PHInational.org

The PHI Coaching Approach is profiled in an article in the May issue of the professional journal Home Healthcare Nurse.

In the article, Marki Flannery, the president of the New York City home care agency Partners in Care, details her organization’s use of the PHI Coaching Approach to improve her aides’ morale and job satisfaction.

She explains that coaching has proven successful in a number of ways, and it remains a big part of Partners in Care’s overall culture.

Introducing Coaching

Flannery writes that just four years ago, the climate at Partners in Care was often hostile and volatile.

Interactions between supervisors and aides “were quite heated, punitive, and often resulted in disciplinary conversations,” she notes.

In order to change that, Flannery and her organization participated in the PHI Center for Coaching Leadership and Supervision (CCSL), a program funded by The John A. Hartford Foundation and The Atlantic Philanthropies.

Through CCSL she and other Partners in Care administrators learned the core skills of the PHI Coaching Approach: active listening, self-management, self-awareness, and presenting problems objectively and without judgment.

Today, everyone who works at Partners in Care — including all 8,500 of its home health aides — have received some form of coaching training.

Consequently, Flannery writes, aides feel less stress, accomplish more during their workdays, and feel more valued within the organization.

Editorial Thanks Home Health Aides

The May issue also contains an editorial (pdf) entitled “From the Heart: Thank You to Home Health, Home Care, and Hospice Aides!” written by Home Healthcare Nurse editor Tina Marrelli.

In her piece, Marrelli cites numerous facts from the recent PHI publication The Direct-Care Worker at a Glance (pdf).

She also notes that the July/August 2012 issue of Home Healthcare Nurse will be devoted to home care aides and hospice aides.

– by Matthew Ozga

NY Capitol Building in Albany

The New York State Budget for 2011-2012, passed on March 31, includes sweeping legislation that will dramatically alter the way New York pays for and delivers Medicaid services, particularly in home- and community-based settings.

Most of the recommendations of Governor Andrew Cuomo’s Medicaid Redesign Team (MRT), which was charged with identifying the best ways to reduce costs and improve the health delivery system, were incorporated.

PHI has been an active proponent for two key measures that were included in the budget:

• Wage parity for home health aides: Organizations providing Medicaid services in the downstate area — New York City and Westchester, Nassau, and Suffolk counties — are required to compensate their home health aides using the living wage of that geographic area, which will result in an hourly wage increase of $2. As a result, home health aides will earn the same wage as personal care aides.
• Care management models and the integration of services within capitated models of care: Beginning in April 2012, consumers who need more than 120 days of community-based long-term care will transition into care management models. And personal care will be incorporated into the Medicaid managed care benefit once the state gets approval from the federal government.

PHI and Independence Care System Provided Blueprint for Reform

PHI and its affiliated managed long-term care organization, Independence Care System, advocated for the wage improvements for home health aides as well as the greater use of care management models. Both of these provisions were in the blueprint (pdf) they presented to the MRT.

Once implemented, these provisions will increase efficiency and address a long-standing inequity in the pay for home health aides.

“Home health aides have always been underpaid for the difficult, sensitive, and important work they do,” says Assembly Member Richard N. Gottfried.

“At some home health agencies, the under-compensation has been shocking. The living wage provision in the state budget, together with other reforms, will bring more fairness to home health aides, reduce costly turnover that reduces quality, assure more appropriate services, and reasonably contain costs. However, it is important that these reforms be implemented carefully, to avoid disruption and unintended damage to good providers,” Gottfried said.

Living Wage Implementation

In New York City, parity with the personal care aides, who currently earn $10 an hour, would be implemented over a 3-year period. Home health aides will begin the transition to parity starting March 1, 2012.

Although Westchester, Nassau, and Suffolk counties have living wage laws in effect, the home health aides working in these counties will not receive an increase until March 1, 2013. However, aides in these counties may reach 115 percent of total compensation required under the New York City living wage law by March 2016.

Health care benefits and paid time off are determined by the collective bargaining agreement (CBA) in effect on January 1, 2011 or by the terms of the Living Wage law in the county in which care is delivered, if there is no union contract.

“This budget finally corrects an injustice that’s been in place for many years,” says PHI New York Policy Director Carol Rodat. “It’s not only good economic policy given the size of the home care aide workforce, but wage parity ensures continuity of care as it makes it possible for aides to remain with their clients when they transition to care management models.”

PHI Longtime Supporter of Wage Parity

PHI has been a strong advocate of improving jobs for home care workers as a means of reforming the Medicaid system. PHI has published several papers that detail the size, training, and health coverage of the home care workforce, including the inequities in the home health aide wages.

“The United Hospital Fund has long supported analytic work that focuses on the direct-care/home care workforce, beginning with the 1994 report, ‘Better Jobs, Better Care: Building the Home Care Work Force,’ and more recently through the support of three PHI reports on the aide workforce,” says UHF Senior Vice President for Program David Gould.

