September 28, 2021
September 28, 2021
An expansive page-one story in Saturday’s New York Times examines the nursing shortage in home care and its emotional, physical and economic impact on families with children needing medically complex care.
State and federal reimbursements lag behind the actual cost of care and “effectively establish a benchmark of workers’ compensation that competitively disadvantages this field,” HCA’s Communications Director Roger Noyes says in the article, which emphasized the challenges of recruiting and retaining nurses in home care versus other settings.
In a report ‘Urgent matter’: Homebound patients waiting on care, shortage of aides across New York State, the Rochester area’s CBS affiliate, News 8 WROC, examined New York’s home care workforce shortage, along with solutions advanced by HCA to address this chronic area of concern exacerbated by the pandemic.
“The pandemic brought the issue of home care ‘first’ into major focus when I observed the trend of patients referred from hospitals to inpatient rehab and long-term care,” said HCA President Al Cardillo in the report. “The newly passed state budget contains $1.6 billion in federal aid for home and community-based services, and the President is proposing new levels of investment in these services. The time is now to channel these investments accordingly to support this home health system.”
In a report by The River Hudson Valley Newsroom, HCA raised concerns that a newly proposed wage mandate “created a requirement for salary with no clarity on how that was ultimately going to be covered,” says HCA President Al Cardillo. “HCA proposed a separate plan that would have used state funds, including federal COVID-19 relief funds, to make direct payments to all types of providers for wage increases and other worker supports, like child care and transportation.”
“Investing in the workforce does have a return on investment economically and in quality of life in the community and for the workforce. It’s long overdue,” Cardillo says.
“While we appreciate the intent of new proposed state budget legislation to increase aide wages, the proposal now under consideration in New York’s state budget would not sufficiently cover the full cost of this new mandate for home care provider employers in New York State, many of whom are operating at negative margins,” HCA recently told McKnight’s Long Term Care News regarding legislation proposed in the state budget.
McKnight’s Long Term Care, Home Health Care News and WIVB4 News in Buffalo covered a new HCA report showing the impact of the pandemic on home care and our call for the state Legislature to restore workforce funding cuts of 50% at a time of rising demand and a shortage of caregivers. Continue reading “McKnight’s, Home Health Care News and WIVB4 Coverage of HCA’s Financial Report on Home Care in the Pandemic”
Weeks into January, 85% of home care and hospice agencies reported that 10% or less of their staff had received at least one dose of the COVID-19 vaccine, the Home Care Association of New York State told MedPage Today. Continue reading “MedPage Today: Struggling to Vaccinate New York’s Home Care Workers”
“Home care and hospice workers are now part of the pool of New Yorkers eligible to receive the COVID-19 vaccine,” reports Home Health Care News on January 10, 2021. “This development didn’t just happen overnight. In fact, it was the result of a significant push from New York home-based care associations, Roger Noyes, director of communications at the Home Care Association of New York State (HCA-NYS), told Home Health Care News.”
Home Health Care News reached out to HCA for comment on a study in the Journal of the American Medical Association which queried home health aides on their experiences early in the COVID-19 health emergency.
“Many of the key themes in this study echo what our organization has identified in our own survey of the home care field,” said HCA’s Communications Director Roger Noyes. “This includes the need for a more coordinated effort at all levels of emergency management to overcome personal protective equipment supply challenges.”
Noyes points out that many home care leaders participated in grassroots efforts to establish voluntary PPE distribution sites in all boroughs of New York City to coordinate with city officials and partner organizations on this area of need.
In a recent report on home health aide shortages in the COVID-19 pandemic, Spectrum News cites HCA data noting that:
hundreds of the thousands of individuals and their families rely on the home care system for care and support; that home care workers are underpaid; and that New York State’s Medicaid program covers only 87% of the cost of home care services.
The news gets worse.
Twenty-nine percent of home health agencies use lines of credit or borrow to meet operating expenses. These are the very agencies that are expected to recruit, train, retain and supervise thousands of home health care aides. But because wages are so low, they are having a tough time. Turnover among some groups is as high as 58 percent.
The report adds: “Again, the HCANYS’ report was released before the worst of the pandemic in the U.S, back in December when most COVID-19-related news was coming out of China and Americans were focused on the holidays.”
In a letter to the editor published by the New York Times this week, HCA responded to an op-ed by E. Tammy Kim highlighting a number of vulnerabilities faced by home health aides in the COVID-19 pandemic — “a global health crisis that has laid bare systemic government gaps,” writes HCA President Al Cardillo in the published letter. He took the occasion to write about HCA-sought remedies, including “funding … urgently needed for wages that match the courage of caregivers at a time when Medicaid rates fall short of this obligation, with warnings of still further state budget cuts to come.”
Cardillo also noted the home care provider community’s voluntary effort to distribute PPE for peer home care providers and workers, noting the need for “a dedicated collective effort by government, payers and emergency management … to further provide these most essential protections.”
Home Health Care News covered HCA’s call for Congressional funds to New York home care providers at the epicenter of the COVID-19 crisis who, we estimate, have weathered at least $200 million in losses.
“We need the NY delegation action to include, by whatever acceptable method, a priority fiscal aid target of $200 million for our state’s home health agencies,” HCA President and CEO Al Cardillo wrote to the entire New York Congressional Delegation. “We appeal to you to work with congressional colleagues to provide for this urgent constituent support.”
