He sure isn't Dick Grayson

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Tomtech
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He sure isn't Dick Grayson

#1

Post by Tomtech » Sat Aug 15, 2015 3:33 am

And I am certainly not Bruce Wayne. But he will likely soon become my ward.
Chris.jpg
Chris is a 40 year old victim of cerebral palsy. He currently lives in a group home in Arlington Texas.

His mother's health is deteriorating and she feels that she no longer has the ability to ensure his interests are protected. She is also concerned that, in the event of her passing, other family members, who are not as reliable as I am, will attempt to gain access to his assets or use his identity for nefarious purposes.

I hope I can supervise his caregivers and ensure his interests are protected.
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Re: He sure isn't Dick Grayson

#2

Post by Foggy » Sat Aug 15, 2015 7:17 am

Good for you, TT. I do believe in good deeds.


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Re: He sure isn't Dick Grayson

#3

Post by Lani » Sat Aug 15, 2015 7:48 am

I'll pm to help you. There are resources, if Texas hasn't totally sucked them dry.


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Tomtech
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Re: He sure isn't Dick Grayson

#4

Post by Tomtech » Wed Mar 16, 2016 3:48 am

Chris is asleep in his new bedroom across the hall.

With the help of The Fogbow Shool of Crazy Law I have learned to navigate through the laws, codes , regulations, and documents involved in getting him the best care possible while still allowing him the ability to live with his family. I wish to thank all involved.

:clap: :clap: :clap:

I would also like to thank the Damned Liberals who ensured that the programs available provided the type of option which will allow this.

:clap: :clap: :clap:

I would also like to thank those who need something in the budget they can look at and say that the care for those like him is a worthy expenditure.

:clap: :clap: :clap:

Again. thank you all.

:clap: :clap: :clap: :clap: :clap:


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June bug
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Re: He sure isn't Dick Grayson

#5

Post by June bug » Wed Mar 16, 2016 3:54 am

Great news, Tomtech!

And thank you.
:clap: :clap: :clap:



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Re: He sure isn't Dick Grayson

#6

Post by Patagoniagirl » Wed Mar 16, 2016 4:14 am

I am glad. I didn't miss this thread in the fast pace that happens here on TFB. And. I am glad to know that folks like TT are around to do something like this for a young man who needs an advocate. Not an easy job. Thank you TT.



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Re: He sure isn't Dick Grayson

#7

Post by realist » Wed Mar 16, 2016 6:28 am

:thumbs: :bighug:


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Re: He sure isn't Dick Grayson

#8

Post by Tomtech » Tue Mar 29, 2016 9:02 pm

I'm two weeks into Chriscare.

Day 1- Setting up his room and getting one of his computers replaced.

Day 2- Getting a new doctor, pharmacy, and medical device supplier.

Day 3- Tackling the system. Getting an appointment with the State mandated agencies which monitor his care and control disbursement of funds.

Day 4-5- Learning the law, The Administrative Code, and locating where the forms are.

Day 6- RN visit.

Day 7- New LVN, Speech Therapist, Physical Therapist and visit from transitional Service Coordinator from the State regulatory agency's . I already had the documents he needed typed, printed out and signed.

Day 8- Social Security office visit with his mother.

Day 9- Local bank visit with his mother to set up new accounts for his funds.

Day 10- Interviewed with and hired help to relieve me. I admit that his needs are more than I can handle alone and the State, under federal grants, will pay for employees. The biggest problems with his previous setting were the rigid schedule which had him up before 6 every morning to keeps his feeding and meds on a schedule and the fact only one person provided for him most of the time with the only relief during business days which he spent in a dayhab facility. My home allows him to wake and sleep on his own initiative and we adjust our days to his needs.

Day 11- Trip to the movies. He chose to see Zoopopia.

Day 12- A day of rest. I did set up his 40" TV to replace the 21" screen he had been using and moved mother's rarely used ROKU to his room. He spends his days watching country music video's on the Youtube channel.

