WWYD About This Dcg And Increasing Pay?

[momofboys]

Sure they are easy if nothing goes wrong. It's the day something goes wrong when it's not so easy after all.

Medication given by inhalation are VERY serious medications. The provider needs to understand the medication, the importance of properly adminstering them as ordered, the knowledge of when to administer the medication if there is a window of time and an "as needed" decision, AND the very serious side effects of each medication.

I don't feel comfortable doing them in my setting. If a provider feels they are easy peasy and doesn't have a lick of problems with them then the kids who need them need to go to that provider. That's not me I don't have the luxury of not knowing the seriousness of these medications.

I am fine with doing them for MY child who sometimes requires them . . for a daycare child I probably would not. In my thought if the child requires thAt much attention I really don't get paid enough to be dealing with it. I wouldn't. . . I was just trying to say that they were not difficult

[momofboys]

There's so much misunderstanding about the care of children with disabilities.

The child care provider HAS to be paid for the care of the child. She HAS to have a client base that can support the care of a special needs child or additional govermental/grant funding accessable. She doesn't have to work for free because the child is disabled.

The support for the care of a special needs child can include personal one to one time above and beyond "regular" care, the INSURANCE to cover the providers "treatment" of the child, the physical alterations to accomodate the child etc.

When you have a very small client base... two/three/four/six/eight clients you have to have enough income from each of the clients to support the care of the special needs child. It takes very little to consume such a small business.

In order to decide whether or not your business can sustain the cost of care for the child you have to be knowledgeable about each aspect of care and the hard cost of providing that care.

If the provider is questioned regarding her inability or unwillingness to care for a child who she is refusing care then she needs to be able to back up the actual cost, her attempts to access funding within her client base and any community funds available, and the affect it will have on her business to provide that care.

Because I'm a RN, I have had many many requests to provide care for special needs kids. Because of this life experience I have been very fastidious about documenting the hard cost of providing any care to children beyond the "average" care over the five years of care I usually provide per child. If I am certain that the care of a child would overwhelm my business and my client base is unable to support the hard costs of the additional care the child needs then I will decline to care for the child.

I'm perfectly aware that I may be challenged one day and I would be willing to undergo whatever govermental involvement is necessary to prove that I can not do what I say I can not do. I will not be bullied.

I will be happy to take a child with special needs and go through the process of documenting the cost of that child's care and evaluating whether or not the cost of the care is feasable. With such a small client base it really doesn't take very much at all to prove the costs of additional one to one care, insurance for any medical care, etc. will consume a business very quickly. Even the cost of two/three dollars per day per client could wreck a small business like a home child care. With a small client base there really isn't much of a window of fee increases that would devestate the business in pretty short order.

Providers should understand THEIR rights to operate, be finacially viable, and provide services they are comfortable with.

Very interesting! So in essence if you only have a client or two you certainly wouldn't be able to "spread the cost around" b/c your client base is not large enough to be able to support having a special needs client. Is that what you are trying to say that in essence your other clients make up for the extra effort/are able to indirectly support you hiring extra staff etc to accomodate a special needs child? Does the state pay extra for special needs b/c certainly the provider shouldn't have to take a loss b/c she has to employ another person to assist.

[momofboys]

I dont know much about them and have never worked with them at all. The dcm has already informed me dcg does not like them and she has to hold her down to do them and wait for dcg to fall asleep to do a session properly. So Im kinda iffy about it from that standpoint too. I dont want to have to hold down a baby to give meds for a period of time, especially when I have active toddlers running around. If she needs a dose every 4 hrs and shes here 10hrs a day (typical if not more of this child) then I will have to "wrestle" with her at least 2 times a day (well, maybe "wrestle" with her once a day if shes napping for the other dose).

I dont know all the details on it really as shes supposed to be on these treatments since last Friday but the mom hasnt brought in the machine to show me so Im also wondering if its really a big concern to her or if its a matter of the state paying her back as well. I know this, I wont write off on anything I dont do.

Homey dont play that.

How old is this child again. . . really that is not the best way to control asthma. My son takes an oral drug & they also have inhalers that have a special mouthpiece & they use the exact same meds that are used in the nebulizer machine but it only takes 10 seconds to administer as opposed to 10-15 min. Maybe she is too young for this. . . I just re-read & see that she is 1.

