How would I best document care given under a care contract?
Mom's elder lawyer says that Medicaid doesn't require the documentation of care to be "super comprehensive", nor does it need to include how much time is spent on EACH task. He wants me to just use a simple check-box system to document what tasks are done on what day. He maintains that my time spent is holey & completely documented with the check-box labeled "24/7 Supervision". In other words, it doesn't matter if it took me 30 min to bathe her or an hour-and-a-half because I'm "on duty" 24 hours per day regardless supervising her & preventing her from "getting into trouble" or wandering off and we have a physician's statement testifying to the effect that she can't be on her own due to her stage of dementia. He maintains that you want "just enough" proof to show Medicaid but "not too much". In his words, "over-documenting makes it look like you were trying too hard to 'pump up' what you were doing & makes Medicaid more tempted to pick you apart & deny payments".
Has anyone else used just a check system & not recorded their actual time per task? How did Medicaid respond to such a simple system?
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Time was recorded for phone calls, research, trips to the post office, cost of mailing and overnight deliveries and probably a few categories I've now forgotten. I charted time as we did in law, in tenths of an hour, but these were typically entries that weren't longer ones such as the time that might be spent cleaning house or going to a medical appointment.
I had a separate sheet for out of pocket expenses, with columns for date, destinations for travel, mileages, costs of trips, etc. (the first sheet was for time, the second was for expenses, so there was some overlap but it helped me remember everything I did).
It's been over a decade so I don't remember exactly how I set up the sheets; they're still on my older computer.
If I were to do this, I think I'd list all of the chores that you do, ranging from meal prep, dishes, household tasks, etc. to driving to medical appointments, ER, etc.
I'd make a chart, with frequently repeated tasks listed horizontally as column heads, and dates listed vertically along the side. I would do it this way because the dates will be more numerous and ongoing, obviously changing, but the tasks would probably generally remain the same.
You can select the method of measurement - fractions of an hour (such as 1/4 hour, 1/2 hour) or write the specific number of minutes. But make it easier to tally by using the same mode - i.e., all fractions, all specific minutes, etc.
Leave a column for miscellaneous and/or new items.
Actually, if you have Excel, you could do it on computer; it will be easier to tally the hours spent. Using the formula function, you just insert the "sum" formula, and the minutes and/or hours will be tallied for you. You can use the multiplication function to calculate mileage costs.
It's also easier to print out if you need to to provide detail for anyone.
If any of this doesn't make sense (and sometimes it's hard to describe in words), let me know. I'll see if I can do a better job of explaining!
Broadly, your lawyer is right; not least because, as I'm sure you find, the length of time per task varies enormously. On the day I happened to be speaking to a civil servant, my routine night time assistance tasks x four had ranged from the standard 15-30 minutes to an hour and a half. I expect she could tell from my voice, too, that I wasn't pumping up anything!
You might also be astonished/shocked/disappointed? to discover quite how cursory and feeble the standard of work on these forms generally is. I'm not suggesting you should dumb down, exactly: it is good to be conscientious. You might find it helpful, for your own information, to write your *own* journal and keep a record of how your time is spent. But it is above and beyond the call of what you're being asked for here. Keep your answers simple, and if Medicaid want further and better particulars they can always ask for them.