“We’re pleased that the state’s budget recognizes the importance of this workforce by providing a movement towards parity for the home health aides. This provision promises to encourage continuity of care while creating better jobs, and we applaud PHI for its work in this arena,” Gould added.

– by the PHI New York State Policy Team

On February 24, New York State’s Medicaid Redesign Team (MRT) passed a package of 79 reforms and cuts, including making wage parity for home care workers a condition for providers to participate in the Medicaid program.

The group of lawmakers, providers, and representatives from trade, union, and consumer groups was appointed by Governor Andrew Cuomo during his first week in office to find ways to cut Medicaid costs for FY 2012.

“Parity is an issue that we have cared deeply about — and fought for — over the last several years,” said Rick Surpin, PHI board chair and president of Independence Care System. “Parity is essentially about creating good jobs and providing good care, which is part of the core of PHI’s work. It is now also a critical element of Medicaid Redesign in New York State.”

The proposed package could save the state $1.14 billion in FY 2012, or a combined total of $2.3 billion in state and federal Medicaid savings.

Positive Impact on Home Care Workers

If passed, effective October 2011, all certified home health agencies, long-term home health care programs, and managed long-term care plans (MLTCs) serving Medicaid clients in a geographic area with a living wage law will be required to comply with that law.

The Medicaid reform package also includes a provision, beginning in 2012, to transition most Medicaid beneficiaries over age 21 who need more than 120 days of care into a MLTC plan, a PACE program, or into Medicaid Advantage Plus managed care programs.

“Since the redesign of the delivery system includes transitioning clients to programs with strong care management, it was imperative that the wage parity proposal be part of the final package,” said PHI New York State Policy Director Carol Rodat.

“This shift would have required many personal care aides — who earn $10 an hour — to take a $2 pay cut in order to stay with their client, who under managed care would receive home health aide services. In short, without parity the changes threaten continuity of care as well as the workforce,” Rodat said.

In exchange for cuts to home health reimbursement and increased use of care management models, the package also includes a provision to expand the scope of practice to allow home health aides to administer pre-poured medications to non-self-directing clients as well as self-directing ones.

Plan Awaits Passage

Governor Cuomo has approved the MRT’s recommendations, which will now be included in the executive budget’s 30-day amendments due to the legislature on March 3. The deadline for passing the state budget is April 1.

“PHI is pleased with the MRT proposal, particularly its positive impact on wages for home care workers,” Rodat said.

To stay abreast of how New York’s direct-care workers will fare under Medicaid Redesign, visit the PHI New York website and subscribe to PHI New York News.

– by Meghan Shineman, PHI New York Policy Analyst

A new section of the PHI PolicyWorks website has been launched to support the work of PHI New York to improve both the quality of direct-care jobs as well as the quality of care for elders and people with disabilities in New York State.

“Opportunities are at hand for New York to make much-needed reforms related to the direct-care workforce,” said New York State Policy Director Carol Rodat. “We are pushing for these reforms and hope others will visit our website to learn more about our work and its importance.”

The New York State web section provides comprehensive information on the state’s direct-care workforce:

Workforce Facts is chock full of information on the state’s direct-care workforce demographics, as well as the projected growth in direct-care worker jobs and the fastest-growing occupations in the state.

Priorities explores the three issues identified by the New York State Policy Team as their top concerns and the solutions they are pursuing to address them.

The Resources section provides links to New York State organizations that have a stake in the state’s delivery of long-term care services and supports — from advocacy to trade organizations and government offices to PHI affiliates.

This section also features Publications pages containing links to reports, including the recently released New York’s Home Care Aide Workforce series and A Home and Community-Based Service System Reform Blueprint (pdf).

The News pages give readers a one-stop spot to stay abreast of timely issues that impact the direct-care workforce in New York State. Users can subscribe to get email updates when new information is posted to PHI New York.

Portals highlighting the efforts of PHI’s regional staff in Michigan, Pennsylvania, and Massachusetts are under development and expected to be launched over the next few months.

“PHI’s regional efforts are a critical component of our policy strategy,” said Steven Edelstein, PHI’s national policy director. “Having strong examples at the state level of what is possible through a Quality Care, Quality Jobs approach helps to both inform and drive these issues in other states as well as at the national level.”

– by Deane Beebe

The U.S. Attorney for the Southern District of New York filed a lawsuit (pdf) against New York City on January 11, claiming that the city’s Medicaid program had improperly authorized 24-hour, community-based personal care services for frail elders and people with disabilities when these consumers would be better served in a nursing home.

The suit alleges that the city disregarded the rules requiring that doctors, nurses, and social workers make recommendations regarding enrolling consumers in home care.