Day 13- Trained the help.

Day 14- Paperwork. I had to make 100 copies (two each) of the documents needed to set mother and the help as employees.

We are preparing for a meeting Friday with the Service Coordinator and a representative of the State required Financial Management Agency which handles payroll.

It's been busy but I wouldn't trade it for anything.


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Re: He sure isn't Dick Grayson

#9

Post by Lee Eel » Tue Mar 29, 2016 10:54 pm

Tomtech wrote:I'm two weeks into Chriscare.

:snippity:

Day 10- Interviewed with and hired help to relieve me. I admit that his needs are more than I can handle alone and the State, under federal grants, will pay for employees. The biggest problems with his previous setting were the rigid schedule which had him up before 6 every morning to keeps his feeding and meds on a schedule and the fact only one person provided for him most of the time with the only relief during business days which he spent in a dayhab facility. My home allows him to wake and sleep on his own initiative and we adjust our days to his needs.

:snippity:

It's been busy but I wouldn't trade it for anything.
Tomtech,
Your name may not be Bruce Wayne, but you look a heck of a lot like a genuine classy-type superhero from here! HUZZAH. :dance: :bighug:


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Re: He sure isn't Dick Grayson

#10

Post by Dolly » Tue Mar 29, 2016 11:17 pm

Tomtech wrote:I'm two weeks into Chriscare.
<snip>
It's been busy but I wouldn't trade it for anything.
Wonderful. It appears that things are coming together nicely, thanks to your dedication and work.
Chris is lucky to have such a special caretaker. And I think you are special.

:bighug: to all.


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Re: He sure isn't Dick Grayson

#11

Post by Plutodog » Wed Mar 30, 2016 12:39 am

:bighug:


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Re: He sure isn't Dick Grayson

#12

Post by Sam the Centipede » Wed Mar 30, 2016 2:03 am

Awesome Tomtech (and Team Tomtech)!!
:thumbs: :clap: :thumbs: :dance:



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Re: He sure isn't Dick Grayson

#13

Post by Volkonski » Wed Mar 30, 2016 6:22 am

Sam the Centipede wrote:Awesome Tomtech (and Team Tomtech)!!
:thumbs: :clap: :thumbs: :dance:
:yeah:

:thumbs: :thumbs: :thumbs:


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Re: He sure isn't Dick Grayson

#14

Post by Mockingbird » Wed Mar 30, 2016 6:59 am

Well done indeed!

You haven't said anything about his developmental or intelligence level. (although his choice of Zootopia indicates it might be in the childhood range).

:think:

I was just thinking that if he is able to correspond on the computer, we could set him up his own thread in the Lounge, and help him keep his mind more active by corresponding and posting "age" appropriate links and videos.



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Tomtech
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Re: He sure isn't Dick Grayson

#15

Post by Tomtech » Wed May 11, 2016 8:55 pm

I need some legal research. I wonder where I could find someone who knows where to look for these things.

We are using the Consumer Directed Services Option under Texas' Home and Community-based Services Program.

Under that option we hire help to care for Chris which is paid for by the state.

Since Chris uses a Gastronomy Tube much of our hired help's time is devoted to feeding him and administering medications. The company who manufactured the feeding tube actually recommend that feeding him a can of nutritional supplements should take 40 minutes and the viscosity of the supplement is such that it can take that long to feed him.

The form used to determine how many hours are allotted for his care each week specifies that the time needed for feeding him cannot be purchased (see page 3.

I'd love to find out why we cannot purchase the time needed for feeding him and administering his medications when that is the main part of their day. That determination must be based on a statute rule or directive and I would love to find out what options are available.



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Re: He sure isn't Dick Grayson

#16

Post by Dolly » Wed May 11, 2016 10:12 pm

Tomtech, I sent you a PM. Hope it helps narrow down your search for info. I don't have any training or knowledge about this subject.