HCA and HCA Member Selfhelp Community Services joined industry voices from around the nation in an NBC News report “Coronavirus concerns show increased need, demand for home care, experts say.”
The article explains the impact of COVID-19 on services, including what the future holds for home care. HCA noted the vital role of technology, and the need for reimbursement of telehealth. “We’re finding that telehealth is vital for reducing exposure in a time of crisis like this,” said HCA Communications Director Roger Noyes.
Selfhelp’s COO Russell Lusak, an HCA Board Member, discussed his organization’s pioneering Virtual Senior Center. Under a grant from the Mother Cabrini Foundation, HCA and Selfhelp are working collaboratively to make the platform available to all providers statewide. “That connection to other people is so important,” Lusak said. “It’s a great option for people that otherwise wouldn’t have the ability to go to a senior center. It’s such an incredible thing to see.”
The Home Care Association of New York State (HCA-NYS), along with two health organization partners, announced a new COVID-19 training initiative for in-home testing on Tuesday, reports Home Health Care News. “Moving forward, the initiative will serve as an early example of how the home setting can fit into the country’s progressive return to normalcy.”
“This is a situation where we are creating a home care infrastructure,” HCA President Al Cardillo said in the report. “If you are ill because you have COVID symptoms, the last thing you should be doing is waiting in line in a congregate area for a test. This will enable doctors or facility care settings to contact in-home agencies to conduct tests for their patients.”
HCA President Al Cardillo was featured in an article for Home Care Pulse last week with comments from state association executives in 12 states on COVID-19. The article shared a “high-level take on the state of home care in their prospective states.”
“The miracles, dedication and impact of New York’s home care agencies and personnel are at unprecedented levels,” he writes. “Home care is serving core roles in hospital decompression, surge mitigation and assistance across the continuum in addition to the extensive in-home care it provides. Agencies are also voluntarily acting as receiving and distribution sites to further render protective supplies to hundreds of fellow agencies in cases where, stunningly, no formal structure was instituted by government’s incident command to deliver these essentials to the home care sector.”
“‘You Are a Miracle’: Home Care Is New Front in Virus Fight,” proclaims the headline in an AP article recently published in the New York Times, noting that “home health care is becoming a new front in the national fight against COVID-19 as some patients come back from hospitals and others strive to stay out of them.”
As COVID-19 patients become medically stable, hospitals look to home care for continued care and monitoring to keep patients safe and prevent a recurrent hospitalization, including services provided by HCA members featured in the article: Americare and the Visiting Nurse Service of New York.
“Fear of COVID-19 exposure is having an impact on the ability of home care agencies to find workers willing to go into patients homes, according to a statewide survey,” reports the Oneonta Daily Star on April 9. “The Home Care Association, a statewide umbrella group, said the survey also found many local provider agencies reported they have patients who are now rejecting care due to concerns about the virus.”
“These findings strongly support the need for priority access to supplies, like personal protective equipment, amid dangerous shortages and the absence of community-based providers from the prioritization lists when supplies are made available,” said Al Cardillo, the association’s president.
“More than 80% of 176 home health and hospice providers surveyed March 31 said the virus has reduced up to a fifth of their workforce, a Home Care Association of New York State poll found,” reports Modern Healthcare on April 9, noting that “telehealth can help mitigate PPE shortages and staffing constraints as well as boost COVID-19 containment efforts.”
“One other important area of urgent need is greater flexibility and reimbursement under Medicare for remote-monitoring technologies — like home telehealth — that can be used to manage patient care and extend the point of contact to in-home patients remotely in certain circumstances or phases in the care plan,” [HCA President Al Cardillp] said in prepared remarks. “While New York’s Medicaid system has rightly allowed such flexibility for telehealth services and billing, the same must be done under Medicare so that these powerful tools can be brought to bear more uniformly for safety reasons.”
“While hospitals are on the front lines of the pandemic, home care providers play a vital, often unnoticed role in keeping patients out of hospitals and nursing homes getting stretched to their limits,” reports The Syracuse Post-Standard on the vital COVID-19 public health role of organizations like Nascentia Health.
The Albany Times Union, on March 26, reports that: “A recent survey by the Home Care Association of New York found that nearly 300 home care providers are serving a collective 14,000 New Yorkers who are considered ‘priority level 1’— meaning they are patients who, without home care, would face a ‘rapid, immediately life-threatening deterioration’ of their health and require transport to another setting such as a hospital.”
“The survey also found that 68 percent of home- and community-based providers say they do not have access to adequate personal protective equipment.”
“‘Almost half (48%) report instances where patients and/or family members refuse entry of staff in the home due to concerns about the virus at a time when home health agencies are working vigorously to screen caregivers and patients alike for the safety of both,'” said HCA President and CEO Al Cardillo.
“It’s a hair-on-fire crisis,” said Roger Noyes, spokesman for New York’s Home Care Association in a March 26 report for Reuters, which made headlines globally.
“As hospitals continue to handle an influx of coronavirus cases, patients who need care but are not critically ill are likely to be sent home. If home care providers can’t stay afloat or decline to offer services, those patients will ‘face a rapid, immediately life-threatening deterioration’ of their health, said Al Cardillo, president of the New York group.”
