As I am in college, pursuing a BS in Psychology, and looking toward a Masters so I can practice what I've learned, it was intreaguing to see what levels of education afforded what types of licensure. To this end, I have decided on a path to LPC. As I was researching this career field, I noticed a discrepancy in the fee schedule of NC DMA. (Of course I checked the fee schedule, who wouldn't?) In the listing for behavioral health I noticed that a QMHP was only allowed to bill under Community Support. This confused me. I knew that working in Mental Health Residential Services, the state laws require us to have a QMHP on staff. (See 10A NCAC 27G.1102(a))
http://reports.oah.state.nc.us/ncac/title%2010a%20-%20health%20and%20human%20services/chapter%2027%20-%20mental%20health,%20community%20facilities%20and%20services/subchapter%20g/10a%20ncac%2027g%20.1102.html
http://www.dhhs.state.nc.us/dma/fee/mhfee/MHFees_031909.pdf
When given the $40 per day allowed for the care of the consumer, and the overhead required to run such specialized homes, how are the providers to pay for the services of a QMHP, when clearly there are no provisions for these services under the DMA? If a Community Support worker spends one hour a week per client, and the Residential Service worker spends 24 hours a day with the client, would it not make sense to focus on the Residential Service's staffing needs as well? It makes one wonder, in light of hearing how horrible the alleged conditions are in some Mental Health Homes, how the State of NC could have missed this?
To this end I have written a letter to our governor, Bev Purdue. We will see what can or will be done to change this.
Tuesday, April 14, 2009
Thursday, April 2, 2009
Letter to Congressman Ethridge/HR 1670
Dear Mr Ethridge,
I spoke with someone in your office today concerning HR 1670, and some provisions that might benefit the consumers you are trying to serve. To this end, I spoke with your office staff concerning the need for mandated education of caregivers and the possibility of funding for that education, as well as making the states more accountable for where they spend the monies offered under this grant. The consumers I work with on a daily basis have so many struggles that make it impossible for them to live alone, most of which exacerbated by the mandates of the state of NC, and their medicaid entitlement.
While the US Congress is trying to make healthcare more available and patient centered, the state is making it harder and harder to provide community related care. Some sort of incentive or regulation must be able to be implemented to ensure the state is not cutting funding at the local level, if the federal government is providing funding to cover this. Were you aware, that in NC, the average cost of care in a community based Adult Care Home is $70 per day? Did you also know that the amount the adult care homes are paid per client by medicaid (often the only form available to the client) is $40 daily, plus $0.60/daily for transportation? This is why our state is constantly in the news about our mental health issues.
As a CNA in home health, I worked in 2004, averaging about 15 hours per week per client. Governor Easely and his cabinet then mandated a cut in home health hours from 15 to 3.5 per week. Not only does that overload the caseload for the CNA, it cuts the number of CNA's needed in the state, causing unemployment to rise. This secondary to the fact that there is no real way to provide personal care, bathing, dressing, cooking meals and cleaning in 3.5 hours a week. It is not possible.
The state of NC cares so much more about the money spent than about the care given, and the clients fall short. If the federal government is going to take a hand in this and offer funds, please make it to where the clients actually see the funds instead of the state determining what my clients (and your family members possibly) are worth.
Thank you for your time,
MB
I spoke with someone in your office today concerning HR 1670, and some provisions that might benefit the consumers you are trying to serve. To this end, I spoke with your office staff concerning the need for mandated education of caregivers and the possibility of funding for that education, as well as making the states more accountable for where they spend the monies offered under this grant. The consumers I work with on a daily basis have so many struggles that make it impossible for them to live alone, most of which exacerbated by the mandates of the state of NC, and their medicaid entitlement.
While the US Congress is trying to make healthcare more available and patient centered, the state is making it harder and harder to provide community related care. Some sort of incentive or regulation must be able to be implemented to ensure the state is not cutting funding at the local level, if the federal government is providing funding to cover this. Were you aware, that in NC, the average cost of care in a community based Adult Care Home is $70 per day? Did you also know that the amount the adult care homes are paid per client by medicaid (often the only form available to the client) is $40 daily, plus $0.60/daily for transportation? This is why our state is constantly in the news about our mental health issues.
As a CNA in home health, I worked in 2004, averaging about 15 hours per week per client. Governor Easely and his cabinet then mandated a cut in home health hours from 15 to 3.5 per week. Not only does that overload the caseload for the CNA, it cuts the number of CNA's needed in the state, causing unemployment to rise. This secondary to the fact that there is no real way to provide personal care, bathing, dressing, cooking meals and cleaning in 3.5 hours a week. It is not possible.
The state of NC cares so much more about the money spent than about the care given, and the clients fall short. If the federal government is going to take a hand in this and offer funds, please make it to where the clients actually see the funds instead of the state determining what my clients (and your family members possibly) are worth.
Thank you for your time,
MB
Tuesday, March 31, 2009
Community Support to Replace Residential Services????
Dear Marsha V Hammond, PHD,
http://madame-defarge.blogspot.com/
First of all, while your appreciation for the lack of funding needed to run a FCH is duly noted, it is not without notice that you offer no resolution to the problem.
As I read your validation as to why you were checkin into the Client Record that began this debacle, a few things came to mind.
1. In the healthcare facilities (including nursing homes) I have worked with, the financial record was not a part of the consumer service or medical record. The financial record was stored in an entirely different record, much like the Medication Administration Record. While, humbly I realize that each facility is different, it struck me odd that a financial record would be included for anyone to see.
2. The medications for the consumers are listed in the Medication Administration Record, which again, is listed in an entirely different record to my knowledge. This would provide you with the access to a consumer's current medications, without the need to filter through paperwork that may or may not be necessary for you to see.