:bighug:


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Tomtech
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Re: He sure isn't Dick Grayson

#17

Post by Tomtech » Mon May 23, 2016 1:26 am

I have a problem with the way Chris' care is allocated and I understand why those who share in administering his care have failed to allocate paid time for Chris' Service Provider, my employee, to feed and medicate Chris.
T.A.C. 40. §9.174. Certification Principles: Service Delivery.
(a) The program provider must:
(33) ensure that supported home living is provided in accordance with the individual's PDP, IPC, implementation plan, transportation plan, and with Appendix C of the HCS Program waiver application approved by CMS and found at http://www.dads.state.tx.us and includes the following elements:
(A) direct personal assistance with activities of daily living (grooming, eating, bathing, dressing, and personal hygiene);
(H) assistance with medications and the performance of tasks delegated by an RN;
Appendix C of the HCS Program waiver application does not address tube feeding and my contention is tube feeding is eating in Chris' case and should be provided for.

I don't see any underlying statute which would prevent Chris' workers from being allocated time towards feeding him. There is actually a statute which allows home care workers to feed an individual even though the worker has no nursing training.

The form for creating the Individual Plan of Care (IPC) does not allow for allocating time to feeding Chris through a gastronomy tube (see page 3).

Chris' workers should be paid for feeding him since one of his disabilities prevents him from eating and others in the program who are unable to eat can have up to 2 hours per day allocating towards eating and another 90 minutes for preparation.

This is also true for Chris medication administration. Chris need to be medicated three times a day and provided water two additional times but somehow there is no method within the form to allocate hours for those.

I don't know the next step to take. A Mandamus Petition seems a little premature. :towel:



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Re: He sure isn't Dick Grayson

#18

Post by Tomtech » Sat Jun 11, 2016 9:13 pm

They may hate me Monday morning.

I finally had time and incentive to dig through the laws and codes which apply to Chris' care. I had to dig my way through two paths. One path proves that the workers we hire are not required to have any specialized training above the training I have provided them when it comes to feeding Chris and giving him water and medication through his feeding tube.

The other path details the procedures which are required to purchase items which cost less that $500 and shows I don't need to have Chris' doctor and therapists create orders and eventually prepare a written assessment in order to purchase low cost items.

They may hate me for throwing the law back at them. One lady, who was at a meeting this past Monday, kept parroting a line that we need a "Doctor's Order" without providing any specifics as to the format of the order they would accept she also literally handed me two 12 page copies of handbooks without giving any indication that she knew what was contained therein.

The next day I had the doctor give me written prescriptions for some items which were not available from the pharmacy while also sending the pharmacy prescriptions for the items they could provide. I sent copies of the prescriptions along with the pharmacy receipts for the items prescribed via the pharmacy but the people i have to deal with declared that those did not meet their requirements and that I needed some other form of an "order" without being specific as to what form the order was required to be in.

All of the person's I have to deal with also informed me that I could not employ my workers to feed or provide medications or water for Chris because the employees were not certified health care workers (all of my employees have been certified as Nurses Aids in the past but they have allowed their licenses to expire).

Today I took the time to prepare responses.
I need to inform you that I was in error when I stated that Chapter 225 of Title 22 of the Texas Administrative Code allowed Service Providers to administer medication, hydration, and nutrition through a Gastronomy Code.

Even though RULE §225.4 defines Health Maintenance Activities as activities which may be exempt from delegation and includes the tasks of feeding and medication via a Gastronomy Tube and RULE §225.10 includes those tasks as tasks which may be delegated to unskilled workers, the entirety of RULE §225 does not apply to delivery of any service for which payment is provided under the consumer-directed service option when the persons who will delivers the service performs a service that is not expressly prohibited from delegation by the Texas Board of Nursing and the consumer who receives the service has a disability and the service would have been performed by the consumer or the consumer's legally authorized representative except for that disability and if the consumer's legally authorized representative is capable of training the person in the proper performance of the service and directs the person to deliver the service.