“More than 80% of providers reported that they were in high need of hand sanitizer, according to a recent survey the Home Care Association of New York State, which represents home care agencies, sent to state health officials on March 18,” reports City and State News. “Nearly as many said they had a similar demand for face masks, with most respondents saying they lacked sufficient personal protective equipment. This shows how difficult it may be for home care workers to abide by state guidance encouraging people visiting at-risk people to don face masks.”
“Some other guidance has also been difficult to implement. Home care providers have been pushed to take the temperature of their staff, but that can be difficult given that workers tend to go directly to their patients’ homes rather than to a central office, said Roger Noyes, director of communications for the Home Care Association of New York State. There has been flexibility given on other regulations however, allowing mandated in-home supervision from nurses to be done through ‘indirect means’ such as by telephone or video calling to reduce in-person interactions.”
“[HCA President Al Cardillo] asked the Legislature to ‘look hard at MRT recommendations for which cost savings are disputable at the levels assigned; consider alternative cost-savings measures advanced by HCA but declined by the MRT; and explore new revenue opportunities from federal aid and other sources to better realign an impact that otherwise would be borne disproportionately by the long term care sector,'” writes Politico New York.
“To get a sense of what the situation on the ground looks like for home health and home care agencies, the Home Care Association of New York State (HCA-NYS) recently surveyed hundreds of providers,” reports Home Health Care News.
“‘Different states and regions are at different stages in surveillance and monitoring,'” Roger Noyes, director of communications at HCA-NYS, told Home Health Care News. ‘Certainly due to our population and the size of our home care programs, the situation in New York can be instructive for other states, including the scale of remedies under consideration and how well they’ve worked.'”
“Broadly, home health and home care agencies in New York are already experiencing challenges that many others throughout the continuum of care are as well, including hospitals. That’s particularly alarming because the need for home-based care will likely rise in the coming weeks, especially as quarantines become stricter and more patients are sent home from institutional settings.”
“Among its findings, the HCA-NYS survey found that most home-based providers lack access to adequate personal protective equipment (PPE). More than 300 home health, home care and hospice agencies participated in the survey, conducted over a roughly 40-hour period this week.”
HCA President Al Cardillo recently discussed sepsis with anchor Benita Zahn for her Health Beat program on Capital Region NBC affiliate WNYT.
The interview, on behalf of partners at Sepsis Alliance, was prompted by new research on sepsis, finding a 40 percent increase in sepsis cases among the Medicare population.
During the segment, which aired March 9, Cardillo discussed the latest sepsis research, signs and symptoms of sepsis, and screening efforts like HCA’s Stop Sepsis at Home protocols.
Watch the segment here: https://wnyt.com/news/health-beat-spesis/5659812/.
The February 4 Times Union includes a letter to the editor from HCA President Al Cardillo in response to an article on home health aide workforce shortages in the Adirondacks.
“The Home Care Association of New York State has long called for a partnership effort by state agencies and the home care industry on a comprehensive statewide analysis of home care workforce shortages,” he writes. “These shortages exist in many communities involving the full scope of home care practice disciplines, from home health aides to nurses to therapists.”
“The system needs actionable steps, and now. The state also needs a comprehensive statistical assessment of the locally specific factors that cause critical-access gaps. These gaps shift the balance toward higher-cost services such as longer hospital stays.”
Home Health Care News reports on the state’s 1% across-the board cuts to Medicaid. These come at a time when home care providers have not had a Medicaid cost-of-living rate adjustment in 10 years, and as providers operate on wafer-thin margins or losses in the majority of cases.
“In that light, this 1% reduction is extremely alarming,” HCA says in the article; and the cuts’ “timing, just before the release of a new budget proposal in only a few weeks, is a harbinger of just how serious the state’s fiscal outlook is — and what else is yet to come amid a projected $6 billion deficit.”
“Home health agencies provide interdisciplinary health care to individuals at home,” writes HCA President Al Cardillo in a viewpoint piece for the Legislative Gazette. “You may be familiar with some forms of this care. Thousands of exceptional people with specialized training make it happen, working together to overcome countless medical, social and environmental hurdles in too-often untold ways.”
With sad and tragic news this week of a young boy passing from sepsis in Cohoes, NY, the Capital Region’s ABC affiliate, News 10 WTEN, spoke to HCA and medical experts on Tuesday about sepsis, including a bill that passed the State Legislature in June to support the work of home care providers in screening for this deadly condition.
“Our goal, particularly with the home health system, is to work not only to monitor, but teach the individual and the family what to look for and how to prevent” sepsis, said HCA President Al Cardillo in the interview. Watch the clip here and learn more about the legislation here. The bill (S.1817/A.3839) awaits action by the Governor.
“Say your employer takes 8 percent from your paycheck this week as a penalty for you possibly being late to work sometime next week, despite a long record of punctuality,” writes HCA President and CEO Al Cardillo in an op-ed for the Albany Times Union last week, setting up an analogy: “That’s what the federal government is doing for Medicare-covered home health services in 2020 with cuts of $1 billion nationwide,” referring to the so-called “behavioral adjustments” under the Patient Driven Groupings Model (PDGM).
He further describes the inherent faults of the “behavioral adjustment” cuts that ride along with PDGM, urging action on a bill to curtail those cuts: H.R. 2573/S.433.
HCA fielded several media calls for comment last week following a press conference in New York City on September 5 where State Senator Roxanne Persaud (D-Brooklyn) and supporters pressed for action on a bill to place limits on home care hours worked. A companion bill is being sponsored by Assemblyman Harvey Epstein (D-Manhattan).