3. The assumptions made about the non-stop firing of staff. I cannot know, nor can you I imagine, with any certainty why staff turnover is as it is in that particular facility. Between the screening process and imminent need for highly qualified staff, and the free will of any employee to come and go as he/she sees fit, it's safe to say that staff will come and go.
4. Accuracy, as any media will surely display, is often a slanted view and highly dependent on the reporting source.
5. I am thoroughly impressed that you indeed see your non-family care home clients in their private homes. Do you have a plan for the provision of consumer needs, such as supervision, medication compliance management, personal care and transportation on a daily basis for the clients you plan to recommend for Section 8? Is there also a plan for monitoring to ensure these services are being provided, or will that also be in your Community Support daily service?
5. As we have already agreed upon, there is not enough money allotted to cover the expenses of the consumers in a facility now. By what means would you suggest the facilities further cover the burden of medication co-pays when the families either cannot or will not pick up the tab? The state Medicaid office does not bother itself with how the co-pays are paid, or whether or not the consumers are financially strapped, nor do the pharmacies have a solution. With as many solutions to problems as you have, perhaps you could suggest a solution here too.
6. While I applaud your thorough investigation, concerning the expenditures by the group home in reference to your consumer, the math confuses me. It is my understanding that the current Medicaid cost of care rate is, after the deduction of the Personal Needs Allowance of $66, at a monthly rate of $1174, compared to the $1300.00 monthly you quoted. Being a psychology major, math is not my forte, however that's a bit of a difference, even when rounding up.
While Governor Perdue cuts back on Special Assistance, we bicker amongst ourselves as to who is doing what. While Community Support is good for targeting specific goals and behaviors, to assume that the presence of the omnipotent CS worker can take the place of the services provided in Residential Treatment is incredibly reckless. A CS worker who sees a client perhaps once a week (I am being generous), for an hour per visit (another display of generosity), cannot possibly have time in that single hour to provide the necessary residential services listed above. As I understand it, CS is authorized for up to 90 days at a time. Do you really expect to teach these residential skills to each of your newly placed Section 8 clients in 90 days time? And how are they to deal with the lack of services until such time as they can be taught? In residential treatment we are often criticized for being underqualified, undereducated and basically unfit to care for YOUR consumer. Forgive me, but CS is relatively new to mental health is it not? I have worked on the front line with clients I've worked with for the last decade or more, some of which come to me telling me what CS is NOT providing, instead of running to the CS worker telling them what I am not doing. I may not YET have your degree, Madame, but face to face experience surely counts for something.
http://madame-defarge.blogspot.com/
First of all, while your appreciation for the lack of funding needed to run a FCH is duly noted, it is not without notice that you offer no resolution to the problem.
As I read your validation as to why you were checkin into the Client Record that began this debacle, a few things came to mind.
1. In the healthcare facilities (including nursing homes) I have worked with, the financial record was not a part of the consumer service or medical record. The financial record was stored in an entirely different record, much like the Medication Administration Record. While, humbly I realize that each facility is different, it struck me odd that a financial record would be included for anyone to see.
2. The medications for the consumers are listed in the Medication Administration Record, which again, is listed in an entirely different record to my knowledge. This would provide you with the access to a consumer's current medications, without the need to filter through paperwork that may or may not be necessary for you to see.
3. The assumptions made about the non-stop firing of staff. I cannot know, nor can you I imagine, with any certainty why staff turnover is as it is in that particular facility. Between the screening process and imminent need for highly qualified staff, and the free will of any employee to come and go as he/she sees fit, it's safe to say that staff will come and go.
4. Accuracy, as any media will surely display, is often a slanted view and highly dependent on the reporting source.
5. I am thoroughly impressed that you indeed see your non-family care home clients in their private homes. Do you have a plan for the provision of consumer needs, such as supervision, medication compliance management, personal care and transportation on a daily basis for the clients you plan to recommend for Section 8? Is there also a plan for monitoring to ensure these services are being provided, or will that also be in your Community Support daily service?
5. As we have already agreed upon, there is not enough money allotted to cover the expenses of the consumers in a facility now. By what means would you suggest the facilities further cover the burden of medication co-pays when the families either cannot or will not pick up the tab? The state Medicaid office does not bother itself with how the co-pays are paid, or whether or not the consumers are financially strapped, nor do the pharmacies have a solution. With as many solutions to problems as you have, perhaps you could suggest a solution here too.
6. While I applaud your thorough investigation, concerning the expenditures by the group home in reference to your consumer, the math confuses me. It is my understanding that the current Medicaid cost of care rate is, after the deduction of the Personal Needs Allowance of $66, at a monthly rate of $1174, compared to the $1300.00 monthly you quoted. Being a psychology major, math is not my forte, however that's a bit of a difference, even when rounding up.
While Governor Perdue cuts back on Special Assistance, we bicker amongst ourselves as to who is doing what. While Community Support is good for targeting specific goals and behaviors, to assume that the presence of the omnipotent CS worker can take the place of the services provided in Residential Treatment is incredibly reckless. A CS worker who sees a client perhaps once a week (I am being generous), for an hour per visit (another display of generosity), cannot possibly have time in that single hour to provide the necessary residential services listed above. As I understand it, CS is authorized for up to 90 days at a time. Do you really expect to teach these residential skills to each of your newly placed Section 8 clients in 90 days time? And how are they to deal with the lack of services until such time as they can be taught? In residential treatment we are often criticized for being underqualified, undereducated and basically unfit to care for YOUR consumer. Forgive me, but CS is relatively new to mental health is it not? I have worked on the front line with clients I've worked with for the last decade or more, some of which come to me telling me what CS is NOT providing, instead of running to the CS worker telling them what I am not doing. I may not YET have your degree, Madame, but face to face experience surely counts for something.
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