pay this money back!!! This is very frustrating.

    I HATE THE STATE!!!!!!!!! What a bunch of jerks.

    Yes, I suppose I should be grateful we get any money for a PCA from them, but it's just so awful in how they went about it. Oh? You were sick and in the hospital? GIVE ME MY MONEY BACK. And the thing is, our PCA actually did WORK!!!! He really did! That's what chaps my hide more than anything. They're treating us like we pulled a fast one on them, like we're some sort of criminals. Grrrrrrrr.

    Merry Christmas to us ....

    Ami
    Wife of Chad (C4/5 since 1988), mom of a great teenager

  • #2
    Have you tried to fight it? Discuss it with Chad's doctor, maybe he will write a letter of need for you.

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    • #3
      This is the usual practice. Rightly or wrongly, the state assumes they are already paying for nursing care for your son when he is in the hospital. Choosing to have his PCA provide care instead of getting it from the nurses in the hospital is seen as an extra that is on you for payment. In my state they also cut off the PCA's pay during any days of hospitalization, and this is generally retroactive as soon as they discover the dates.

      If he was working before this hospitalization, he may be eligible for state short-term disability income during the time he was off work. Have you explored this? I assume he had no sick leave pay from his job, correct?

      (KLD)
      The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

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      • #4
        Very interesting story, I've been wanting to find out something like this for awhile now.

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        • #5
          SCI nurse writes:
          "Choosing to have his PCA provide care instead of getting it from the nurses in the hospital is seen as an extra that is on you for payment."

          This may be, but I doubt if Zilla had a "choice". Have you ever tried to get a hospital's nurses to take proper care of a spinal patient when they are admitted with complications?

          Even with no PCA, I would never leave Steve in their care if he is admitted for any problem. I always stay with him. While there are a few exceptions, I find that the definition of "skilled nursing" means they are skilled at avoiding doing their job. this is just from our personal experience, of course :&gt[img]/forum/images/smilies/wink.gif[/img]

          Russ Byrd

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          • #6
            It sucks being in a hospital where nurses don't know anything about caring for a SCI pacient. I'm a C4-C5 and was in a hospital back in '99 with an infection and they took me in through emergency, blah blah... I got a room about 3am and they put me in bed laying on my back. A nurse came and stuck a cath in me and the whole rest of the night/morning I was left unturned. Breakfast time came around and they put the tray on the table next to me and that's it. They didn't even bother to feed me or ask if I needed help. My mom showed up around 9:30am or 10 and saw me in the same position as when she left, and the food there. What did she do? She took off work all those days I was in the hospital and stayed by my side from morning till about 1am everyday to take care of me. This was the most frustrating situation I ever been through I even got in a fight with the doc to let me go home but no luck said my life was at risk because of the infection. So in this case, my mom still worked as my provider even though I was in the hospital with all the nurses around. You shouldn't need to pay back the state the problem is that they don't understand what we go through in situations like these.

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            • #7
              Yes, this is what is so aggravating about it all. The hospital was in NO way set up to take care of a high level quad. There was no one to turn him, no one to feed him (similar thing tech - they would just bring him lunch and it would just sit there .... ummmm HELLO! he is completely paralyzed! how is the food supposed to get to his mouth????? then they would be surprised when he hadn't eaten it when they came back 2 hours later ... "not hungry today?" they'd say, the one day no one could be there at dinner..... ARGH!!!) And no one to cath him every 6 hours - he needs to be cathed EXACTLY every six hours, not APPROXIMATELY every six hours. So his PCA did it during the day, I/his mom did it at night/in the evenings. His PCA worked!!!!

              The regulation is written to say "When PCA care is not needed, such as when you are hospitalized ...." .... so I think that is ambigious enough to fight. He NEEDED his PCA - and the hospital will even write a letter to support us. They will state that they could not take care of him as he needed to be cared for, so we are going to appeal. We may lose, but at least we'll go down fighting. This just ticks me off!

              And unfortunately, his job offers no short term disability benefits. And he's totally out of sick leave. So we're SOL. Oh well.... At least I have a good job!!

              Thanks for the sympathy Russ, it's really nice that you understand.

              Ami

              (he's my fiance, not my son [img]/forum/images/smilies/biggrin.gif[/img])
              Wife of Chad (C4/5 since 1988), mom of a great teenager

              Comment


              • #8
                I too provide much of my mother's care when she is hospitalized, but I don't get paid. The state is paying for the nursing care. If you don't get it, then your family/friends will need to shout long and loud, go through the appropriate complaint process, and be a royal pain in the neck to get what is needed. The nurses and hospital administrators are always glad to see my mother discharged so they can get me off their back!

