WWYD About This Dcg And Increasing Pay?

[E Daycare]

The preemie that I have just turned 1 two weeks ago. Ive had nothing but issues with this family (being very late dropping off and picking up, being early at drop off, no calls, late payments, dcd that has no brains, dcg chews on everything I own etc...) and now I have a new one. The dcg has very bad breathing problems. She is always snotty and I go through a box of tissues every week shes here and shes here just 4 days a week. On her 1 year doc appt her mom pushed real hard for her to get a breathing machine. I find thats great and proactive and I really hope it helps. Her doctor granted the breathing machine. So heres where it affects me. Her mother told me yesterday that the dcg will need this breathing machine every 4 hrs and that shes going to bring it and show me how to use it. That the doctor told her if I use it with her dcg then she can completely write off care. She will pay me upfront and the state will reimburse her. I was a little taken aback. For these reasons:

A) She is already very discounted through me. I needed her business so I knocked off 25$ a week to get her to bring her kid here.

B) She is now down to 4 days a week so that knocks down another 30$ a day as her family needs to "save money". So that puts me at a bind because I filled her thinking that Id at least have a 5 day a weeker. Now Im out $220 a month from these people.

Do I go back and charge her the full time rate I orginally advertised for now that the state will reinburse her and insist she goes back to full time? If so, I dont have anything like this stated in my contract as Ive never had a issue like this before and how do I go about bringing this up? This will take away from the other kids in my care as this needs to be done for 10min at a time. Her mom informed me dcg fights it so its best to do it when shes sleeping. Thats all fine and dandy but what about the other times I need to do it and its not nap time? The girl is with me 10hrs a day. So there will be at least 2 times, maybe 3 thatll Ill need to do this.

Also, because Im just certified in Child development, CPR, AED and First aid, I have not certs in any other "developmentally impaired" field though and I dont know if Im even legally allowed to give this type of treatment. I dont know if it matters on the legal standpoint anyways as it could be just like with giving medication, as long as I have parent consent. When she interviewed me she insisted that the only things the dcg was behind on was feeding (this is a complete separate issue anyways. Ill get into that one later. These people are winners let me tell you) but I kinda figured shed be slow developing in other areas and was ready to help with anything physical or mental that I could with the education I have.

What would you guys do in this predicament? My husband has had it with this family and wants me to start advertising asap to get a full timer in here willing to pay a full rate or at least be here full time. Im kinda on board with him because its been one fail after another with this family and I dont want to be used as a way for them to get something for nothing. She seemed really gung-ho that the state would pay her back so I want to be gung-ho and get my full rate too. Id love to terminate this family overall though and just be done with the headache. If I can but its been hard to get clients. So till then, what would you do?

[DCMomOf3]

Is it a nebulizer? My son needs to use his on and off, it's not hard to do, and takes about 15 minutes a session. You would just need a medication authorization I am pretty sure. I would not say no to a Neb if it were me.

I would tell her that if you choose to take the added responsibility of the treatments you will have to re-write her contract with full time/full week pay. Then tell her you will draw up new contracts for her by tomorrow.

[E Daycare]

Is it a nebulizer? My son needs to use his on and off, it's not hard to do, and takes about 15 minutes a session. You would just need a medication authorization I am pretty sure. I would not say no to a Neb if it were me.

I would tell her that if you choose to take the added responsibility of the treatments you will have to re-write her contract with full time/full week pay. Then tell her you will draw up new contracts for her by tomorrow.

Im not sure if its a nebulizer or not but Im sure it is. She was vague on that and just wanted to inform me the state would give her money back. I do like the idea about re-writing her contract. The only thing is I JUST did this and require the newly signed forms to be given to me today. Would it look crazy for me to tell her that I need to do this again?

[DCMomOf3]

i wouldn't think it would look crazy if she told you of the change after you gave her the contracts to sign.

[lvt77]

wow I wonder if she only pused for the neb. becuase she knew she could get help with daycare cost? Sounds ratehr fishy.

I have a 7mo DCB that has been put on one. I don't give meds, but mom works just down the street so she comes to do it. He has a lot of reactions with the meds and even had to call 911 once. I cried when all that happened.

I feel in my heart of hearts that the child I take care of needs someone who knows more about his condition, the parents are also a piece of work and dont tell me anything. I feel very stressed when the child is here, because of all the issues we already have had. As well as the liability issues that are imposed on me.
If you feel that you will not be able to give the child the attention the child will need to stay well, then maybe you should let the mom know this. See if she can come give the child the meds. or tell her to find someone who can give the child more time and attention...

[marniewon]

If it's a nebulizer it's super easy to do. The medicine comes all ready and all you do is dump it in, turn it on and hold it on her face. I wouldn't think you'd need more extensive training or certs to that. But....because it is taking more of your time than originally contracted for, yes, I would write a new contract (even though you just did - you didn't have this info before now) stating your full time full rate. If they don't want to pay it, they can find someone else. Have this start (the full rate) the day you start doing the treatments. If you still want this family gone, you can advertise and term them when you find someone else.

[nannyde]

I don't do discounts for four days a week. I do a minimum of three days a week and I charge 25 percent of my weekly fee per day. So if I charged 100 dollars a week it would be 25 dollars a day times four days would equal 100 dollars. If the child was here three days a week it would be 75 dollars.

