Tag Archives: home care

Home-care workers facing numerous challenges during pandemic

Photo: Deborah Crowe

Photo: Deborah Crowe

Is home health care the next COVID-19 hot spot? It may very well be, according to home care workers and leaders of a union that represents many of them. In a video press conference on April 15, several home care workers said that neither their agency nor the federal government was doing enough to keep them safe.

Social distancing while performing in-home care is impossible due to the intimate nature of their jobs, said the workers, who provide personal assistance and health care support. Continue reading

Is this home care project a model for caring for the frail, chronically ill?

Photo: GraphicStock

Photo: GraphicStock

As health insurers adopt population health strategies they find that home-bound patients are the most difficult to reach. Under fee-for-service payment, insurers didn’t need to focus on these patients.

But the combination of the star-rating program that Medicare uses in its Medicare Advantage plans and the need to prevent hospital readmissions means health insurers now are paying extra attention to home-bound patients with chronic illnesses. Typically, these are the 5 percent of patients who account for half of all spending. Continue reading

PACE legislation to expand in-home care passes Congress

Photo by My Future via Flickr

Photo by My Future via Flickr

The House of Representatives on Oct. 21 passed legislation aimed at reducing costs and strengthening comprehensive, coordinated health care and related long-term services for some of the country’s most vulnerable citizens. It now heads to the President Barack Obama’s desk for his signature.

The Providing Programs of All Inclusive Care for the Elderly Act (PACE) Innovation Act (S 1362) will expand the current PACE program by allowing the Centers for Medicare and Medicaid (CMS) to conduct demonstration projects, using the PACE Model of Care, to serve individuals with disabilities an integrated, community-based setting that supports independence and enhances quality of life. It will also work to improve health outcomes and reduce costs for seniors who are eligible for both Medicare and Medicaid. Continue reading

Investigation reveals N.Y. lax on home care oversight

In the Albany (N.Y.) Times Union, Matt Drange’s investigation is titled “Home health care in crisis.” Having read the piece, I can say it’s safe to take that declaration at face value. At the very time that home care is booming in New York as a cheaper, more convenient alternative to nursing homes, the state has cut back on its number of health inspectors. Meanwhile, the complexity of home care cases is rising, as hospitals release patients earlier and the population as a whole ages. The results, Drange writes, have been predictable.

Lapses have gone undetected or, in many cases, unpunished by the Department of Health, the arm of state government tasked with overseeing home health agencies. Providers are not required to notify the department when patients experience sudden or unexpected changes in their condition, including death. And even when the state does learn about these incidents, it doesn’t always act on the information, records show.

For the investigation, Drange looked at public records regarding Medicaid billing, home care agency registration and plenty of state inspection reports. He focused his review on 40 of the worst offenders, and found more than enough examples to illustrate a system in crisis. Drange’s anecdotes recount numerous egregious lapses in care, and I strongly recommend digging into the meat of the piece, if only to see what incredible detail he found in public records. For now though, at the risk of mild spoilers, I’ll just reveal that they all end in the same way: The problem goes undetected, unenforced, or underpunished.

In the end, as reporters have found in other states as well, the root of the problem seems to be a weak and vaguely defined regulatory system. In his investigation, for example, Drange found a sharp contrast between the oversight of nursing homes and home care, two institutions which often perform similar functions.

(Researcher Sam Krinsky of the United Healthcare Workers East 1199 Union) said the culture of home care differs vastly from that of nursing homes, which have received more attention in New York and elsewhere.

Statements of deficiencies issued to home care agencies by the Department of Health are “not something that we take seriously,” Krinsky said.

“In nursing homes, the inspections are a big deal. There are a lot more regulations they have to comply with … It’s just a much more robust system,” he said. “In home care, it’s more of a review of paperwork. It [Department of Health] doesn’t have any teeth.”

Your thoughts on this story?

Drange, an AHCJ member and recent graduate of the Columbia Journalism School, did this investigation as his master’s project. He invites feedback from other health care reporters about the story and anything he could have done differently. Feel free to comment below or send your thoughts to him at mattdrange@gmail.com or on Twitter (@mattdrange).