                Unfortunately though, I think it is unrealistic to expect that the state will pay for your hospitalization (which should include nursing care, even if it is not what you get at home) and also pay your PCA. Of course you can always private pay for PCA care if you can afford it, but I know of no state-funded programs that will pay like this if they know you are hospitalized.

                (KLD)
                The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

                Comment


                • #9
                  KLD,

                  I am also a pain in the neck to nurses and administrators. But going through channels doesn't insure you will recieve proper care for a loved one.
                  When Steve had his medtronic pump installed a few years back, I was amazed how lazy the nursing staff was. I had planned to stay with him at night and work during the day. When they found out that he needed to be cathed every few hours, the first thing they pulled was trying to pressure the doctor to order an indwelling catheter to save them the trouble. I told them no and stayed with him through the stay and cathed him myself. I know hospitals are short staffed, but these people were simply lazy. If he wanted water, they would drag their feet and I would finally have to get ugly with them. (I was not allowed to go into the room to fill his water, or would have done so myself) I did complain, and also a family in a neighboring room had some major problems. The elderly father had stopped breathing, and they could not get the nurses to even respond. When they finally did,(and he was revived) one of the daughters said a few choice words to a nurse about not responding and all of a sudden we had nurses coming out of hiding places everywhere and security guards threatening to throw the daughter out of the hospital. When the adminstrators and the security guards were saying all this to the family that had almost lost their father, I walked into the hall and told the administrator that I was a witness against his staff and hospital for this family and he would be well advised to stop threatening them. The security guard later came and apologized, saying he was not told about why the family was so distraught.

                  Russ Byrd

                  Comment


                  • #10
                    I had excellent care during my recent three-night hospital adventure. But the quality of nurses varied a lot. Some were very attentive to my special needs and were very willing to do what was needed. Others, though, were far less helpful. I had someone stay with me 24/7 to make absolutely certain that my needs were met.

                    I really admire you guys for taking care of your loved ones the way you do.

                    Comment


                    • #11
                      KLD, please stop making assumptions about us. The state does NOT pay for Chad's hospitalization. He is gainly employed person with PRIVATE insurance and his INSURANCE pays for his hospitalization, NOT the state.

                      And it is NOT unreasonable in our view that the state should pay for his PCA during his hospitalization. We should just agree to disagree ok??? Maybe you have a rosy eyed view of nurses and hospitals, but even the NURSES at this hospitals are willing to write a letter saying that we needed his PCA. Did you even read my last post at all????

                      This is a caregivers forum and you are being less than supportive. I would like to vent in peace please and not be preached to by you!!!!!

                      Ami (who is getting VERY aggravated, yes)

                      p.s. *I* don't get paid either KLD, nor do I expect to, but I would like to not have to pay back our PCA's wages. GRRRRRR.
                      Wife of Chad (C4/5 since 1988), mom of a great teenager

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                      • #12
                        Update: we just talked to the Head of the program that administers the PCA $$ and he is going to put through an exception waiver for us. He isn't sure if it will be approved, but he thinks there is a good chance it will be given the situation in the hospital - for example, they were completely unable to get a call button rigged up for Chad and he was not within yelling distance of the nurses station. So the regulation that says "when PCA care is not needed, for example, when you are hospitalized ...." is what he going to use - that his PCA *was* in fact needed because the hospital was physically incapable of caring for him. And the hospital will document that for us willingly.

                        YEAH!!! I don't know for sure if we'll win, but at least I feel better knowing they aren't treating us like criminals who were trying to pull a fast one on them.

                        Ami
                        Wife of Chad (C4/5 since 1988), mom of a great teenager

                        Comment


                        • #13
                          Z
                          I'm glad to hear that the admin is willing to go to bat for your PCA wages! That's great. Sometimes you have to look high and far AND wide for a person like that! Good on you!
                          Happy thanksgiving.
                          [img]/forum/images/smilies/smile.gif[/img]

                          We are all faced with a series of great opportunities... Brilliantly disguised as impossible situations.
                          Arlington Cemetery is full of soldiers—the presidents buried there are few and far between. -Rusty VanReeves

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                          • #14
                            Ami,
                            good for you and let us know how it works out.

                            Clipper, I am glad you have someone who stays with you in the hospital. It is just not worth taking a chance that the staff will be alert if something happens that they are needed.

                            Russ Byrd

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