Is it legal to confine a wheelchair chair bound patient to bed alone for 10 hours?

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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?

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The DSHS will only pay for home care if it is cheaper than nursing home care.
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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Some states permit client to totally decide for self, and there is not much you can do if they are adamant to stay in home. I personally know one example where family tried to declare incompetent, and patient went before judge who reversed. Main concern is always fire.
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!
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This is a terrible situation for sure, but doesn't she have any family? That is the first place to go, then to the community. Was she active in church? Do her neighbors know about her plight? Does she have meals on wheels or anything during the day? Dig deeper before sending her to jail oh right it's a nursing home. Not much difference in that and jail in my mind.
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I am an RN and from my experience( I am in Virginia) a client who is immobile should not be living alone.. But then I am told that if they have capacity, they can make their own decisions even if there decisions are poor. I have lady with MS and she is approved thru medicaid for 7 hours a day..that is it.... 56 a week...Medicaid will rarely if ever approve for more that 56 hours. The rest is to be supplemented by family and friends....If that cant be done they should be in a facility. It seems we wait till something happens and then we act all b/c they have capacity..Doesnt make sense to me .
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I agree with cwillie - this existence must be horrendous for her - my mum lives with me and has the same immobility issues. She is put to bed at 9.00 pm by two carers (I technically go 'off duty' at that point, but am only sitting in the lounge until I go to bed so she is not alone. I stay up myself until 1.00 am and then I go into her bedroom, turn her over, give her a drink and then go to bed myself. I am up around 8.00 am at which time I check her again and wait for the carers who come at 9.30 to get her up out of bed, washed, etc., It is not humane to leave any person who is totally immobile alone, and I'm utterly amazed that she doesn't have bed sores through lying in one place for so long. She must be as stiff as a board when somebody finally comes to get her out of bed, and very, very frightened. You should call your equivalent of social services (I am in the UK). What would happen if there were an electrical fault in the night and her house went up in flames - doesn't bear thinking about. Also, does she have an air mattress? If so, these can malfunction - twice when I have gone in to turn my mum over I've found that the carers have knocked the on/off switch on the motor with the result that the mattress has deflated and my mum has been lying on a flat board. Had I not been in to remedy this situation she would have faced another 8.5 hours like this - not on. Please help this lady out. She obviously can't advocate for herself.
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I'm also in Washington State (up in Skagit County), and I work in the local Aging & Disability Resources Center. I help people apply for the COPES program and work side-by-side with COPES Case Managers for our county, so although I'm not an expert, I know quite a bit! :) My suggestion would be first to help your client call her COPES case manager, and let the case manager know that her hours need to be increased. Here in Washington, the number of hours are based on an in-home assessment called the CARE Tool. The COPES program can offer services in the client's home, or in an Adult Family Home or Assisted Living Facility.

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.
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In my opinion a person that has absolutely no mobility can no longer live in their own home without 24/7 care from a multitude of caregivers, regardless of their own personal desires. Her existence sounds like one of the lower circles of hell to me, alone and helpless with no one who seems to give a d%# but a hired caregiver? She needs to be in a nursing home. As MaggieMarshall advised you call Adult Protective Services, hopefully they can get something done about this.
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jestes, this doesn't sound right. Thank you for advocating for her, best you can.
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I think you are saying you care for her 24/7 a day and only get paid for 14 hrs a day who is the second nurse you should have a 14 hr shift and she then you both would be pd fully not one nurse 24/7 but 2 that would cover weekends as well
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Call Adult Protective Services and report her circumstances. That will assuredly and rightfully rattle some cages.
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