A change in state regulations that went into effect Oct. 1 loosened requirements regarding personal care assistance, resulting in more choices for those who need aides in the home.
Graham Smith, owner of Priority Home Healthcare, is one of the first Juneau companies responding to the new regulations. The public typically thinks "senior services" when thinking about personal care assistance, Smith said. However, his five employees take care of people from early middle age through the elderly.
The new regulations enabled Smith to provide a client, Nancy Andison, 38, bedridden with primary progressive multiple sclerosis, with care tailored to her particular needs.
"She is getting 56 hours of PCA services a week," Smith said. "She was receiving only a fragment of that (before Oct. 1). She is delighted."
Andison has been struggling to live independently since 1989. She cannot brush her teeth or take a shower unaided, and her husband injured his back helping her. Now, CPAs Hector Mojica and Tom Lee assist her with hygiene, exercise, eating and dressing.
"They call it 'activities of daily living,' " Andison said. "That's everything from taking notes from a phone message to making me special health-food chocolate chip cookies for breakfast. That's been one of the big benefits because they focus on my having a good life rather than just keeping me alive."
Mojica and Lee help Andison get exercise in a passive stander. Although she can't walk, standing helps boost circulation, maintain bone density and prevent bed sores.
"Tom had no experience, but he's is one of the best caretakers I've ever had," Andison said, noting compassion and willingness can make up for training.
"One of the big advantages of this program is that you can be friends with the people who help you," she added. "And several people have told my husband how much happier I am. They can see the difference."
The new program is called CD/PCA for consumer-directed personal care assistance.
"Clients are now able to choose the PCA, the hours the PCA will work, the tasks the PCA will perform," Smith of Priority Home Healthcare said. "The client is now basically the employer, rather than being the recipient of agency-based services. You get to choose someone you like and that same person will come each time."
Under the new rules, a PCA can be a family member, Smith noted. Older regulations did not allow grown children to be paid to take care of their parents.
"With agency-based services, the PCA was restricted by policy," Smith said. "They couldn't take the client in their vehicles. Now you can take the client to the doctor's office, shopping, or to the swimming pool for exercise."
Previously, PCAs had to know cardiopulmonary resuscitation and be a certified nursing assistant. Now the only requirement is age, 18.
Smith, who describes himself as a "recovering accountant," uses his organizational and bookkeeping skills to keep his service cost-effective. Clients interview, hire, train, schedule, supervise and fire their PCAs. When they remit the PCA's time card to Smith, he manages payroll, paying between $12 and $14 an hour.
Priority Home Healthcare begins by meeting with a client to assess needs and make sure he or she is eligible for Alaska Medicaid. Smith then estimates the number of hours of assistance needed. Next, Priority provides training materials and assists in screening and hiring the PCA. The company also pays payroll taxes and related workers' compensation insurance, freeing the client of most paperwork.
Founded in 1997, Priority Home Healthcare has more than 100 clients around Southeast.
"It's rather satisfying to know that it's a meaningful service," said Smith, who also is a dealer for specialized wheelchairs and other appliances that help the disabled.
Only four states provide a CD/PCA program. The Alaska program is patterned after one in Montana. Offering a decent wage helps make the program a success, Smith said. He starts aides out at $12 an hour. In Washington state, they begin at $6.73/hour.
Ken Dean, the PCA coordinator for Juneau-based nonprofit group Southeast Alaska Independent Living, said he's enthused about Smith's business.
"We want to educate the consumer and the providers that these programs work," Dean said.
SAIL serves more than 300 people in Juneau, Sitka and Ketchikan. Many, like Andison, need home assistance.
"The main thing that the changes (in regulations) do is give control over the PCA to the person with the disability rather than an agency," Dean said. "I know lots of horror stories where people were left sitting in their wheelchairs for over a week. Some of us thought it was senseless the way it was arranged, and we have been active in bringing about this change."
"There won't be any more of this 'We have used your hours; we can't serve you for the rest of the month.' Before Oct. 1, the person with the disability had no control. He was at the mercy of whoever was sent," added Dean, who himself uses a wheelchair.
Susan Cook of Anchorage, who works in senior services for the state division of Medical Assistance, said there are several statewide providers for the CD/PCA program: Access Alaska, Center for the Community and Consumer Direct Services.
For details about the regulation, go to the senior services Web site at www.state.ak.us. Find the Department of Health and Social Services. Then click on "senior services," then "personal care." For the project Web site, look at pca.infoinsights.com.
Ann Chandonnet can be reached at firstname.lastname@example.org.