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  #1  
Old 02-01-2011, 12:24 PM
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Default WWYD About This Dcg And Increasing Pay?

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?
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Old 02-01-2011, 12:36 PM
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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.
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Old 02-01-2011, 12:41 PM
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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?
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Old 02-01-2011, 12:56 PM
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i wouldn't think it would look crazy if she told you of the change after you gave her the contracts to sign.
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Old 02-01-2011, 01:22 PM
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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...
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Old 02-01-2011, 01:29 PM
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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.
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Old 02-01-2011, 01:41 PM
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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.
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Old 02-01-2011, 01:42 PM
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Everything Marniewon and Nan just said.
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Old 02-01-2011, 01:46 PM
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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?
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Old 02-01-2011, 01:47 PM
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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.
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Old 02-01-2011, 02:14 PM
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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.
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Old 02-01-2011, 02:20 PM
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http://www.childcarelaw.org/docs/ADA...l%203%2009.pdf


Here is some helpful info
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Old 02-01-2011, 02:33 PM
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Here is info on Section 504

http://www.hhs.gov/ocr/civilrights/r...sheets/504.pdf
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Old 02-01-2011, 02:33 PM
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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.
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Old 02-01-2011, 02:37 PM
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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.
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Old 02-01-2011, 02:44 PM
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Quote:
Originally Posted by nannyde View Post
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.
wow you have some knowledge under your belt. very impressive. Thank you for taking the time to explain that to me as I did not know that. CA is a sue happy state.... I am always afraid of getting sued.....YOu would be shocked over the things that people sue for here its unreal..... Glad I now know this information for future.

Thanks so much
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Old 02-01-2011, 02:49 PM
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Quote:
Originally Posted by nannyde View Post
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.
You can NOT charge more for a child who has special needs or deny a child care its against the law

Ex A: My middle child has ADHD combined type he is special needs if I went to find daycare for him and provider said she was charging higer rate because he is more work THIS IS AGAINST THE law he is cover under ADA

Ex B: I take my ADHD child and try to get him in a center who recieves Subsidy care they decide they will charge me more because he is more work they would lose any goverment assitants they recieve because of section 504

As you see she could be in a heap of trouble for charging more for a special needs child as the law states children with disabilities has a right to be treated, edcuated, etc. as all others maybe not in those words. No it doesnt FORCE her to care for this child but it says this child should be treated the same as others and she can get rid of said child for other reasons but she can not use the reason based on the childs special need.
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Old 02-01-2011, 03:13 PM
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Originally Posted by Abigail View Post
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.
Im not licensed so I dont really know what to do with that lol.

I wouldnt be asking for more (persay) as I charge all the others in my care MORE but because they argued they couldnt afford the $175.00 so I charge $150.00 and now they come 4 days a week its down to $120.00. I normally charge daily of $35.00 and only get the $30.00 a day from them. With the constant crap I get from this family this was my last straw. And since now the state would be paying wouldnt they be able to afford my regular rate? Or is it just bad that since I have to do added care the extra 5$ a day just seems too harsh?

Today the dcg stayed 45min late because the parent insisted on bringing her here during the ice storm and the dcm ran into a ditch. My husband had to walk dcg down the driveway in her pumpkin seat and there was no base in the car he put her in and they drove away unsecured. I keep a complete log notebook on this dcg of every day happenings because this is just insane to me. Shes the reason why I started logging all my kids.

I didnt raise my rates, kept them the same because they are pretty "up there" I think to begin with and its a lot to get the 30$ a day I can get from some people.

The medication fee is a good idea. I like it but right now they are getting to not be worth my time, effort, and stress. Today was it for me.

Thanks for all the input guys!! You cant cover your butts too much in this job.
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Old 02-01-2011, 03:35 PM
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Great now I am confused... lol

I am just going to stick with what I thought I learned in college many moons ago which is what Ms. Ky posted....
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Old 02-01-2011, 03:52 PM
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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?
Nebs are a piece of cake, particularly if the child can sit on their own. You can even put them in a high chair to do it. She can ask for a mask that goes around his head so you wouldn't even have to hold it for the child. Easy! But I do understand your concerns about the payment. It would be hard for me to know what to do.

