Tuesday, January 10, 2006

Good Help Is Hard to Come By

Today I had to restart my search to hire a personal care assistant. I had a candidate for the job and had offered him the job, and today I learn he is accepting a new job. So, after an exhaustive search that started around December 20th, I have to start over now on January 9th. I have one week to find potential candidates, interview them, check their references, organize our schedules, train them, and hope they do not find something else better first. By the way, if you live in Kansas City and are interested, send me an e-mail at jason@ibelievedesign.com.

For those who do not know what a Personal Care Assistant (PCA) is - A PCA is someone who helps a person with a disability with the tasks that they can not do for themselves. Since I have Muscular Dystrophy and use a power wheelchair I need help with many tasks. Some of the tasks my PCA would do - clean, cook, take/place stuff on shelves, assist me in organizing, vacuum, transfer me on/off the toilet, drive me to school, drive me to do errands, and much more. A great candidate would even be able to be my hands on fixing my computer when the hardware has problems, but unfortunately it can be hard enough just to find someone to cover the basics.

Why is it so hard? Because in a job rich environment such as Johnson County Kansas is, it is hard to pay $8.00 an hour to have someone work non-traditional hours doing a non-traditional job. You don't need any experience to do this job, but apparently you do need to have nothing better to do. Medicaid sets the reimbursement rates for personal assistance in Kansas (and most states that are lucky enough to have a community based WAIVER (we'll talk about waivers another time)) and they don't set it very hard. I actually could start my PCAs at a slightly higher $8.50 but then I would have no way of rewarding them for good work. So I start them at $8.00 so I can give them a raise, since I can't on Medicaid to do so. As a matter of fact, I have seen the reimbursement rate go backwards instead of forward. Besides choosing whether to start my PCAs at $8.00 versus $8.25 or $8.50, I do not have much flexibility in paying my PCAs.

Why is a PCA necessary? So I can live independently in the community. So I can continue my studies at Rockhurst. So I can graduate and get a job and pay taxes. PCAs are the vital tool that help many people with disabilities take control of their lives and contribute to society. In my case, if I don't have PCAs I am stuck, and would end up in a nursing home - a very bleak outlook for a twenty-five year old with great aspirations.

The intent of this post is not solely to gripe about Medicaid or the "system" but to educate. Money that goes towards helping people live independently in their own homes and communities is an example of social tax dollars put to good use. On average hiring help at home is cheaper than nursing home care, and it preserves the dignity of the person needing help, while also allowing them true freedom. Also, is the benefit of the PCAs who are hired to do the job and the money they give back to the community and the government; it is a domino effect. Unfortunately, the system needs some work, and even I admit it could be run better.

How can we help cut down Medicaid costs and make sure individuals keep their dignity and have true freedom and independence? Many ideas can go a long way, but I'll throw one out today. Give beneficiaries more freedom in hiring their care. Once you've met the requirements that you have a disability and need assistance, you should be able to spend the dollars as needed. Furthermore if the "reimbursement" came straight to me, instead of through the "payroll" agent, I could have more flexibility in how much I pay my PCAs and what hours they work. The more rules and bureaucracy that stands between the individual needing help and the tax dollars, the more the waste, and the less efficient the system. Let's start giving the money to the people who need it, and give them the freedom (with minimal restrictions) to use it in the way that best fits their needs. We can achieve maximum efficiency in Medicaid by not blanketing everyone with rigid one-size fits all stereotypes, and instead transforming to a more elastic all sizes fit every single one (who needs it) approach.

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