This bill has arisen in the wake of litigation, emergency rulemaking and, most recently, a New York Court of Appeals decision on the issue of 24-hour home care over the past several months.
News reports quoting HCA on the matter are at the links below:
Newsday published a comprehensive report yesterday on the demand for home care workers on Long Island. As part of the report, HCA and members noted some of the local dynamics, including competitive pressures from New York City (where the comparative ease of public transportation and higher state-mandated wage parity levels draw workforce from areas of Nassau County), as well as staff vacancy levels that exist system-wide due to policy and economic trends.
“Roger Noyes, communications director for the Home Care Association of New York state, said that starting in 2011-12, the state required higher wages for its Medicaid home care cases, with a $3-an-hour higher minimum wage in New York City compared to Long Island and Westchester, plus an extra $1 in benefits. The resulting wage differential made it harder to recruit for Nassau County, he said, in particular for home health aides, nurses and physical therapists.”
“Noyes said his group recently surveyed its membership of home care providers and found that more than 17 percent of home health and personal care aide cases went unfilled. It also found a 20 percent shortfall in nurses, and another 20 percent shortfall in therapists.”
“An initiative to fight a potentially deadly disease began in New York with help from a local nurse. Now, it’s taking off across the state — and around the country,” writes Amy Roth in the July 2 edition of the Utica Observer-Dispatch.
“Stop Sepsis at Home, an initiative of the Home Care Association of New York State, uses the nation’s first screening and intervention tool to identify home care patients who are at risk for sepsis, who are in the early stages and need treatment, and who have severe sepsis and need emergency care. It also involves training for health care providers and education for patients and families.”
HCA President Al Cardillo joined a recent home care Industry Roundtable hosted by the Law firm Hodgson Russ and the Albany Business Review.
Check out the Business Review’s transcript of the program offering perspectives on the home care workforce challenge statewide, including approaches that providers and HCA, through legislation, are taking to address it, plus the role of technology and other issues confronting the field.
“The federal system that was created to fund home care was created in the 60s, and in the 70s in New York State,” says Mr. Cardillo in one part of the exchange. “It’s a very different world today in terms of who goes into the hospital, how sick they are when they come out, who goes into nursing homes, and who we want being cared for in the community.”
He adds: “The funding structure that wraps around home care needs to be modernized to the way that services are provided today.”
HCA and our Western New York members, Catholic Health Home Care and Visiting Nursing Association of WNY (VNA), were featured in a Buffalo Business First article on the impact of home care labor shortages. Catholic Health Home Care describes a workforce drop of 500 to 335, and VNA similarly reports a decline in home health aide employment due in large part to competition from other fields and wage policies. Citing our annual report on home care trends, HCA notes: “Our data shows that some of the shortages that exist are having an impact on starting care; hospitals’ need to discharge patients; and agencies not being able to always admit the patient or be able to provide services in a timely basis.”
“Brooklyn-based Metropolitan Jewish Home Care, doing business as MJHS Home Care, plans to lay off more than 100 employees amid significant business challenges,” writes Crain’s New York Business, quoting HCA on some of the financial challenges faced by the industry. See the report here.
“Certified home health agencies have been especially vulnerable to costly mandates, inadequate payor rates and exposure to systemwide volatility in the home and community-based marketplace,” said Roger Noyes, director of communications at the Home Care Association of New York State, in an email.Continue reading “Crain’s NY Business: Home Care Agency plans layoffs in challenging market”
Home Health Care News conducted a wide-ranging Q&A interview with HCA’s new President Al Cardillo, covering his background in health care, as well as specific topics like wage-and-hour rules, compliance, value based payment, a new Medicare home health payment reform model and more. Read the interview here.
Home Health Care News recently reported on the movement of new regulations to create an advanced home health aide designation in New York State. “The new regulations deal mostly with medications,” says HCA. “The real opportunity area seems to be for patients who are unable to self-administer medications, due to memory issues or the complexity of their medication needs.”
“A lot depends on how an agency opts to utilize this new designation,” HCA adds. “Right now, it’s unclear whether any potential new costs will outweigh the savings. It’s also unknown how [payers] and workforce dynamics will drive this cost calculation.”
HCA was recently quoted in an article for Home Health Care News on new litigation affecting compensation 24-hour/live-in services. “Going forward, the issue is, if aides get paid for every hour, it will cost the system an incredible amount of money,” said Andrew Koski, HCA’s vice president for program policy and services. “If that funding should not be available or if the aides are not paid adequately, then you’re going to have basically very hard-to-find agencies and aides that are going to work these [24-hour care] cases… The only alternative [for patients] is to go without care, get less care than you need or go into an institution.” Read the full article here.
HCA was quoted in a Home Health Care News article about a state budget provision limiting the number of contracts that a Managed Long Term Care plan can have with a Licensed Home Care Services Agency. “We are very concerned about the impact of arbitrary contract limits on continuity of care and individualized contracting relationships that might have specific clinical, cultural or language value, even if the LHCSA does not have the case volume to help an MLTC stay within its contract limit,” HCA says in the article, which can be read in full here.
Crain’s Health Pulse reports on HCA’s financial and program statistics for home care, hospice and MLTC.