[cillybean83]

my son is 13 months old, he was a preemie and he has asthma, he uses an inhalor, he takes liquid steroids (at times) and he uses a nebbie...it isn't hard to do, but if she doesn't feel comfortable she shouldn't have to do it!

My kids kicks and fights and HATES his treatments, but I do them because he's MY kid...I honestly wouldn't want to do them for someone elses kid! Mom needs to come give him the treatments.

[E Daycare]

You guys are such a great wealth of information! Thank you all so much for your input!

As of today, the 5th day of this treatment, the dcm has yet to consult me on the machine nor tell me if/when I should start this. Im going to inform her today (if I see her, grandma has been dropping her off and yesterdays pickup resulted in my DH taking the dcg to the car cause of our icy driveway so I didnt get to speak to the mom) that if still needs me to do this Ill need a doctors note with exact specifications of dosages and times as well as the doctors information. I will hand her an addendum to my contract with medication dosage fees (per dose) and tell her this will be a trial. If dcg fights this and it becomes too time consuming I will tell her she or someone else will have to come and administer the doses.

Since she doesnt seem too eager to get rolling with this Im not too eager to push the issue.

[dEHmom]

It sounds like you've gotten a lot of great advice, and have a solution in toe.

I think there is nothing wrong with you raising the rates to the regular rates. You did her a favor in the beginning, she has not respected all of your policies during the time you've had this dcg. So you have every right to adjust the rate accordingly. Maybe I'm wrong, but I think it's no different then when you get a lower interest rate on a credit card, you are late on a payment 3 times and your interest rate goes up. Tell her she needs to take the full time spot at the full time rate, or you are going to need to fill the spot.

It's not a matter of you charging her more because of special needs. If she fought you on this, you have proof everyone else is paying the regular rate, so she's not getting charged more per say.

As for caring for the child, I know kids like to take advantage of times when they know no one can do anything about anything. When my kids know I'm in the bathroom, thats when they head for the treats. That's when they throw, hit, punch, bite, or whatever. They wait for the moments you are distracted or unavailable. So if you are having to take 1/4 of an hour or more (considering you'll have to prep, then administer) 2-3 times a day, you are now leaving the other children unattended to a degree for approx 1 hour a day, or 5 hours a week. I think if you are not comfortable or able to provide this treatment, you should not be forced to.

My "red flag" on this topic is, if the child is on day 5 of treatments, and it is so necessary to have this machine for the well being of this child, why have you not had to use it yet? By the mom's eagerness for this machine, I agree with previous posters that she is just looking for the funding from the government. I bet she gets a new wardrobe, laptop,camera or something in the next month. Sounds to me like she just pushed the subject. I don't know anything about nebs but I would assume this child is not severe enough to need multiple treatments a day, so the mom is probably just going to get you to administer so that she can claim it?

[Mrs.Ky]

There's so much misunderstanding about the care of children with disabilities.

The child care provider HAS to be paid for the care of the child. She HAS to have a client base that can support the care of a special needs child or additional govermental/grant funding accessable. She doesn't have to work for free because the child is disabled.

The support for the care of a special needs child can include personal one to one time above and beyond "regular" care, the INSURANCE to cover the providers "treatment" of the child, the physical alterations to accomodate the child etc.

When you have a very small client base... two/three/four/six/eight clients you have to have enough income from each of the clients to support the care of the special needs child. It takes very little to consume such a small business.

In order to decide whether or not your business can sustain the cost of care for the child you have to be knowledgeable about each aspect of care and the hard cost of providing that care.

If the provider is questioned regarding her inability or unwillingness to care for a child who she is refusing care then she needs to be able to back up the actual cost, her attempts to access funding within her client base and any community funds available, and the affect it will have on her business to provide that care.

Because I'm a RN, I have had many many requests to provide care for special needs kids. Because of this life experience I have been very fastidious about documenting the hard cost of providing any care to children beyond the "average" care over the five years of care I usually provide per child. If I am certain that the care of a child would overwhelm my business and my client base is unable to support the hard costs of the additional care the child needs then I will decline to care for the child.

I'm perfectly aware that I may be challenged one day and I would be willing to undergo whatever govermental involvement is necessary to prove that I can not do what I say I can not do. I will not be bullied.

I will be happy to take a child with special needs and go through the process of documenting the cost of that child's care and evaluating whether or not the cost of the care is feasable. With such a small client base it really doesn't take very much at all to prove the costs of additional one to one care, insurance for any medical care, etc. will consume a business very quickly. Even the cost of two/three dollars per day per client could wreck a small business like a home child care. With a small client base there really isn't much of a window of fee increases that would devestate the business in pretty short order.

