The state Legislative Auditor released a report yesterday heavily criticizing the Medicaid-funded personal care assistance service (summary and full text available here). The PCA program provides assistance to people with disabilities and the elderly with the ordinary tasks of daily living: eating, bathing, dressing, etc. The report several structural problems with the program, such as workers being paid for more than 24 hours of service in a day and home care agencies providing insufficient supervision for workers.
Before I go any further, I should make a disclaimer: the views expressed here are my own and not those of the Minnesota Department of Human Services.
The report makes a few points that deserve further discussion:
- Workers being paid more than 24 hours in a day: Fraud and abuse undoubtedly occurs, but the some of these billing irregularities can be attributed to shortcomings in the Medicaid reimbursement system. Every PCA worker is required to have a unique provider number. But the backlog for issuing provider numbers is several weeks long and, in the meantime, agencies need to fill shifts for their clients. So agencies might use an existing provider number to bill for those hours until the new provider number is issued. I’m not excusing the practice, but it’s one created by external factors.
- All PCA consumers should have professional supervision of their workers: I have mixed feelings about this. I understand the need for supervision, especially in cases where the individual is particularly vulnerable. But plenty of people are capable of supervising their own workers and sending in a professional would simply be a waste of time and money.
- Some PCA workers are working more than 40 hours a week, raising questions about quality of care: Well, if you earned only $9-$11 an hour with few benefits, you might be inclined to pick up extra shifts. And I don’t sense the same collective hand-wringing about physicians and nurses working overtime in hospitals. Finally, I’m not sure that raising amorphous concerns about quality–without presenting any supporting data–is either helpful or particularly insightful.
The Legislature is sure to pass several policy fixes for the PCA program and many of them are overdue. But it’s worth remembering that the vast majority of PCA recipients are using the service to meet basic needs and, in its absence, they would be placed in institutions.
Why don’t they just put you in charge? Mark the PCA Czar does have a certain ring to it…
You should be in charge. These people don’t know what they’re talking about. The complaints in this report makes me nervous.
“Many recipients strongly value the PCA services they receive, although there has been little systematic analysis of outcomes.”
Systematic analysis of outcomes? I get to get in and out of bed every day. I have someone to drive me to work. I have all sorts of positive outcomes from using these PCA services. Some things don’t require a lot of number crunching.
I agree totally with you, Mark. I’d like to add that the overall tone seems to be that a lot of us are just too stupid to hire and direct people to help us. I’m getting more done for me now that there isn’t a professional supervisor getting in the way. Like a lot of people with disabilities, I have needs that don’t fit the norm, and it’s tiresome convincing a professional that their way isn’t necessarily the best way of doing things. I don’t need a professional to come in and decide whether or not I’m getting good care. I’m the expert on meeting my own needs.
I understand belt-tightening in these hard times, but it always seems to squeeze people who aren’t likely to make a big fuss about it. Money is wasted way more on institutions than on the PCA programs. I used to have independent living, I pay my own employees less in one year than what the state used to pay independent living for in one month. And I get better and more care now!