POLITICO PRO sought HCA’s comment on a state budget proposal to allow for community paramedicine. HCA has, in the past, expressed concerns with community paramedicine legislation because these past proposals seemed to encourage the circumvention of existing licensure requirements for care provided in the home. This prompted a multi-association effort to draft a new bill based on existing licensure roles. The Governor’s proposal appears to largely track with the spirit of this multi-association approach, favored by HCA.
“HCA appreciates the direction of Governor Cuomo’s community paramedicine proposal,” said Roger Noyes, a spokesman for the group. “We specifically appreciate its recognition of needed collaboration between EMS and duly-licensed home care providers for any services that would occur in the home setting. … HCA is optimistic about the approach included in the Governor’s budget and needs to review it further for possible syncing with other existing collaboration initiatives and approaches.”
Home Health Care News has reported on the impact of major winter storms on home care providers, including the work of HCA member Visiting Nurse Service of New York (VNSNY) to reach patients in need.
In addition to meeting the new emergency prep regulations at the federal level, agencies in New York are already required to meet a set of ‘pretty robust state regulations, according to Roger Noyes, director of communications of the New York State Home Care Association (HCA-NYS). Providers have “needed to fine tune their existing protocols, policies and procedures” to meet the additional federal requirements, he told Home Health Care News.
The state also recently enacted a law that requires input from home care providers in county emergency management plans. The association worked to link up providers with local emergency management officials in a statewide campaign that has so far reached 40 of the 62 counties in New York.
Home Health Care News (HHCN) reports on HCA’s grant to expand use of HCA’s first-in-the nation home care sepsis screening and intervention tool.
The Home Care Association of New York State (HCA-NYS) has been awarded a grant of nearly $150,000 to fight and prevent sepsis—one of the leading causes of hospitalization.
The grant comes from the the New York State Health Foundation (NYSHealth), and will provide training and implementation of HCA’s sepsis-intervention protocols with home care providers across New York State. Continue reading “How One Home Care Association is Taking on Sepsis”
The Second Department, Appellate Division on September 13 issued decisions in Andreyeyeva v. New York Health Care, Inc. and Moreno v. Future Care Health Services, Inc. — two cases with similar facts involving 24-hour, live-in aides and which pose a major impact for home care providers and their patients.
The court held that, to the extent that the aides were not “residential” employees (who “lived” on the premises of their employer), the aides were entitled to be paid the minimum wage for all 24 hours of their shifts, regardless of whether they were afforded 8 hours for sleep (including 5 hours of uninterrupted sleep time) and three hours for meals (also known as the so-called “13-hour rule”).
As Politico news reports, “the Home Care Association of New York State has met with the Cuomo administration and stressed that without state action, its members will be decimated as home care providers could face millions of dollars worth of financial liabilities.”
“The court’s decision, which invalidates the so-called 13-hour rule that providers have relied on in good faith for these services, opens up major potential exposure for wage costs, and this exposure results from discrepancies in state regulations and guidelines,” said Roger Noyes, a spokesman for the Home Care Association of New York State.
Read the full article here.
The National Public Radio (NPR) program “Marketplace Weekend Edition” reached out to HCA last week about the serious workforce infrastructure challenges in home care.
This issue has gained national prominence, in part due to a recent public hearing by the state Assembly’s core committees on Health, Aging, Labor and the Task Force on People with Disabilities, chaired by Assembly Health Committee Chairman Richard Gottfried. HCA Executive Vice President Al Cardillo testified at the hearing, prompting the NPR interview request.
In the interview, Mr. Cardillo described the stresses of workforce recruitment and retention challenges on: workforce continuity; the patient experience of care; and system costs, especially at a time of continued, enormous fiscal pressures on the home care industry. These pressures all coincide as the need “far exceeds the number of workers,” Mr. Cardillo said. He provided concrete examples of ways in which workers need to be matched to the individual and his or her specific care needs, amid the workforce shortage. Continue reading “NPR’s Marketplace Brings HCA’s Voice on Workforce Issues to National Audience”
Politico New York reports on a ruling in the New York State Supreme Court, Appellate Division, First Department, which holds that live-in home care aides are not necessarily a category of employee who need only be paid for 13 hours of a 24-hour shift. According to the court, live-in aides who fall outside of that category would be entitled to be paid for each hour of a 24-hour shift.
“The cost differences are staggering,” said Al Cardillo, executive vice president for the Home Care Association of New York State. “This would have major implications.”
Read the full Politico report at https://hca-nys.org/wp-content/uploads/2017/04/Appellate-Court-ruling-has-home-care-agencies-on-edge.pdf.
Home Health Care News reports that “The New York State Supreme Court ruled on April 11 that caregivers can be paid for sleep and mealtimes in a 24-hour shift, representing a major upset for home care providers if the decision is upheld.”
“This case has potential far-reaching impacts on the costs of services,” Roger Noyes, director of communications at the Home Care Association of New York (HCA) told HHCN. “For those providers that do have a high concentration of 24-hour, live-in cases, the new costs would be enormous.”
However, data on the prevalence of 24-hour, live-in caregiving is not entirely conclusive across the industry, according to Noyes.
“If the Tokhtaman or other rulings hold, this will add significant new labor costs and regulatory distinctions that the state needs to sort out both in terms of its published requirements for providers and in its establishment of Medicaid rates to cover labor costs,” Noyes said. “Otherwise, providers are left in limbo as far as the requirements while subject to a hole in reimbursement for meeting the costs of compliance.”