Providers should understand THEIR rights to operate, be finacially viable, and provide services they are comfortable with.

She CAN get more funding from the state for a special needs child BUT she can NOT charge the parent more money based on the childs special need. My Son has an IEP in place at school for his special need the school does get more funding for his special need because he needs more intervetion but the school does not charge me.

[Mrs.Ky]

You guys are such a great wealth of information! Thank you all so much for your input!

As of today, the 5th day of this treatment, the dcm has yet to consult me on the machine nor tell me if/when I should start this. Im going to inform her today (if I see her, grandma has been dropping her off and yesterdays pickup resulted in my DH taking the dcg to the car cause of our icy driveway so I didnt get to speak to the mom) that if still needs me to do this Ill need a doctors note with exact specifications of dosages and times as well as the doctors information. I will hand her an addendum to my contract with medication dosage fees (per dose) and tell her this will be a trial. If dcg fights this and it becomes too time consuming I will tell her she or someone else will have to come and administer the doses.

Since she doesnt seem too eager to get rolling with this Im not too eager to push the issue.

Might wanna read this before you charge med fee:

How does a childcare provider cover the costs of providing special services to a child with a disability?

Childcare providers may NOT charge parents of children with special needs additional fees to provide services required by the ADA. For example, if a center is asked to do simple procedures that are required by the ADA, like finger-prick blood glucose tests for children with diabetes, it cannot charge the child’s parents extra. (Of course, the parents must provide all appropriate testing equipment, training and special food necessary for the child). Instead, the provider must spread the cost across all families participating in the program. If the childcare provider is providing services beyond those required by ADA, like hiring licensed medical personnel to conduct complicated medical procedures, it may charge the child’s family.

This is the link to the site I got it off of:http://www.spannj.org/publications/childcarepub.htm

[nannyde]

Might wanna read this before you charge med fee:

How does a childcare provider cover the costs of providing special services to a child with a disability?

Childcare providers may NOT charge parents of children with special needs additional fees to provide services required by the ADA. For example, if a center is asked to do simple procedures that are required by the ADA, like finger-prick blood glucose tests for children with diabetes, it cannot charge the child’s parents extra. (Of course, the parents must provide all appropriate testing equipment, training and special food necessary for the child). Instead, the provider must spread the cost across all families participating in the program. If the childcare provider is providing services beyond those required by ADA, like hiring licensed medical personnel to conduct complicated medical procedures, it may charge the child’s family.

This is the link to the site I got it off of:http://www.spannj.org/publications/childcarepub.htm

The child has to first be deemed disabled. Having a prescription of nebs does not a special needs child make. Most kids receiving neb treatments never qualify as disabled. If the child IS disabled the parents need to do the hard work of getting the child diagnosed and providing the provider with the documentation that she is indeed a disabled child and qualifies under the disability act.

Until the provider receives documentation stating the child has a disability she CAN charge for medication administration.

The cost of a disabled child's care MUST be divided equally amoung the other clients. You MUST have a client base that CAN afford the cost of that child's care OR it becomes an undo burden.

A child who could have as many as three nebulizer treatments a day (assuming there is only one medication and not a combination of meds that must be given separately) can fundamentally alter a program. The TIME it takes to do this level of care, the documentation, parent contacts, and medical verification and training may well be beyond the ability of a single provider caring for a small group of children.

Providers shouldn't assume THEY must assume the cost but rather "can their client base support the cost?". We are NOT expected to do special needs care for free.

[nannyde]

This is a part of the commonly asked questions for children and the ADA.

5. Q: My insurance company says it will raise our rates if we accept children with disabilities. Do I still have to admit them into my program?

A: Yes. Higher insurance rates are not a valid reason for excluding children with disabilities from a child care program. The extra cost should be treated as overhead and divided equally among all paying customers.

Where this applies to home providers is the small NUMBERS of paying customers. If you only have a client base of three/four/five/six clients it takes VERY precious little to put the cost of special services into their fees before the extra costs requires the parents to leave the business and put their child into a program that is not supporting special needs care OR has hundreds of clients to share the costs.

This is REAL life.

You HAVE to have a client base to support the cost of special needs kids AND you must know when a child actually qualifies as a disabled kid. There is a LOT of confusion about this. Providers are just told to DO but not told that they do not have to DO expensive (time equals money) care if they do not have a client base to support it.