My policy with nebulizers: We do not give nebulizer or breathing treatments. Please do not ask if we will do this. If your child requires treatments they can not attend the day care until their condition allows them to be in care without the need of the treatments. We also do not allow parents to give breathing treatments in our home. We will accept a child after receiving a treatment. Please let us know if you have given your child a nebulizer treatment before care.

I had a terrible time with the nebulizer treatments a few years ago. It was when they pulled all the kids cold medicine off of the shelves and stopped giving antibiotics for colds. The only thing "left" for the docs to prescribe is nebs so I ended up with a bunch of kids in my house who had them. They also give them 40-50 jets in each prescription so I had parents wanting to use them for colds months after they were originally seen.

They would be ordered every four to six hours and I would have parents coming in at eight in the morning telling me they had one at four a.m. so they needed one right away. They would all say the same thing: I couldn't give it any earlier... so he needs it now. If the kid was here nine hours I could end up doing as many as three a day per KID.

The day my staff assistant and I did TWENTY of them in one day I said ENOUGH. Because I'm a RN I had more liability with assessment and documentation then the average provider does. It was consuming so much of my time that I couldn't do it anymore. I started to charge a "medication administration fee" of twelve dollars per treatment. That stoped it cold. Eventually I morphed into a policy where I just don't do them. I had too many issues with parents not wanting to pay the fee and wanting to come here to do it so I had to put a stop to that.

The funny thing is now that I don't offer them ... I no longer have kids in my day care that "need" them during the day. I had too many issues of parents bringing sick kids in and calling it asthma or reactive airway disease. Once I put a stop to the free they keep their kids home when they have colds.

If you are going to do it CHARGE for it. Make it steep. If the child is special needs then you need to be funded for him as a special needs kid. Medication administration fee AND a daily fee for special care.

[Blackcat31]

Everything Marniewon and Nan just said.

[lvt77]

Please correct me if I am wrong...
I was told that the ADA would consider this discrimination and that you cant charge more for a child that has special needs?? Or is it that you cant tell them you won't allow them to attend? Lol I forget?

[grandmom]

I think you could be in hot water on two counts.

1. I don't really know much about the ADA - Americans with Disabilities Act - but if MY child were terminated shortly after I told my provider that a new breathing machine was required, I'd think about ADA.

2. If you raise your rates just so the state can pay for it, the state can frown on that.

Be very careful. Maybe terminate NOW vs. after the machine. Maybe start ground work for termination for some other reason. Start enforcing the late payment fee or something that you can fall back on if they challenge you when you terminate. KWIM?

I'm with you, don't get me wrong. Just be careful.

[Mrs.Ky]

Please correct me if I am wrong...
I was told that the ADA would consider this discrimination and that you cant charge more for a child that has special needs?? Or is it that you cant tell them you won't allow them to attend? Lol I forget?

You are very much correct ADA and section 504 is in place to protect children with disabilities such as mental and health. If she was to get rid of the child because the child needed extra treatment for a medical disability she could be in hot water BUT she has every right to use another reason such as parents paying late picking up late,etc. she also can not charge more because the child has a special medical need.

[Blackcat31]

http://www.childcarelaw.org/docs/ADA%20Q%20and%20A%202009%20Final%203%2009.pdf

Here is some helpful info

[Mrs.Ky]

Here is info on Section 504

http://www.hhs.gov/ocr/civilrights/resources/factsheets/504.pdf

[nannyde]

The child has very bad breathing problems and doesn't respond well to being treated with the nebulizer. She needs the one to one care of a specialist trained in respiratory therapy. A home day care setting is not the right place for a child with this level of care unless a trained staff person is available for her medical needs at all times.

The Disability Act does not force providers to provide care they are not capable of safely doing.

I'm not aware of the Department of Justice ever taking a home day care provider to court for not complying with the disability act. If anyone knows of any case PLEASE post a link. I know about CENTERS being sued under the ADA but not a single case of a Home Day Care provider.

You CAN charge for any services you provide for children who are acutely ill. You CAN charge medication administration fees for acutely ill children. The ADA does not protect children with illnesses that are normal childhood illness and are resolved over short durations. It also doesn't force providers to care for children when the provider feels she is incompetent and unable to safely care for that child.

[Abigail]

I would call your licensing and ask what you need to do in order to administer a nebulizer treatment. (I had this as a child because I was born with asthma. Also had to take it during elementary school in the nurse's office too.) If it is considered medication, does your handbook have anything about you NOT giving any forms of medications? Mine does with a parent consent and they must fill out a form. If you don't though, I would ask if you are required to give the treatment when you call.

If you just had everyone turn in a new contract today, I wouldn't want to have them sign another one. Did you raise your rates too? If you are going to term down the road, I would wait a bit as you are advertising and let others know you might have a spot opening soon. Then, term once you have documentation of one more late pickup or early drop off or late payment. You obviously have records of these from the past, if not, create them.

I wish you the best of luck. You should also ask the mom for the dr's name and number because you "have a few questions to ask him" that you will not share with the mom because.....you will call and mention you are the child's provider and want to know if they really get reimbursed for daycare costs and when or whatever other questions you may have.

Also, if you honestly feel you cannot provide the proper care this child now requires, that is okay to term with that being said and a two week notice. I read it somewhere and it is NOT discrimination. It's honesty and caring and if you're unable to provide the proper care for this child's newly aquired needs then it is best to let them know. You could even try it for a week or two and then decide.