As Home Health Care News reports, “Lawmakers, too, were pushing for a delay to give agencies more time to comply with the significant changes. The Home Care Association (HCA) of New York worked with New York Congressman John Faso to urge CMS to delay the effective date as recently as March 27, when Rep. Faso sent a letter to CMS Administrator Seema Verma.”
“Home care providers understand the rationales and goals of the CoP changes, and they report vigorous and hurried efforts to get their staff trained and ready,” the letter reads. “Moving back implementation by six months will allow for all parties involved to be better prepared to operate and ultimately provide quality care to home care beneficiaries.”
Rep. Faso’s letter can be read here.
Bloomberg Health Law Reporter has written about a new bill signed into law that would create flexibility in the assignment of home health aides for an expanded set of tasks.
The law creates a new designation called an “Advanced Home Health Aide.” HCA has led similar proposals to allow for flexible assignment of home health aides, under the discretion and oversight of nurses. We support the intent of the new law, but, as HCA told Bloomberg, ‘‘the implementation phase still requires additional work. Among many issues still unaddressed are the need for funds to train and compensate advanced home health aides under the state Medicaid program and other payers, as well as the need to address the cost of new oversight duties for home care agencies.”
‘‘These cost factors are all the more important in the context of a new statewide minimum wage hike set to go into effect on Dec. 31,” HCA added.
You can read the article here.
HCA Executive Vice President Al Cardillo and colleagues from the state’s quality improvement organization (IPRO) were featured this weekend on a widely broadcast radio-news program to promote sepsis public awareness and describe clinical initiatives being partnered by IPRO and HCA.
The radio coverage, as part of the Upstate Issues weekly program, spanned several radio stations, including WGY (810 AM and 103.1 FM) and FM stations: The River (99.5), Kiss FM (102.3), Oldies 98.3, and PYX 106 (106.5).
A link to the segment online is at http://wgy.iheart.com/onair/upstate-issues-57169/a-deadly-ignorance-15142256/.
The Utica-Observer Dispatch reports on HCA’s efforts to raise awareness about the sepsis crisis, including our work with partners on a first-in-the-nation sepsis screening tool for home care nurses. Read the article here.
HCA Board Member Elizabeth Zicari, President of HCA Home Care, had an op-ed recently published in the Rochester Democrat and Chronicle newspaper about the work her organization is doing to participate in Bring The Vote Home-NY, an HCA-organized effort to help seniors vote from home.
“During this year’s presidential election season, we hear a lot about voter turnout, polls, and voter registration issues, but one important constituency demands attention: the 400,000 elderly, chronically ill, and persons with disabilities in New York state who receive home care services,” Ms. Zicari writes. “Many of these individuals are homebound, meaning they have difficulty getting to the polls on Election Day. Others have life-limiting illnesses or disabilities that hinder their access to election sites because of transportation issues or the incredibly taxing effort it takes to leave home — access issues that many of us take for granted.”
Modern Healthcare reports on the impact of Medicare home health cuts proposed for 2017. Quoting HCA, the report notes that “New York Medicare-certified providers have been operating at a loss on Medicare payments for several years in a row, said Roger Noyes, a spokesman for the Home Care Association of New York State. Noyes said 60% of New York agencies have reported having to reduce staff or cut other costs to function, and half have used a line of credit or borrowed money for operating expenses over the last two years … He said the reimbursement cuts haven’t fully accounted for regional variations, such as higher wages for workers and high concentrations of hospital-based certified agencies and dual-eligibles in some areas of the country. Some New York agencies have had to close, Noyes said, while others have cut staffing or are looking at consolidating.”
Crain’s Health Pulse reported today on a new rule offering flexibility for home care physician orders. “Home care agencies say a new rule under consideration by the Department of Health would make it easier to get reimbursed for physician-ordered services,” Crain’s reports. The rule would extend the physician order deadline to “12 months after admission to the agency, or prior to billing, whichever is sooner,” in an effort to align state and federal requirements.
“We appreciate the state’s support for a sensible timeline that has worked under Medicare,” said Joanne Cunningham, president of the Home Care Association of New York State, in a statement. “This proposal ensures that providers and physicians can focus on the initiation or modification of the care itself.”
Today, HCA President Joanne Cunningham had an op-ed published in the Albany Times Union where she outlined one of HCA’s major positions and concerns – that the Governor’s proposed $15 wage mandate must be funded and not draw energy or focus at a time when other home care program and reimbursement needs must be addressed in the state budget.
She stressed the enormous impact of the mandate – a stunning $1.9 billion for home care – but noted that the industry is “troubled” by the fact that “this new mandate draws focus away from home care needs long left unaddressed.” HCA “has long advocated for improved reimbursement to support home care worker wages and benefits,” she wrote. “We agree that staff should be compensated in measure to the valued work they do.” However, “funding for this wage mandate is vital,” and “past history gives us pause” when it comes to the state’s past promises to cover unfunded labor mandates.