Last edited by momofboys; 02-01-2011 at 05:03 PM. Reason: spelling
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Old 02-01-2011, 04:12 PM
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So in your state if you watch more than one family can you still watch more families if one of the families is recieveing free care from the state? I think there is a law against this in my state... Just saying you may want to check that out. Who knows this may be your out.
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Old 02-01-2011, 05:02 PM
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I guess my issue is she was already giving them special deals/discounts & now she has to do additional work, would it now be for less $$$ since the state would pay or will the parent still pay her & get reimbursed? What if she was to do an across-the-board raising of fees? It is no one's business if she raises her fees for everyone. No state can mandate how much you charge. Maybe that is what you could do if you are already on the low end.
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Old 02-01-2011, 05:18 PM
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You can NOT charge more for a child who has special needs or deny a child care its against the law

Ex A: My middle child has ADHD combined type he is special needs if I went to find daycare for him and provider said she was charging higer rate because he is more work THIS IS AGAINST THE law he is cover under ADA

Ex B: I take my ADHD child and try to get him in a center who recieves Subsidy care they decide they will charge me more because he is more work they would lose any goverment assitants they recieve because of section 504

As you see she could be in a heap of trouble for charging more for a special needs child as the law states children with disabilities has a right to be treated, edcuated, etc. as all others maybe not in those words. No it doesnt FORCE her to care for this child but it says this child should be treated the same as others and she can get rid of said child for other reasons but she can not use the reason based on the childs special need.
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.
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Old 02-01-2011, 05:19 PM
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My rates are $175.00 weekly/$35.00 Daily. At the time they wanted care they said they couldnt afford the $175.00 a week so I charge them $30.00 a day or the $150.00 a week. The other non-discounted children are at $35.00 a day. This family is also taking away a day so its down to 4 days a week at $120.00 a week. Basically Ive discounted them $220 a month now that shes part time. Would it seem that bad if I told her she now has to go to the actual full time rate at the $35.00 a day? I guess when it comes down to it, its really ONLY $25.00 a week but still.

I guess Im just annoyed at the fact she seemed overly happy to have to put her kid on a breathing machine and get paid by the state for it. The extra work is besides the point. Its just one thing after another with this family and its always something for nothing.
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Old 02-01-2011, 05:30 PM
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Nebs are a piece of cake, particularly if the child can sit on their own. You can even put them in a high chair to do it. She can ask for a mask that goes around his head so you wouldn't even have to hold it for the child. Easy! But I do understand your concerns about the payment. It would be hard for me to know what to do.
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.
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Old 02-01-2011, 05:37 PM
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Im not trying to be an insensitive caregiver who cares all about pay but with this family I have to hit them in their wallets to get them to hear me. I know children have changing needs but I feel as if some things were hidden from me when we first interviewed in September. The snotty nose issue was a "allergy issue" at the time. Then it was a "cold issue from being in a new environment" at my house. Now its turned into a actual medical need. She also need PT but Im never aware of when the PT will come to my home or what they do with her if they come while not at my house.

My nephew was a preemie so Im aware of some developmental delays preemies pose but Im really starting to wonder if a caregiver who actually specializes in disabled children would be better for her. Im always waiting for the other shoe to fall with her. Shes currently on a bunch of medications for this recurring cold, an inhaler, special formula mixtures and the family hasnt been following through with feeding her actual baby food so Ive been teaching her how to eat baby food too. Shes becoming a special needs child. I have some very active toddlers to tend to and where the dcg isnt much of a problem really its just a lot more then Im comfortable with. Beggars cant be choosers but Im waiting for them to bring in special walkers and things because thatll be next to aid in her walking development or something to that nature.
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Old 02-01-2011, 05:43 PM
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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 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.
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Old 02-01-2011, 05:47 PM
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My rates are $175.00 weekly/$35.00 Daily. At the time they wanted care they said they couldnt afford the $175.00 a week so I charge them $30.00 a day or the $150.00 a week. The other non-discounted children are at $35.00 a day. This family is also taking away a day so its down to 4 days a week at $120.00 a week. Basically Ive discounted them $220 a month now that shes part time. Would it seem that bad if I told her she now has to go to the actual full time rate at the $35.00 a day? I guess when it comes down to it, its really ONLY $25.00 a week but still.

