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How have cuts impacted you/your family/clients?

 
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sweetgypsyrosie



Joined: 26 Oct 2005
Posts: 2

PostPosted: Thu Oct 27, 2005 3:42 pm    Post subject: How have cuts impacted you/your family/clients? Reply with quote

I'm having trouble buying the state's song and dance that the new way of doing business in Indiana is having a minimal impact on families. This question is being posed to encourage everyone to be graphic in detailing what the impact will be on people's services, thus, their lives. It's very important that we, real people, get our stories out there so there's more on record than the sugar-coated message from the state's messengers.

Cuts in the daily rate at my loved one's house will be nearly 40%. It appears that the provider will find it necessary to cut the number of hours being served. This means that one of the parents will have to quit a good-paying job to provide services that were previously covered under the waiver. This means that the person with disabilities will not be able to continue with their participation in community activities at the same level because of hours being cut. The person with disabilities' search for a job and employment will be jeopardized because of lack of hours. The health and safety demands are great and will absolutely have to be seen to, in spite of the cut in daily rate (translating to a cut in hours). What happens to the quality of life?

Transportation always has been an issue and will continue to be as no one is addressing specifically the guidelines for providers to reimburse families when the family has to provide transportation because the providers can't for a number of reasons.

There is a question of how involved the case manager will continue to be due to the state's short-sighted view of the case manager's importance on the support team, thus cutting their reimbursement. This could dramatically impact the quality of services people with disabilities receive.

Who will the providers be accountable to? Themselves apparently!

Please join me in expressing what you forsee as issues for you/your family/those you serve after November 1.
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sanga61



Joined: 22 Oct 2005
Posts: 13

PostPosted: Fri Oct 28, 2005 6:03 am    Post subject: Graphics Reply with quote

I agree, Gypsy. I think the details are very important. Maybe a new forum could be started for stories. People could tell in very specific details how they or their family member will be impacted by the cuts.
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hoosiermama



Joined: 24 Oct 2005
Posts: 8

PostPosted: Fri Oct 28, 2005 12:47 pm    Post subject: Reply with quote

I have two stories so far.

#1 Individual with autism was told by their res provider that they would only provide X amount of 1:1 services period. This individual, a very private person who can only take just so much chaos, will now be required to hang out with other clients in the agency who knows how many days per week (on top of a 40 hour a week day program) in order for the provider not to lose any money. So much for his private life and his alone time I can only imagine the imact this is going to have on this individual in the long run.

#2 Roomates. Both of whom have their own lives and interests are set to lose ALL of their 1:1 time. If one wants to go somewhere they going to have to take the other roommate with them. I would guess their is going to be plenty of behavioral issues with people who are required to go places where they don't want to go.

Don't let the state fool you. Services were cut and you will notice a difference. The residential providers aren't going to lose thousands of dollars a year and keep the same service level. They just aren't and can't.

I can't blame the res-providers, they have to watch their bottom line otherwise they will have to close their doors. The state, however, should not have told the familes that this was just a simple little paperwork change. Families were told that services would not be cut and res-providers were told that they could cut services. Makes for interesting meetings.
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Shallandersen



Joined: 24 Oct 2005
Posts: 5
Location: Ft Wayne

PostPosted: Tue Nov 01, 2005 9:41 pm    Post subject: the rate cuts Reply with quote

I agree that this a song and dance from The powers that be. There are agencies laying off staff. ( that is what the powers wanted!) but any agency can only cut administratively so far. Someone has to run and agency and pay employees and provide quality assurance and training and pay bills and assure agency compliance with everyones governmental standards. The next place to start cutting is hands on care staff. ( who, by the way are (were) taxpaying Hoosiers until they got laid off) or the agency can cut wages, again of fellow taxpaying Hoosiers. And how long do you think those caregivers can afford to stick around when they have bills to pay themselves. Now we are down to the family stories of what big cuts can do to a family.
Equal cuts from the Notice of Action makes some good sense but when the powers cut from what was used over the last year they failed to realize the conditions under which hours were not fully utilized. hospitalizations, vacations, billing not done on a routine time period, lack of available staff to fill the allotted hours, the cuts were made on the wrong measurment. And here we are back to the stories about what big cuts from used hours last year can do to a family today. All families, those with family members with disabilities and those who have just lost their job.
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Provider1



Joined: 31 Oct 2005
Posts: 17

PostPosted: Wed Nov 02, 2005 10:00 am    Post subject: Reply with quote

By the same token I know that there is also a lot of, shall we say pork for lack of a better term. I know that case managers and families artificially raised what they could get in plans of care so that when cuts were made there was still enough hours...I know that there are consumers getting full staffing up to ten or twelve hours per day while the consumer's mother...who is fully capable of providing some care is in the house this entire time. 300 plus hours per month for someone who lives with her mother. Now she is complaining because the daily rate only supports 180 hours per month. This is what she used in the last year...She will be fine. However all she see's is that she lost 120 of her hours per month...She really didn't...She is getting what she utilized. I'll agree that this system doesn't seem to be much simpler, however it is something that must be done or the system will not be able to exist much longer.
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sweetgypsyrosie



Joined: 26 Oct 2005
Posts: 2

PostPosted: Wed Nov 02, 2005 2:29 pm    Post subject: Impact on families Reply with quote