Several news outlets gave press coverage about the impact of a minimum wage increase on home care. The coverage stemmed from legislative hearings where lawmakers questioned state health officials about the impact, and where health organizations delivered testimony about our impact analysis. That analysis finds that a minimum wage increase to $15 per hour would have a $1.7 billion impact on New York’s home care community whose reimbursement is capped by Medicaid. Below are some links to the news stories:
State must pick up $2.9 billion tab for higher wages, providers tell legislators (Crain’s Health Pulse, January 26, 2016)
No plan to account for wage hike (Times Union, January 26, 2016)
Health providers predict big trouble from $15 minimum wage (Gannett News Service, January 25, 2016)
WNYC reports on new federal overtime requirements for home health aides, reporting that “home health agencies operate on thin margins and most actually lose money, according to Roger Noyes, a spokesman for the Home Care Association of New York State. Noyes said employers now will have even greater incentive to limit overtime by using more workers to cover shorter shifts. ‘That affects the aide, and that affects the patient who might have multiple care-givers coming into their home — especially for those patients that require a lot of care,’ Noyes said.”
Listen to the report here.
The Albany Times Union explores the impact of minimum wage changes in fast-food on other sectors of the economy, including home care. According to the report, “‘We have heard some concerns about recruitment issues in home care stemming from market forces at play, such as wage changes in other industries,’ said Roger Noyes, spokesman for the Home Care Association of New York State.” Read the full report here.
The Wall Street Journal reports on a home care legal settlement which prompted a response from HCA. As reported by the Journal:
“Roger Noyes, a spokesman for the Home Care Association of New York State, which represents state home health-care providers, said they ‘provide a vital, cost-effective service to elderly, disabled and chronically ill New Yorkers.’ The activities of these agencies are ‘heavily regulated’ or monitored by state officials, Mr. Noyes said. The vast majority of them have internal procedures to make sure they comply with regulations and staff supervisions, he said.”
Read the Wall Street Journal article here.
Crain’s Health Pulse reports on HCA’s Home Care-Hospital Collaboration Program: “Back in 2013, the Home Care Association of New York State and the Iroquois Healthcare Alliance pushed for an initiative that supported home health care providers, hospitals and doctors as they hashed out collaborative models. Their ally was state Sen. Kemp Hannon (R-Nassau), who in February introduced legislation (S.1110) that established a program in the Department of Health ‘to facilitate innovation in hospital, home care agency and physician collaboration in meeting health care needs in communities.’ The bill was adapted in the state budget; it creates a statute within the Public Health Law to support ‘Hospital-Home Care-Physician Collaboration’ programs. The collaboratives can include long-term care facilities, behavioral health, supportive housing and other providers. The new statute provide a framework for programmatic, financial and regulatory support to facilitate transitions in care; use of clinical pathways; application of telehealth/telemedicine services; health home development; development and demonstration of new models of integrated or collaborative care; bundled payment demonstrations; and other initiatives. HCA said the new models are distinct from DSRIP in that they are ‘more open and flexible, may be smaller or larger in scale, and may be developed and implemented by different configurations of collaborating providers.'”
Download the report here.
The Utica Observer-Dispatch reported on legislation to create an “advanced home health aide” designation. The paper reported: “’The Home Care Association of New York State has long supported proposals for the flexible assignment of home care personnel,’ said Communications Director Roger Noyes. ‘In past years, we have advanced such proposals of our own, as a way of promoting access and continuity of patient care, as well as making the health care system more efficient in the care of patients at home.’ There still are, he noted, though, concerns that need to be addressed, including financing.” Read the article here.
“Lourdes at Home’s growing physical therapy department has received some glowing praise. The therapy team has won the Home Care Proud contest of the Home Care Association of New York State,” states News Channel 34 in Binghamton.
See the news report here.
The Albany Business Review reports on education levels and wages in health care, quoting HCA Board Member Joseph Twardy of the Visiting Nurse Service of Northeastern New York and HCA President Joanne Cunningham. “We’ve heard several stories about home health aides who enter the health care profession, distinguish themselves in their work on behalf of patients, and then move on to mentorship roles of their own,” Ms. Cunningham says in the article.
The Utica Observer Dispatch examines New York State proposals to allow home health aides to perform certain additional tasks under the supervision of an RN. “By being able to have a home health aide perform certain tasks under the nurse’s direction, that creates some more flexibility for assignment of aide personnel,” says HCA Communications Director Roger Noyes in the article.
Read the article here.
City & State magazine named HCA Communications Director Roger Noyes to its list of “40 under 40” Rising Stars.
Read the article here.
In the latest edition of Caring Magazine, HCA Communications Director Roger Noyes reports on the major changes occurring in New York’s Medicaid home care program.
Read the article here.
HCA’s Communications Director Roger Noyes writes a personal essay about his Great-Great Aunt Clara Noyes who headed the Red Cross’ Nursing Division during World War I. The article appears in the online Caring Magazine, a publication of the National Association for Home Care and Hospice (NAHC).
Read the article here.
State Senator Cecilia Tkaczyk visits with home care patient William Sprague, who suffers from schizophrenia, was homeless and had to go to the hospital multiple times before obtaining an apartment and getting home care services from Always There Home Care to help manage his condition. Read about her visit in the Middletown Times Herald Record.
Read the article here.
The Dunkirk Observer reports on Congressional efforts to streamline the home health authorization process. “Since it was implemented two years ago, the Medicare face-to-face documentation requirement has only created enormous new cost pressures for providers seeking to comply with the complex and duplicative mandate,” says HCA President Joanne Cunningham. “Worse yet, the current requirements have also placed undue limitations on access to care for the vast majority of Medicare beneficiaries whose clinical conditions are, without question, supported by the Medicare benefit and determined by the physician as requiring home care services. HCA greatly appreciates Congressmen Reed’s leadership in seeking a solution that maintains the important bridge between a home care provider and its physician community while mitigating the administrative burdens on both.”
