FOR BREAKING NEWS VISIT WWW.QNS.COM SEPTEMBER 7, 2017 • HEALTH • THE QUEENS COURIER 45
health
The Elder Law Minute TM
Understanding Medicaid Personal Care Services
BY RONALD A. FATOULLAH, ESQ.
AND STACEY MESHNICK, ESQ.
Th e New York State Medicaid program
provides coverage for a category of
home care services called Personal Care
Services (PCS). Under the Medicaid
rules and regulations, personal care services
are defi ned as the assistance of a
personal care aide/home attendant with
nutritional, environmental support, and
personal care functions. According
to the regulations, such services must
be essential to the maintenance of the
patient’s health and safety in his or her
own home, ordered by the attending
physician, and based on an assessment
of the patient’s needs and based upon
the appropriateness and cost-eff ectiveness
of services. 1
Th e two “levels” of PCS in New York
State are Housekeeping, which is considered
“Level 1” and Personal Care, which
is “Level 2”. Housekeeping services are
limited to eight hours per week and entail
housekeeping, cleaning, meal preparation,
grocery shopping, and laundry.
Level 2 personal care consists of housekeeping
tasks as well as assistance with
personal needs such as bathing, dressing,
toileting, walking, turning and positioning,
feeding, and routine skin care.
1 18 NYCRR §505.14(a)(1);
ELDER LAW
PCS must be medically necessary and is
intended for individuals who can be safely
maintained at home.
In order to receive PCS, the individual
must be able to direct care or have someone
with daily contact who is able to direct
care. In addition, if the patient has a condition
that is unstable, i.e., expected to
show sudden deterioration or improvement,
and requires some type of skilled
professional or nursing judgment, he or
she will not be eligible for PCS care.
Personal Care Aides/Home Attendants
may not perform tasks that are deemed
“skilled.” Th ey diff er slightly from “home
health aides” who can provide skilled
care in Certifi ed Home Health agencies
(CHHA) because they are supervised by
nurses.
However, aides in the Medicaid
Consumer Directed Personal Assistance
Program (CDPAP) are not bound by
these restrictions, and may perform
tasks that would otherwise be considered
“skilled”.
In order to receive PCS, one must
fi rst apply for and become eligible for
community Medicaid. Once found eligible,
the individual can be evaluated
by a Managed Long Term Care agency
(MLTC) to determine the number of
hours the agency will provide.
New York State has two types of
24-hour care available when medically
necessary. (1) Live-in 24-hour personal
care services means “the provision of care
by one personal care aide for a patient
who, because of the patient’s medical
condition, needs assistance during a calendar
day with toileting, walking, transferring,
turning and positioning, or feeding
and whose need for assistance is suffi
ciently infrequent that a live-in 24-hour
personal care aide would be likely to
obtain, on a regular basis, fi ve hours daily
of uninterrupted sleep during the aide’s
eight hour period of sleep.” Th e patient’s
home must have sleeping accommodations
for a personal care aide. If this is not
the case, split-shift (two 12- hour aides)
must be authorized.2
(2) Split-shift or “Continuous personal
care services” means “the provision
of uninterrupted care, by more than
one personal care aide, for more than 16
hours in a calendar day for a patient who,
because of the patient’s medical condition,
needs assistance during such calen-
2 Id at §(a)(3)(iii)(a)(4)
dar day with toileting, walking, transferring,
turning or positioning, and needs
assistance with such frequency that a
live-in 24-hour personal care aide would
be unlikely to obtain, on a regular basis,
fi ve hours daily of uninterrupted sleep
during the aide’s eight hour period of
sleep.” Before December 2015, split-shift
continuous care was only for people with
“unscheduled” needs, while live-in was
for predictable needs. Now regulations
require that agencies look at the frequency
of the need.3
Given the diff erent rules and the diffi -
culty of navigating the system, it is advisable
to seek assistance from a qualifi ed
elder care attorney.
Ronald A. Fatoullah, Esq. is the principal
of Ronald Fatoullah & Associates, a law
fi rm that concentrates in elder law, estate
planning, Medicaid planning, guardianships,
estate administration, trusts, wills,
and real estate. Stacey Meshnick, Esq. is
a senior staff attorney at the fi rm who
has chaired the fi rm’s Medicaid department
for over 15 years. Th e law fi rm can
be reached at 718-261-1700, 516-466-
4422, or toll free at 1-877-ELDER-LAW
or 1-877-ESTATES. Mr. Fatoullah is also
a partner with Advice Period, a wealth
management fi rm, and he can be reached
at 424-256-7273.
3 Id at §(a)(2)
RONALD FATOULLAH
ESQ, CELA*
LEARNING NEW THINGS AND AGING
Virtually everyone remains capable of
learning throughout their lives. Th ere is
no known age at which the elderly lose
their ability to learn new things although
due to illness and other medical issues,
many can and do experience increased
diffi culties in learning.
It may appear as if the elderly have
failed to grasp any new ideas. Th is is not
because they have been unable to learn,
but because they may choose not to risk
making mistakes and looking foolish – a
caution which the old share with younger
people.
Th ere may be times when the old person
may have either mental and/or physical
impairments that can interfere with
what they have already assimilated.
Circumstances can deprive this individual
of an opportunity to take in
information needed for reliable decision
making and a continuous intellectual
curiosity, or this information may
go by too quickly and in an unsatisfactory
form. For example, the print may be
too small to read, or the voice too inaudible
to clearly hear.
Whether this individual has actually
learned much in a particular situation is
not the question. It is whether he is capable
of learning. Th e answer is an emphatic
yes – given a little help!
Yes, there may be age-related disabilities,
yet it is still likely that an elderly person
learns more than we give him credit
for.
A recent study on aging demonstrated
continued learning that occurs during
the second phase of the aged individual’s
lifespan.
A positive thought to close on: the
young as well as the elderly can, in fact
acquire new learning comprehension as
they age. Th is should give pause to those
who no longer believe this is still possible.
Here is my belief on learning and
aging that can be understood in terms of
the following fi ve key points:
1. By living an active and productive
lifestyle.
2. By maintaining close relationships
with family and community.
3. By staying involved with signifi cant
activities.
4. By living each day with hopeful
expectations.
5. By giving aid and comfort to those
who are less fortunate.
In my opinion, this is learning in its
fi nest and truest form.
Quotable Quote: “A house without
books is like a room without windows.”
Author: Anon.
Sheldon Ornstein Ed.D, RN, LNHA
Dr. Sheldon Ornstein is a
registered professional nurse
with a doctoral degree in
nursing organization. He
has specialized in the care
of older adults and has
published many articles on
the subject. He has done
post-graduate work in gerontology
and has taught
at several universities. In
2013, he was inducted into
the Nursing Hall of Fame at
Teachers College, Columbia
University.