In the example above, Provider 1 seems dismayed that the consumer's mother is in the house and is fully capable of providing some care. It appears to me she is providing much care.If the consumer only received 300 hours/mo, the family still is providing the remaining 420 hours of care in a 30-day month. It saddens me to read that someone, expecially a provider, would pass an opinion on whether a family will be fine or not. Apparently, you are in homes and should know the demands of 24-hour care. Even parents absolutely have to take care of day-to-day things in spite of the extra demands of 24-hour care on their time. The direct impact will be seen only after the damage is done. There are any number of reasons family members are in the house and care is still needed for a person with a disability. Years of 24-hour care takes its toll on family members. The waivers were put in place to allow PWD to live at home. If family members become unable to care for their loved ones because of adequate services being taken away, then the state of Indiana will really have to spend the big dollars when the state is forced to take full-time care of PWD.
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Provider1



Joined: 31 Oct 2005
Posts: 17

PostPosted: Fri Nov 04, 2005 10:57 am    Post subject: Re: Impact on families Reply with quote

sweetgypsyrosie wrote:
In the example above, Provider 1 seems dismayed that the consumer's mother is in the house and is fully capable of providing some care. It appears to me she is providing much care.If the consumer only received 300 hours/mo, the family still is providing the remaining 420 hours of care in a 30-day month. It saddens me to read that someone, expecially a provider, would pass an opinion on whether a family will be fine or not. Apparently, you are in homes and should know the demands of 24-hour care. Even parents absolutely have to take care of day-to-day things in spite of the extra demands of 24-hour care on their time. The direct impact will be seen only after the damage is done. There are any number of reasons family members are in the house and care is still needed for a person with a disability. Years of 24-hour care takes its toll on family members. The waivers were put in place to allow PWD to live at home. If family members become unable to care for their loved ones because of adequate services being taken away, then the state of Indiana will really have to spend the big dollars when the state is forced to take full-time care of PWD.


Your opinion of me as a provider is way off. This situatioin that I refer to is a situation where the parent really does no care at all. My staff is with the consumer from the time the person gets up until the time the person goes to bed. THe rest of the time that the mother is caring for the individual is when the consumer is in bed asleep. We provide 9 to 10 hours per day. That leaves 14 to 15 hours per day for the parent to care for the individual. Most of which the individual is asleep. What is really sad about this situation is the parent does not work. Even more sad is the fact that there are plenty of people who need 24 hour care and supervision who have had their hours cut...Because the state chose to cut those persons in 24 hour supported living sites first. Now I have people being forced into 3 and 4 person settings while someone living at home gets complete staff support for almost the entire time the person is awake, and I have people who are struggling to have enoughstaffing hours in a day to get by in a 24 hour supported Living situation. I am not bad mouthing families...I was making a point that the system has allowed for many to take advantage of the system the way it was set up. And take advantage some people did!!! Now we are all paying the piper!!!

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shonna42



Joined: 16 Nov 2005
Posts: 4
Location: Winslow, IN

PostPosted: Wed Nov 16, 2005 4:35 pm    Post subject: Reply with quote

Okay, in defense to Provider1 here I have to say that their example of services is due to POOR Case Management! If in fact the Case Manager has been doing their job, home visits and such, then the need for services should have been much lower!

Now I serve several children on the DD Waiver, and I am finding that these families are not even getting the 20 hours I built into the plan a year ago! They are lucky if they are getting 5 hours weekly!

My independent clients (Supported Living) are being done the same way! It is a sad situation here, and what makes it even sadder is that the Case Manager now has no "power" to enforce the hours that were once given!

The providers are only accountable for the what ISP hours specify! Which is a crock, because you can't even put hours in the dang thing! According to the State as long as the goals are being worked on, the provider is covered!!!!

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McNone



Joined: 23 Nov 2005
Posts: 2

PostPosted: Fri Feb 24, 2006 3:33 pm    Post subject: Our biggest Cut! Reply with quote

As a small provider, our biggest cut went to an individual who lived at home and recieved HMK and ATTC. His cut totaled over $ 30,000 for the year.
We made an honest attempt to work with the family to make a team decision as to what our options were. The whole "doubling up option" is lost when it's an individual who lives in the family home, who wants a perfect stranger coming into your home to take care of 2 consumers at once? Community doubling up is not an option, with a profound consumer in a wheelchair?
When BDDS was contacted for help in this issue, their reply was that "doubling up with 2 consumers to 1 staff was never an option for supported living consumers". Period. No further discussion, and certainly no other suggestions.
Providers certainly can't provide 30,000 dollars of services without being paid. Is anyone else still struggling with this mess?
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kirksmom



Joined: 02 Nov 2005
Posts: 4

PostPosted: Sat Feb 25, 2006 11:38 pm    Post subject: Reply with quote

My son was given a daily rate of 48.99 and by my calculations should have been around 75-80 dollars. In Aug. '05 we switched to a new provider of RHS services and when the state looked at the billing history from the time designated the previous provider was billing at respite rates and also failed to bill for several months. Now the current provider is being told to provide the same services for a much lower rate. They have done just that, but I know are only breaking even. This is not fair to them and gives no flexibility for us.

I was told by BDDS waiver specialists that since this was not a health and safety issue nothing could be done. I have written letters to the Mitch Dainels, Dave Gootee, John Dickerson, my legislators and others. No replies from any with solutions on what to do. I have contacted Indiana Protection and Advocacy and they say I have a legitimate argument and something should be changed. I filed for a hearing with Indiana Hearing and Appeals. The word from them is that it could be 3-6 months before I get a hearing date. I've also contacted CMS to let them know what is going on.

I understand the whole deal with cost containment and that cuts would be made. Ours is not a health and safety issue, it is matter of right and wrong. I guess the governor and all those answering to him are not concerned about doing what is right as long as we can balance the budget in record time. But at who's expense? Who will be the ones hurt in the long run?
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