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    PA is stopping agency attendants from doing bowel care.

    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.
    Last edited by forestranger52; 6 Aug 2012, 6:27 PM.
    C 5/6 Comp.
    No Tri's or hand function.

    Far better it is to try mighty things, to win glorious triumphs, even though checkered by failure. Than to take rank with those poor spirits who neither enjoy much or suffer much, because they live in the grey twilight that knows neither victory or defeat.

    Teddy Roosevelt

    #2
    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?
    "Would you rather reduce deficits and interest rates by raising revenue from those who are not now paying their fair share, or would you rather accept larger budget deficits, higher interest rates, and higher unemployment? And I think I know your answer." Ronald Reagan"

    Comment


      #3
      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)
      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


        #4
        Originally posted by forestranger52 View Post
        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.

        Comment


          #5
          Colostomy?

          Comment


            #6
            Originally posted by LaMemChose View Post
            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.
            Every day I wake up is a good one

            Comment


              #7
              Originally posted by cheesecake View Post
              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?

              Comment


                #8
                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.

                Comment


                  #9
                  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 View Post
                  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)
                  Courage doesn't always roar. Sometimes courage is the quiet voice at the end of the day saying, "I will try again tomorrow."

                  Disclaimer: Answers, suggestions, and/or comments do not constitute medical advice expressed or implied and are based solely on my experiences as a SCI patient. Please consult your attending physician for medical advise and treatment. In the event of a medical emergency please call 911.

                  Comment


                    #10
                    Originally posted by Sue Pendleton View Post
                    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.
                    Sue, in my state, the rehab centers (and nursing homes, assisted living facilities, etc.) are not any different than the acute care hospitals or licensed home health agencies. CNAs or other UAPs are NOT allowed to do invasive procedures. For this reason, many rehab centers no longer employ CNAs, but use LVNs instead, or the RN has to do these procedures themselves. I remember when we had to stop our CNAs from doing intermittent cath and bowel care when I worked in the private sector...and that was around 1986. It did not matter if the RN was in the room or not. By law, the RN is in charge, and so if they assign a CNA to perform a procedure in violation of these regulations, the RN risks loosing their license, regardless if the RN is present or not.(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


                      #11
                      Originally posted by LaMemChose View Post
                      Absolutely. i was aware of why it would be a horrid choice when I wrote it, but to remain indy, what are other options?
                      LAMEM~ My reply was rhetorical, I absolutely knew why you posted what you did.

                      For many on these boards their colostomy freed them to be fully independent. Many have posted openly about their decisions and have no regrets.

                      I do find it bothersome however that health care mandates either an RN or family to do the care but generally will not pay for the RN visits for bowel care. Few are independently wealthy to lift the cost.

                      When will health care and insurance catch up with improved survival rate, increased life expectancy and the right to choose?

                      Foreststranger, if it were me, I would explore all options. Are you a veteran with a service related injury?
                      Every day I wake up is a good one

                      Comment


                        #12
                        Have phone calls into disability lawyers, the new director of the govenours disability council and disability rights networks. We need an injunction to at least slow this down.

                        Turnover in home care is over 90%. Lazy bums around here all want on welfare or disability. Almost imposible to find attendants. Wish like Mass and Oregon where all PCA's are state employees. Low pay no help. If the pay was 12 bucks an hour there would be no problem. Never had anyone but attendants or nurses aids do bowel program. At the VA, only the workers with the lowest pay grade did the job. Two employees on floor I remembered from 2003, been there over 30 years and great people. UNBELIEVABLY dedicated to deal with entire floor of SCI's and all the bowel programs/ problems.

                        Did ask VA nurse for Doc to approve colostomy, I have no other choice but one. New govenour would like to force as many folks into nursing homes as possible to pay back buddies who paid to have him elected. Massive cuts to disability programs. Most people without good hand function will be institutionalized.
                        Last edited by forestranger52; 7 Aug 2012, 7:47 PM.
                        C 5/6 Comp.
                        No Tri's or hand function.

                        Far better it is to try mighty things, to win glorious triumphs, even though checkered by failure. Than to take rank with those poor spirits who neither enjoy much or suffer much, because they live in the grey twilight that knows neither victory or defeat.

                        Teddy Roosevelt

                        Comment


                          #13
                          Are you on VA pension?? If you are an eligible Veteran, you should be talking to your SCI social worker about applying for VA fee-basis bowel and bladder care in your home. Their job is to help you with this process. You can also talk to your PVA NSO about this.

                          The inpatient VA staff is not controlled by state law or practice regulations. The VA is able to set their own standards of care and scope of practice (within in some limits) for what UAPs are allowed to do. That is not true of the private sector, which is under the control of state law.

                          (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


                            #14
                            Thanks Ms. Dunn. The VA Nurse told the soicial worker and she called me today about exactly what you said. That will definately help me sleep better.

                            As a crip, I thank God every day for the VA and they have always been a tremendous help to me. This should protect me from the dreaded nh. I can only hope for the other folks without hand function. One cervical injury up or down has so much control over a life.
                            C 5/6 Comp.
                            No Tri's or hand function.

                            Far better it is to try mighty things, to win glorious triumphs, even though checkered by failure. Than to take rank with those poor spirits who neither enjoy much or suffer much, because they live in the grey twilight that knows neither victory or defeat.

                            Teddy Roosevelt

                            Comment


                              #15
                              ok dumb question i train all mine the literal are culled fromnewspaper add. and i teach them what they need to do

                              they change my sp change bags for me before the colonospy did boewl treatment

                              is that not a alternative?

                              Comment

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