New York State’s Consumer Directed Personal Care Program (CDPAP), allows a patient to select, hire and train a home attendant, who can even be a family member.
(as seen in the Community News Group Eldercare Section, October 3-9, 2014)
Caring for an aging loved one can be one of the hardest tasks imaginable. It takes a lot of time and commitment to insure a loved one gets the care she needs. Wouldn’t it be nice if you could get paid to do it? As it turns out sometimes you can.
New York State runs a statewide Medicaid program called the Consumer Directed Personal Assistance Program or CDPAPthat permits the patient or her family to hire and train a person to provide the required care. The program allows patients with chronic disabling conditions to take charge of their own care and select their own caregiver. This person can be a family member and that family member can get paid for their help.
The Consumer Directed Personal Care Program allows the patient or the family representative to select, train, oversee, and if necessary dismiss an attendant. Even better, the hired attendant does not need to have previous training in medicine or nursing. He can be a friend, a neighbor or even a family member. The only family member not permitted to participate in the program is a spouse or parent.
Once an attendant is hired she can perform all the tasks usually assigned to a home health aide. This includes assisting the patient with such activities as bathing, eating, dressing, and toileting. Even better, the hired caregiver is not limited to home attendant tasks. CDPAP allows the caregiver to perform tasks that nurses usually perform. Some of these tasks include administering medication, cleaning wounds, suctioning tracheostomies, giving insulin injections and administering oxygen to a patient on a ventilator.
CDPAP offers advantages for the hired caregiver as well as the patient. The caregiver does not work for an agency; she is considered an independent consultant and is paid through a “fiscal intermediary,” an entity that is contracted to provide services authorized by that county or managed care plan. The state pays her wages and even offers her such benefits as health care and paid time off.
CDPAP was originally designed to allow chronically ill or physically disabled individuals including the elderly, to oversee their own care. Before CDPAP many mentally astute individuals who happen to be disabled were forced to live in confined facilities like nursing homes. Now these individuals are able to proceed with their lives in the comfort of their homes.
The program was conceived in 1973 by four individuals with disabilities who desired to take charge of their own care. The original plan, which was called Concepts in Care, grew and in the 1980’s, won a contract with New York’s Human Resources Administration (HRA). Finally in 1995, the program was accepted statewide and became available to all New York disabled and elderly residents.
There are basic requirements that a patient must meet to participate in the consumer directed program. The patient must be a New York state resident, must qualify for Medicaid, must be elderly or disabled and must require assistance with basic activities of daily living or need skilled care. Other prerequisites require the patient to be medically stable and be capable of overseeing his own care. If the patient cannot direct the care, a designated representative, such as a family member can assume the role.
To start the application process, the patient’s doctor must complete a Physician’s Order for Services and send it to the local social service department. Once the application is reviewed, a nurse will visit the home and determine whether the recipient is an appropriate candidate for the program.
Most of these factors make the CDPAP a beneficial program for chronically infirmed individuals. However there are two major downsides to the program. The first is that the patient cannot self-determine the number of hours she desires. The visiting nurse determines the number of hours when she makes the home visit. If the family and the nurse disagree on hours, however, the family can appeal the decision and request a Fair Hearing by New York State’s Office of Temporary Assistance (OTDA). Upon review the OTDA can revise the hours.
The second downside is the pay. This is a Medicaid program; this means the hired attendant does not earn significant money. Medicaid home attendants often earn little more than minimum wage; so if you take on this role, don’t expect to make a lot of money. This is still very much an act of love.
However, in a situation where a family member is already providing care for an infirmed loved one, the little bit extra often make a hard job, a little easier.