[Mrs.Ky]

The child has to first be deemed disabled. Having a prescription of nebs does not a special needs child make. Most kids receiving neb treatments never qualify as disabled. If the child IS disabled the parents need to do the hard work of getting the child diagnosed and providing the provider with the documentation that she is indeed a disabled child and qualifies under the disability act.

Until the provider receives documentation stating the child has a disability she CAN charge for medication administration.

The cost of a disabled child's care MUST be divided equally amoung the other clients. You MUST have a client base that CAN afford the cost of that child's care OR it becomes an undo burden.

A child who could have as many as three nebulizer treatments a day (assuming there is only one medication and not a combination of meds that must be given separately) can fundamentally alter a program. The TIME it takes to do this level of care, the documentation, parent contacts, and medical verification and training may well be beyond the ability of a single provider caring for a small group of children.

Providers shouldn't assume THEY must assume the cost but rather "can their client base support the cost?". We are NOT expected to do special needs care for free.

Section 504 protects qualified individuals with disabilities. Under this law, individuals with disabilities are defined as persons with a physical or mental impairment which substantially limits one or more major life activities. People who have a history of, or who are regarded as having a physical or mental impairment that substantially limits one or more major life activities, are also covered. Major life activities include caring for one's self, walking, seeing, hearing, speaking, breathing, working, performing manual tasks, and learning. Some examples of impairments which may substantially limit major life activities, even with the help of medication or aids/devices, are: AIDS, alcoholism, blindness or visual impairment, cancer, deafness or hearing impairment, diabetes, drug addiction, heart disease, and mental illness.

I would say this child falls under special needs. You are right not all kids who use a neb machie are special needs my oldest Son has one he has ashtma but it only acts up when he is sick with a cold thats it. Provider stated DCG had trouble breathing and needs a neb machine by doctors orders alls doctor has to do is write on paper that the child needs this machine to breathe on a daily basis and she will be deemed special needs as this LIMITS her daily funcation of life.

[nannyde]

Section 504 protects qualified individuals with disabilities. Under this law, individuals with disabilities are
defined as persons with a physical or mental impairment which substantially limits one or more major life
activities. People who have a history of, or who are regarded as having a physical or mental impairment that
substantially limits one or more major life activities, are also covered. Major life activities include caring for
one's self, walking, seeing, hearing, speaking, breathing, working, performing manual tasks, and learning. Some
examples of impairments which may substantially limit major life activities, even with the help of medication or
aids/devices, are: AIDS, alcoholism, blindness or visual impairment, cancer, deafness or hearing impairment,
diabetes, drug addiction, heart disease, and mental illness.

I would say this child falls under special needs. You are right not all kids who use a neb machie are special needs my oldest Son has one he has ashtma but it only acts up when he is sick with a cold thats it. Provider stated DCG had trouble breathing and needs a neb machine by doctors orders alls doctor has to do is write on paper that the child needs this machine to breathe on a daily basis and she will be deemed special needs as this LIMITS her daily funcation of life.

Nah

Missing a few days of day care isn't a major life activity.

I'm just saying that if the child needs respiratory therapy and it is a burden of time and money for the provider she needs to have a client base to support the care of the child or the funding from indirect sources.

If she doesn't have that funding then she needs to be clear to the parents that her business can't sustain the child's care needs.

She CAN collect fees for the care IF the child is just acutely ill and doesn't have any proper documentation that the illness at this time "substantially limits any major life activities".

The disability act gets thrown into a lot of conversations about mildly or acutely ill children who do not have a "life altering" condition at all. We need to know the difference and have the documentation to support it.

[Mrs.Ky]

Nah

Missing a few days of day care isn't a major life activity.

I'm just saying that if the child needs respiratory therapy and it is a burden of time and money for the provider she needs to have a client base to support the care of the child or the funding from indirect sources.

If she doesn't have that funding then she needs to be clear to the parents that her business can't sustain the child's care needs.

She CAN collect fees for the care IF the child is just acutely ill and doesn't have any proper documentation that the illness at this time "substantially limits any major life activities".

The disability act gets thrown into a lot of conversations about mildly or acutely ill children who do not have a "life altering" condition at all. We need to know the difference and have the documentation to support it.

Oh Nan you are so wise I have a feeling we are alot alike and we like to have the last word ::