It also contends that the city had reauthorized 24-hour personal care services without conducting the required assessments and that in some cases the consumers were receiving too much care.

Suit Implies Financial Gain

The U.S. Attorney’s office claims that New York City had overbilled Medicaid by “at least tens of millions of dollars” and implies that the city did so for financial gain. Beginning in 2006, only the state and federal government shared the cost of Medicaid Personal Care Services (pdf), but the city has been responsible for a share of nursing home care costs, according to The New York Times.

“We don’t think that the suit is well-founded,” New York City Mayor Michael Bloomberg told the New York Daily News. “We never received one cent from the process. But it will certainly require a lot of expense on the city’s part for our lawyers to go through lots of documentation.”

“We’re proud that our elderly residents, wherever possible, are not forced into nursing homes,” Bloomberg added.

Chilling Effect on Home Care

On January 12, dozens of disability rights advocates, consumer advocacy organizations, legal representatives, and consumers sent a letter (pdf) to Preet Bharara, the U.S. Attorney who brought the suit against the city, asking that it be withdrawn immediately.

The letter states that New York City has done an excellent job of complying with the Supreme Court’s Olmstead decision, which requires states to provide care in community settings rather than institutions when possible.

The advocates also take issue with the complaint that the consumers cited in the suit would have received “more intensive,” “more appropriate,” or “safer” care in a nursing home compared with home care, calling such claims a “myth.”

They write that “we are concerned that the lawsuit is already having a chilling effect and will discourage the authorization of adequate Medicaid home care for people who desperately need it to live in their homes.”

Applauded, Not Punished

“New York City’s personal care program is a success story — it should be applauded, not punished, for enabling so many people with disabilities, old and young, to remain in the community rather than enter nursing homes,” Valerie Bogart, director of the Evelyn Frank Legal Resources Program at Selfhelp Community Services, told PHI. Bogart helped organize the advocates’ response to the suit.

The advocates also question the allegation that the city gains financially by authorizing more personal care services than needed, because “the City’s share of Medicaid costs is the same for all long-term care services, whether at home or in nursing homes.”

“The physician who brought the so-called whistleblower case may personally believe that these individuals belong in nursing homes, but his views should not be endorsed by the federal government — they completely fly in the face of the Americans with Disabilities Act and Olmstead,” Bogart said.

“The federal prosecutors should be going after real Medicaid fraud, not punishing New York City for providing 24-hour home care for people who desperately need it,” she continued.

Independence Care System, a PHI affiliate that operates a nonprofit, Medicaid-managed long-term care plan in New York City, signed onto the letter.

– by Deane Beebe

The findings from a new analysis of elderly consumers with both Medicare and Medicaid who receive personal care services in New York City were released in late December in a report entitled “Medicaid Personal Care in New York City: Service Use and Spending Patterns.”

The analysis, by the Medicaid Institute at United Hospital Fund (UHF), was designed to capture a profile of the characteristics of these personal care recipients, including Medicaid enrollment patterns, personal care service use, and overall Medicaid service use and spending.

UHF researchers Sarah Samis and Michael Birnbaum examined elderly dual eligible consumers who received personal care services in 2008. They also followed elderly dual eligibles who first began receiving personal care services in 2003, following them from 2002, before they started receiving services, through 2008.

Some of the Findings

Medicaid Enrollment Patterns

• The consumers receiving personal care services had been enrolled in Medicaid for a total of 7 years or longer.
• The average time on Medicaid before receiving personal care services was 13 months.

Duration of Personal Care Service Use

• Over 40 percent of the consumers receiving personal care services received them for at least 7 years, with an average of 4.75 years.
• The average length of time of care received tended to be either short-term (two years or less) or long-term (six years or more).

Amount of Care Received

• “High intensity users” of personal care services had higher rates of mental illness or cognitive impairment, as well as higher Medicaid spending on other long-term care services, before receiving personal care services.
• “High intensity users” received care for an average of 1.5 years longer than low-intensity users.

Personal Care Recipients Overall Medicaid Service Use and Costs

• Once these consumers began receiving personal care services, they typically did not revert to lower levels of service use or cost.

Rates of Personal Care Service Use Across New York City

• There was substantial variation in the patterns of personal care service use and spending across neighborhoods in New York City, with duals in some neighborhoods twice as likely as duals in other neighborhoods to receive personal care services. Other patterns — such as volume of services delivered per episode — showed some uniformity throughout the city.

“This report is a valuable contribution to understanding New York’s personal care program, the beneficiaries, and their service needs over time,” said PHI New York State Policy Director Carol Rodat. “These findings should encourage policymakers to pursue better data systems, as well as a standardized assessment process to help ensure uniform application of eligibility standards going forward.”

– by Deane Beebe