Need more Hours.
Dear Need more Hours,
There are roughly five basic approaches I would suggest you use. You can
do them in order or all at the same time:
1. Learn and know the rules, requirements, benefits and limitations of your
state's program. These should be available upon request to the state agency
that governs the program - usually the state Medicaid agency, but it could
be called the Dept. on Aging, Dept. on Aging and Disability, Dept.of Social
Services, Dept.of Human Services, Welfare, etc. The address and other contact
information should be on the official paperwork provided to you when you were
determined eligible and on the copy of service plan provided to you and which
you signed. Information and knowledge is power. You should also be able to
get this information from your "case worker" or "counselor".
If you cannot find your agency, the Center for PAS website has contact
information for agencies related to PAS by state.
2. Contact your case worker or counselor and request another assessment.
In your request, state that the services you receive are not adequate to protect
your health, safety and welfare. Almost every program is required under federal
and/or state law to protect health, safety, and welfare so it could be very
important that you use this kind of wording. If possible, ask for help from
an advocate like a friendly attorney, an advocate from a CIL, your state's
protection and advocacy services, AAA,or other similar person/organization.
Note: The reason I recommend the knowledge phase first is because some programs
have rules which state if the services available cannot protect the health
and safety of the recipient, then the recipient is NOT eligible for the program.
This doesn't necessarily mean that you shouldn't advocate for more services,
but you should know all the possible consequences of advocating for more service.
You can find contact
information for CILs on the Center for PAS website.
3. Federally funded programs and most state funded programs require that
there be an appeal / grievance mechanism for every program. Again, based on
the information from (1), above, follow the appeal procedure outlined in the
rules and file a formal appeal / grievance against not being afforded sufficient
services. Get help from an advocate if possible or needed as indicated in
(2), above. When describing the situation and reason for your appeal try to
use objective (don't curse, swear, or name-call, no matter how angry you are)
reasons based on health and safety factors. Even though critically important
in my opinion, issues around having fun, socializing, dating / personal relationships
and so on, often do not count and bear no weight in the official decisions
around how much service a person gets. Also, make the case that you CANNOT
get by, get help from friends, etc. if these "informal supports"
are not really or sufficiently available.
4. Many programs have "caps", or limitations as to how much service
any one person can get. These "caps" are usually very difficult
to get around. Again, this is information you need to fund out per (1), above.
However,even if there is a "cap", you could still try to file a
lawsuit or complaint under the ADA/Olmstead decision that you have a right
to services if the only alternative is a nursing facility or other institution.
You should get help from your state protection and advocacy services or other
knowledgeable attorney if you possible can with filing a lawsuit or complaint.
Otherwise, get help from a CIL or AAA if they have the skills to help. You
can also file a formal complaint under the ADA/Olmstead with your regional
CMS Office of Civil Rights using the same rationale and argument outlined,
above.
5. Finally, don't forget political and "people" power. I have
known people to have success by writing to their state Senator or Representative
describing the problem and asking for their help. Also, you can get friends,
family, local advocates, etc.to work with you to write letters to the editor,
editorials, set up media events and so on to plead your case.
Best regards,
Mike
