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Southeast Alaska agencies caring for the disabled and elderly in their homes said Tuesday that proposed measures to prevent fraud also make it difficult to provide adequate care.
After costs soared from $8 million to $80 million since 2000, the state proposed new rules to monitor personal care assistants.
The number of beneficiaries has steadily increased, from 1,300 in 2001 to 3,800 this year, after the state allowed people to hire friends and relatives as caregivers.
Through an audit, the Alaska Department of Health and Social Services discovered not all caretakers were certified; some homes had more than one assistant. The audit also showed it was not clear whether some recipients were eligible for care.
Personal care assistants are paid $21 an hour to do chores such as bathing, cooking and cleaning. For agencies specializing in in-home care, a portion of the $21 reimbursement pays company overhead, and starting wages for personal care assistants in Alaska average $12 to $14.50 an hour, according to Connie Sipe, executive director of the Center for Community. The money comes from Medicaid, with the federal government contributing 60 percent and the state paying the rest.
Some of the proposed rules limit the time for a chore. For instance, the first draft of the regulations says the state will not pay an assistant for giving a bath longer than 15 minutes.
"It's a more efficient way to gather data," said Odette Jamieson, program manager and administrator for the Personal Care Assistance program.
The regulations require extensive paperwork and documentation on what is being billed. Barbara Knapp, with the Division of Seniors and Disability Services, said the state has not kept detailed records on the patients or the assistants.
But cases are more complicated and time-consuming than what the proposed regulations allow, Connie Sipe of the private agency Center for Community said Tuesday at a workshop in Juneau about the regulations.
Sipe wondered how an assistant can shop at a market if only 30 minutes is allowed for the whole trip.
"It's not practical. It's impossible," Sipe said, adding that labor laws require an employee to be paid for all work.
Barbare Lewis of the Alaska Native Sisterhood Grand Camp in Haines said it's impossible to do laundry in 30 minutes.
"My main concern is that we don't reduce services that are needed," Lewis said.
Private caregiver agencies also were concerned the regulations would not be practical in rural villages, where a bath may require extra time to scoop water from a well, haul it to the cabin and heat it.
Some cases would be reviewed on an individual basis, said Jon Sherwood of the department's office of program review.
Proof of a care recipient's physical condition also will be required. Individuals interested in caring for their friends or relatives must have completed related training and have proper certification.
Caregivers will not be paid for stand-by assistance for emergencies unless approved.
Jamieson said the new measures should help reduce the program's cost.
The department is still accepting comments on the draft regulations through Aug. 15. Oral and written statements may be submitted at a Juneau hearing on Aug. 9. By law, the department must consider suggestions from the public and then compose a final draft.
To review the proposed changes, visit hss.state.ak.us/publicnotice/regulations.cfm.
Andrew Petty can be reached at firstname.lastname@example.org