I apologize for my error. But need to point out that the law makes provisions wherewith the employees who care for Chris are not required to have a license nor are they required to receive any training above the training performed by Pat or myself as her delegate.

Thomas Davis DR
I need some clarification.

The adaptive aids Christopher needs include, but are not limited to, an electronic control unit, which I can obtain at a cost of $79.99 plus shipping, handling, and taxes, a pill crusher, a specialized thermometer, a hand-held shower device, multivitamin products specifically Vitamin D 1000mg and SOD Fluoride CHW 1mg F of which Christopher currently has prescriptions.

Christopher also needs Bowel Program supplies, not limited to, Fleet Enema, Magnesium Citrate, and Miralax Powder. Please advise as to what is needed to get these items. We have prescriptions for each of these items.

You state that “(a)ccording to CFC guidelines, we (D&S Community Services) need a written physician’s order for all adaptive aids”. Chapter §9.170(3) of Subchapter D of Title 40, Part 1 of the Texas Administrative Code applied to Program Provider reimbursement and states that ”If the program provider submits a claim for an adaptive aid that costs $500 or more or for a minor home modification that costs $1,000 or more, the claim must be supported by a written assessment from a licensed professional specified by DADS in the HCS Program Billing Guidelines and other documentation as required by the HCS Program Billing Guidelines”.

I do not believe any of the Adaptive Aids which have been discussed cost more than $500, either individually as purchases or as a total cost for the remainder of the IPC year. Please cite where the CFC Guidelines require a written physician’s, or other professional’s, order for Adaptive Aids which cost less than $500 and, in the alternative, why you anticipate that any of the Adaptive Aids I have requested will cost more than $500.

You stated that “(w)e (D&S) have not received all of Christopher’s information” Please specify what information you require and a plan for obtaining that information. Please specify what actions have been taken to obtain the information you require.

While I took steps to purchase the software (GRID 3) Christopher uses for communications as an augmentative communication software through Medicare his previous program provider failed to take the steps necessary for the purchase under that program and the purchase was made using Christopher’s funds held in trust by Live Life Freely. All of the other items Christopher uses for communications were purchased by his mother and loaned to Christopher for his use. Therefore there are no “adaptive aid funds that was used for electric communication devices by the former facility ‘Live Life Freely’.”

I wish to follow the guidance from Section 6000, Adaptive Aids, Minor Home Modifications and Dental Treatment for items costing less that $500. I will assist you to obtain the documentation required before purchasing the adaptive aid but reserve the right to take actions if I believe your people are not making a good faith effort to obtain items which Christopher needs.

We need to reach an agreement as to which Adaptive Aids Christopher needs. Since none of the items cost more than $500 there is no need to a written assessment or physicians order other than the prescriptions he currently has and/or which were copied in the original emails (attached).

We need to reach an agreement as per 6161(1)(b). I don’t see a form available for documenting this agreement. Unless you, or another person, determine which DADS form would be applicable to document an agreement I will prepare a draft agreement within the next few days. While there is possibility that an agreement may be difficult please keep in mind that I have a physician’s order or prescription for all the items I have requested.

With the exception of the handheld shower device, none of the items requested require Proof of Non-coverage by Medicaid and Medicare. I would like to see provisions made for potentially obtaining the hand held shower device when Christopher’s IPC is revised on May 21st unless you can assure me that item is covered by Medicaid or Medicare.


6161(1)(c) provides that the Program Provider must obtain the proof of non-coverage. Please take affirmative action to determine if a handheld shower device is covered by Medicare or Medicaid as soon as practical such that the item can be excluded or included in the agreement in time to include or preclude it from the IPC. If there is a doubt as to whether a handheld shower device can be covered through Medicare and/or Medicaid I would like to include language in Christopher’s Plan which will preclude us from revising the IPC at a later date in the event that the device will not be covered.