I guess Im just annoyed at the fact she seemed overly happy to have to put her kid on a breathing machine and get paid by the state for it. The extra work is besides the point. Its just one thing after another with this family and its always something for nothing.
Are you saying that because the child is now deemed an asthmatic that the state will pay for the child's day care? I guess I don't get how the breathing machine makes her qualify for free day care???? If the parent was able to get a diagnosis that qualifies her for special needs fuding then are you sure it's not to be given in ADDITION to the fee they pay and the Mom is just SAYING that the money they give is to BE the fee? In other words the Mom is saying the money that you get from the State is to go to the regular day care fee instead of it going to the provider for the special needs care?

The Mom may WANT it to go for the regular day care rate but that doesn't mean that is what the money is intended for. I would find out directly from the State if they are paying the fees for the special needs care and whether or not the parents are to continue to pay their regular fee. If you got extra State monies on TOP of their fee it may be more worth it.

Think of it like this: If it's a big enough deal that it enables the parent to get special funding because of it then it's a big enough deal for YOU to get special funding because of it. It works both ways. It doesn't make sense that the State recognizes the child is entitled to funding but none of the "special" of it actually goes to the provider who is doing it?
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Old 02-01-2011, 05:55 PM
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Are you saying that because the child is now deemed an asthmatic that the state will pay for the child's day care? I guess I don't get how the breathing machine makes her qualify for free day care???? If the parent was able to get a diagnosis that qualifies her for special needs fuding then are you sure it's not to be given in ADDITION to the fee they pay and the Mom is just SAYING that the money they give is to BE the fee? In other words the Mom is saying the money that you get from the State is to go to the regular day care fee instead of it going to the provider for the special needs care?

The Mom may WANT it to go for the regular day care rate but that doesn't mean that is what the money is intended for. I would find out directly from the State if they are paying the fees for the special needs care and whether or not the parents are to continue to pay their regular fee. If you got extra State monies on TOP of their fee it may be more worth it.

Think of it like this: If it's a big enough deal that it enables the parent to get special funding because of it then it's a big enough deal for YOU to get special funding because of it. It works both ways. It doesn't make sense that the State recognizes the child is entitled to funding but none of the "special" of it actually goes to the provider who is doing it?
Hmmmm good points! Dcm mentioned that if I was to administer these treatments in while dcg was in my care then im no longer considered a regular caregiver but something else. Cant remember actually what she called it. She said then the state will write off the days of care I administer the treatments. If/when the dcm says I need to start doing this, Im going to require a doctors note with the doctors information.
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Old 02-01-2011, 05:59 PM
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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.
Word of advice: never allow a parent to med train you. Get the training from someone who is a trained trainor.

I can't imagine giving an infant this while they are napping. She may be talking about doing the "wand" where you point the wand at the kids nose. I've never had that work out too well.

The machine is noisy... the mist going in their face is annoying. Even if she WAS sleeping she would wake right up.

You won't be doing it twice a day. You will be giving one right at arrival, four hours after that, and four hours after that. You will find that they will tell you that the kid had it four hours ago when they arrive so that they can have one right when they get there. This puts you into the window of having to do it three times.

A very common scenario is that the parents want you to do ALL the treatments for the day while the kid is on your clock. All they have to do is SAY that they coudn't give it before day care because they HAD to give it in the middle of the night and the next one is due fifteen minutes after they get to your house.

If you pass the medicine back and forth with the machine count the doses. You may find out that you have the same number of them in the box that you had when you sent the kid home the day before. When the kid fights a treatment that takes fifteen minutes it's really easy for the parent if you just do it all at your house.
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Old 02-01-2011, 06:00 PM
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Originally Posted by nannyde View Post
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
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Old 02-01-2011, 06:04 PM
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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.
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Old 02-01-2011, 06:07 PM
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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.
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Old 02-01-2011, 08:40 PM
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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.
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Old 02-02-2011, 05:29 AM
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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.
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Old 02-02-2011, 06:19 AM
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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?
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Old 02-02-2011, 07:41 AM
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Quote:
Originally Posted by nannyde View Post
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.
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Old 02-02-2011, 07:52 AM
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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
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Old 02-02-2011, 08:33 AM
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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.
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Old 02-02-2011, 08:38 AM
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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.
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Old 02-02-2011, 03:12 PM
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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.

Last edited by Michael; 02-02-2011 at 05:37 PM.
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Old 02-02-2011, 03:35 PM
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nannyde nannyde is offline
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Originally Posted by Mrs.Ky View Post
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.
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Old 02-02-2011, 05:17 PM
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Mrs.Ky Mrs.Ky is offline
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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
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