ALBANY — Today the state Assembly held a public hearing on home care workforce issues.
This hearing follows an earlier one, held last week (on February 22) in New York City. HCA sent the following statement in response to the February 22 hearing: https://hca-nys.org/policy-positions/hca-statement-state-assembly-hearing-on-home-care-workforce-issues.
Today’s HCA testimony in Albany was presented by HCA Executive Vice President Al Cardillo. The testimony can be downloaded from our website at: https://hca-nys.org/wp-content/uploads/2017/02/Testimony-of-Home-Care-Association-of-NYS_Homecare-Workforce-Hearing-2-27-2017.pdf.
“The public health system has been reconfigured to require and rely on ready access to timely, capable and person-centered home care,” Mr. Cardillo said. “Current governmental policies and reforms are rapidly and substantially deepening this reliance.”
“These service and personnel needs are significant in all geographic regions – rural, urban and suburban. Additionally, each region creates a unique set of challenges to the delivery of services in home and community, and to the personnel responsible to deliver and manage them. In rural areas for example, there are large travel distances, low population density, limited community and health/social resources, and remote distributions of households. Urban and suburban areas likewise present geographic-specific, sometimes neighborhood-specific, needs and challenges.”
According to a recent HCA survey, home care agencies across New York State report a 24% turnover rate for home care aides and a 21% turnover rate for nurses and other professional staff. This same survey found that approximately 14% of home health aide, 17% of personal care aide, 13.5% of registered nurse, and 10.6% of therapist positions are unfilled due to shortages. Providers also report they are unable to accept an average of 37.3 cases due to staff shortages statewide. One agency separately reports having to turn down 350 patients in just one county due to the shortage of aides. These findings raise major concerns about the capacity of home care to deliver needed services, as well as continuity-of-care issues for patients who rely on a stable and consistent workforce to meet their daily, intensive needs.
HCA has submitted Article VII language to the Legislature and Executive to direct the establishment and implementation of a comprehensive home care policy and plan —with the active involvement of all stakeholders, and the close oversight of the Legislature — to address workforce issues. The HCA proposal would ensure:
- Adequate number and location of home care services agencies, including licensed agencies, certified home health agencies, and long term home health care program providers.
- Adequate capacity of the direct care workforce in numbers, locations, hours of availability and necessary areas of training.
- Adequate capacity and accessibility of both basic and specialty training programs for direct care staff, including specialty training in: care management; population health; palliative care; pediatrics; specialized screenings for clinical risk areas; behavioral health; areas of health disparity; use of point-of-service technology, and others.
- New skills, scope-of-practice flexibility and/or changes needed to meet the needs of new populations and/or new models of care and coverage at home.
- Identification of and incorporation of technologies which assist in service efficiency and meeting workforce capacity needs.
- Provisions needed to support and incentivize direct care workers’ employment in home care, including but not limited to support for transportation, peer support, worker escort, day care, and career ladder opportunities.
- Strategies for collaboration with the Departments of Labor and Education, the State University of New York, area health education centers, the Center for Health Workforce Studies, professional schools, state home care associations, and others on encouraging career/employment interest in home health.
- Provisions for managed care and non-managed care financing to support agency, worker and training capacity, including compensation amounts necessary to recruit and retain a sufficient, quality and diverse direct care workforce at a time when managed long term care plans and home care providers are shouldering aggregate operating losses and other financial pressures due to the funding structure of home care. These findings are detailed in our report on the financial condition of the home care and MLTC sectors, available at https://hca-nys.org/wp-content/uploads/2017/01/NYSHomeCareProgramandFinancialTrends2017.pdf.
- Recommendations to the Legislature and Governor for administrative and/or legislative modification of state insurance requirements for private and commercial policies’ home care coverage to ensure that beneficiaries have access to home care service coverage consistent with prevailing standards of medical practice and state policies for health care delivery.
Roger L. Noyes
Communications Director, Home Care Association of New York State (HCA)
(518) 810-0665 (office); (518) 275-6961 (cell)