Has D&S services obtained DADS approval of an annual vendor? If not, I request that you advice me of your plan to meet the requirements for bids as outlined in 6160(1)(d).

Proof of ownership in not applicable for any items requested.

My review of the Medicaid State Plan has not found a requirement for documentation which justifies the medical necessity determination for any items requested as adaptive aids. If you believe otherwise please cite the section or sections of the Medicaid State Plan which contains the requirements as soon as possible so that an agreement can be reached prior to the May 21st IPC Revision Meeting.

I need the inform you that Ms. Woods and I have began the process of obtaining a new power chair for Christopher and repairs to his most recently received manual wheelchair. It is our belief that these items will be covered by Medicaid and/or Medicare and there is no need to incorporate them in his IPC or to take efforts needed to obtain these items under Chapter 6000.

Thank you
Thomas Davis DR
BTW: Chapter 6000 was one of the 12 page copies of code which was handed me without any information as to how it applies to Chris' needs and no effort was made to apply the regulations contained therein.

Those are drafts which can be changed before being sent such that they are received by the recipients Monday Morning.

Please let me know what you think.

I hate throwing laws and codes at people whose job is to know and apply them. They should be the ones with knowledge of the codes and laws which apply to their profession and should have properly advised me on the application of the laws to ensure that Chris receives everything he is entitled to.

I would hate to have had to deal with these issues prior to learning what I have learned as a member of this forum.

ETA: Can I sue someone for incompetence and failure to take steps to achieve the goals I requested them to achieve?



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Re: He sure isn't Dick Grayson

#19

Post by TollandRCR » Sat Jun 11, 2016 9:22 pm

I cannot help you draft these materials, but I do have one piece of advice: an attorney can do wonders in making bureaucrats sit up and take notice. If your perfectly rational approach does not work, then I would seek specialized legal advice (even if you yourself are a lawyer).


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Tomtech
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Re: He sure isn't Dick Grayson

#20

Post by Tomtech » Sat Jun 11, 2016 11:28 pm

TollandRCR wrote:I cannot help you draft these materials, but I do have one piece of advice: an attorney can do wonders in making bureaucrats sit up and take notice. If your perfectly rational approach does not work, then I would seek specialized legal advice (even if you yourself are a lawyer).
I wish I had one. Until all administrative efforts are exhausted I don't see where I can get Legal Aid to assist. His mother is currently burning through her inheritance and has too many assets and too high of an income to qualify for Legal Aid anyway. Of course, she doesn't have the funds to hire an attorney.

I may try and contact a large firm seeking a cause but they will likely look at his mother's assets before deciding that they cannot take the case pro bono.

I think I can get what he needs but we are going to use more of his mother's and our assets than we had hoped for.



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Re: He sure isn't Dick Grayson

#21

Post by Lani » Sun Jun 12, 2016 1:24 am

I don't know about your state, I'm sorry to say. In Hawaii, the income of the person with the disability is what is considered, and that includes young children. The State-Federal Protection & Advocacy agency, Legal Aid in some cases, and Civil Rights Commission can be tapped for assistance, including providing an advocate during the administrative process.


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Tomtech
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Re: He sure isn't Dick Grayson

#22

Post by Tomtech » Sun Sep 18, 2016 9:12 pm

I posted a followup to my post from last year on DailyKos.

Myself, Chris' mother, grandmother, and Aunt Liz no longer have the funds to help apply toward Chris. Chris' income is enough to keep things going indefinitely but we need to cut back on outings.

I had also promised Chris' grandmother, mother, and his Aunt Liz that I would try and recover much of the cost they put into his communications system but I have reached the point where that is no longer feasible through the programs he is on.

We have started a fundraiser on GoFundMe with the hope of repaying those who have invested in him this past year and to have funds for major outings such as concerts, ballgames, and Special Olympics.


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