Read the article here.
Inside Health Policy reports on an HCA-backed letter by New York’s Congressional Delegation seeking relief from Medicare documentation requirements for authorization of home health services.
HCA talks to the Utica Observer-Dispatch about the growing incidence of dementia and its impact on home care.
Read the article here.
In the June 2013 edition of Caring Magazine, HCA Communications Director Roger Noyes reports on the efforts of home care providers in response to Hurricane Sandy, as well as state policy initiatives to assist home care providers in their emergency response roles.
Several media outlets reported on the work of HCA members — and home care generally — in response to the devastation of Hurricane Sandy. See the links below.
HCA President Joanne Cunningham had a budget op-ed published in the Journal News on March 20 and co-wrote an op-ed in the March 27 Rochester Democrat and Chronicle with HCA Board Chair Vicky Hines, President and CEO of the Visiting Nurse Service of Rochester and Monroe County. The Journal News op-ed can be read here. The Democrat and Chronicle op-ed can be read here.
The Albany Times Union today published an op-ed by HCA President Joanne Cunningham entitled “Cuomo’s plan puts home health care in peril.” In the op-ed, Ms. Cunningham writes: “The governor’s $1 billion blow to home care will mean that successful, cost-effective home care models will fold, including agencies that have served their communities for decades. Chronically ill, elderly and disabled New Yorkers will spend more time in hospitals, nursing homes and institutions. Medicaid costs will increase; and the entire health care system will suffer.”
Read the full op-ed here.
HCA President Joanne Cunningham was quoted in a March 18 Times Union article on the inclusion of an unfunded wage mandate for home care in the state budget. “There is a sense it’s pretty loose and could be interpreted pretty broadly,” Ms. Cunningham says.
HCA was quoted in a Wall Street Journal article on aspects of the state budget — including an unfunded home care wage mandate — which do not save state dollars. In the article, entitled “Savings Plan Isn’t All Savings,” HCA is quoted as saying of the home care wage mandate that: “It’s a proposal that would add costs to providers in the context of a Medicaid redesign process aimed at making health care more efficient.” Read the article here.
The New York Times reached out to HCA President Joanne Cunningham seeking HCA’s perspective on assertions made by Governor Cuomo’s administration about Medicaid spending in the state budget. As HCA has extensively reported to the membership, the Governor singled out home care in his budget speech on February 1 using misleading data and politically-charged rhetoric about home care administrative costs and rates of spending.
The New York Post has published a letter to the editor by HCA President Joanne Cunningham in response to an op-ed about the cost of Medicaid.
Ms. Cunningham writes: “Elizabeth Lynam points to Medicaid spending differences between New York and other states, but New York is different for other reasons — high labor costs, extensive mandates and standards, high taxes and a disproportionate number of chronically ill patients (“Where Cuomo Should Cut Medicaid,” Post-Opinion, Nov. 30).
“HCA has advanced numerous legislative proposals for making Medicaid even more efficient,” she adds. “While previous governors have been slow to embrace our constructive approach, we look forward to bringing our ideas to the incoming Cuomo administration for its consideration during the upcoming budget.”
The New York Times today published a letter to the editor by HCA President Joanne Cunningham on federal health reform. She writes: “Home health care has received much attention lately as part of the national health reform debate … these services are a vital component of the health system, caring for the elderly, people with disabilities and the chronically ill, and helping patients avoid higher cost service use, like acute-care emergency room visits, lengthier inpatient stays or premature nursing home admission.”
HCA President Joanne Cunningham appeared on the December 6 CBS Evening News broadcast to discuss the impact of proposed home health care cuts as part of national health reform efforts. “A health care reform bill that includes significant cuts is very troubling because what it means is that patients don’t get served, services get cut, programs get cut,” Ms. Cunningham said.
HCA was quoted in an October 4 article in Newsday entitled “Lawmakers eye Medicare trims to pay for health overhaul.”
In the article, HCA describes the financial fragility of home care in New York State, noting that growth in the number of new certified home health agencies has been capped by a statewide moratorium and, in fact, the state has seen a loss in the number of Certified Home Health Agencies (CHHAs).
HCA Communications Director Roger Noyes “said Medicare cuts, combined with shrinking state Medicaid funds, could result in more agencies closing,” according to the article, which can be found here.
The Associated Press (AP) ran a story today on the Governor’s proposed cuts to home care, noting: “The trend of moving more patients from hospitals and nursing homes into less expensive home care treatment faces potential budget cuts in New York despite its potential to save government millions of Medicaid dollars.”
The story, which ran in several news outlets throughout New York State, included an interview with David Senecal, a patient at HCA-member agency Visiting Nurse Association of Albany, Saratoga, Rensselaer. Mr. Senecal has quadriplegia after injuring his spinal cord when he was 13. In 1980 “he was able to get home care and for the first time since the accident, felt independent,” the report states.
The story also quotes HCA President Joanne Cunningham, who described the devastating proposed home care cuts, and said: “Today’s home care patient 20 years ago would be in the hospital or nursing home.”
Read the article online.