James Fuccione, former Director of Legislative and Public Affairs for the Home Care Alliance, was extensively quoted in an article in the Springfield Republican today. The article, “Personal care attendants have less training, checks than other home care workers,” by Shira Schoenberg, Statehouse reporter for the Republican, compares background checks and training requirements for workers in the state Personal Care Attendant program with workers employed by home care agencies that provide services under the Executive Office of Elder Affairs home care program.
Home care workforce struggles are being highlighted based on data collected by the Paraprofessional Healthcare Institute and reported by WBUR.
The data is staggering and all points to a theme that the New England states will struggle with attracting enough home care workers to meet demand. The six states in the region also have the lowest birthing rates in the country. Combined with a rapidly aging population, researchers conclude that the workforce has to come from outside the region and likely outside of the united States entirely. The story points out the following stats:
As of 2014, more than a quarter of the home health care workers in Massachusetts were foreign-born, according to census data compiled by the Paraprofessional Healthcare Institute. Forty-one percent of the nursing assistants in the state’s assisted living facilities were also born outside of the U.S. And these numbers likely miss immigrants who work part-time or who may be here illegally and working under the radar.
The WBUR story quotes Barry Bluestone, a professor of public policy at Northeastern University who’s run some of the jobs numbers, and predicts that in Massachusetts, “we’re going to need about 93,000 additional home care workers over the next 10 years, or almost 10,000 a year.”
Bluestone lays out that the enormous challenge is potentially compounded by the political landscape:
“These are overwhelmingly immigrant workers, and what I fear is if the current kind of political environment either shuts off immigration, or potential immigrants look at the United States and say this is not a very comfortable or safe place to be,” Bluestone says. “I don’t have any idea how we’re going to fill those 10,000 jobs each year.”
WBUR also had a follow-up piece on their “Morning Edition” show spoke only to 1199 Service Employees International Union as a “representative” of the home care industry and workforce. SEIU shared national wage data and touted their work to achieve local raises to personal care attendants (PCA), leaving unaddressed the broader problem for home health aides, homemakers and other in-home caregivers related to rates and regulation. Recognizing the difficulty of covering a complex issue in a five-minute radio interview, the Home Care Alliance contacted WBUR with clarifying information and offered the organization’s expertise, along with that of member agencies.
For those looking, employers and job seekers in the home health industry may find career information through the New England Home Care Career Center, which is co-managed by the Home Care Alliance of Massachusetts.
Return to www.thinkhomecare.org.
Did you hear? The Alliance has moved!
Our new location is in Chinatown, just a few minutes walk from South Station. Our address is:
Home Care Alliance of Massachusetts
75 Kneeland St., Ste. 709
Boston, MA 02111
Return to www.thinkhomecare.org.
Though a statement published in a Boston Globe online article, MassHealth revealed that their first round of home health agency audits uncovered $22.5 million in improper billing.
Nine home health agencies were involved in the initial audits conducted in response to steep spending growth in the MassHealth home health program. As the Globe article points out, the majority of that spending growth is driven by 62 companies that have come online since 2013.
In response, the Home Care Alliance is making its statement on the audits available. The full text of the statement is copied below:
Home Care Alliance of MA Statement on MassHealth Audits
BOSTON, MA – MassHealth announced today that audits of home health providers have uncovered more than $22 million in improper payments. The audits were initiated in an effort to identify the sources of recent dramatic spending growth on MassHealth home health services.
The Home Care Alliance of Massachusetts, a nonprofit trade association representing home health and home care providers, has been working side-by-side with the state Medicaid office staff since these audits were announced. The Alliance supported and continues to support MassHealth’s efforts to ensure appropriate services are being provided. This includes a temporary moratorium on new providers, and a prior authorization process for approving home health care services. In the months since the latter measure was put in place, both sides are in constant communication to relay concerns and suggestions. After years of lax oversight, Governor Baker’s administration has put a long-overdue emphasis on program accountability to assure that only eligible MassHealth members receive the in-home services they need to preserve their health and well-being.
“Massachusetts is fortunate in having some the best home health providers in the country and we support MassHealth in these efforts because we want to preserve the high standards of quality that patients and their families should expect,” said Patricia Kelleher, Executive Director of the Home Care Alliance of MA. “These audits only help to prove what our organization has been saying for years: There needs to be better state oversight as well as a higher bar of entry into the market.”
“Many of the MassHealth enrollees that our member agencies see have severe and persistent mental illnesses, and the multiple medications that they take can cause additional medical problems that require ongoing medical attention,” added Kelleher. “The agencies who do this work feel that they are a huge part of the health care safety net, providing valuable services to patients and families who otherwise would be placed in costlier care settings and/or become a detriment or even threat to their communities.”
The decision to add new management controls was driven by growth in utilization of the benefit particularly between FY 2013 and FY 2015. At present approximately 32,000 MassHealth enrollees are using home health services on an annual basis. Of these approximately 7,000 are receiving home health to assist in managing a mental or behavioral health condition, 4,000 are under age 21 and 9,300 are over age 61.
“Although MassHealth has not shared the specific audit results with us, we will continue to push for better standards and support program integrity efforts on behalf of all agencies that are playing by the rules and providing great care,” said Kelleher.
Return to www.thinkhomecare.org.
The US Department of Justice announced that 301 individuals have been charged with falsely billing Medicare a total of approximately $900 million in what is being called the largest coordinated Medicare fraud take down in history.
Home health services were among a list of services involved in the fraud schemes that also included physical and occupational therapy, durable medical equipment (DME) and prescription drugs. In the process, the HHS Inspector General released a data brief titled “Nationwide Analysis of Common Characteristics in OIG Home Health Fraud Cases.”
That data brief reveal some trends in outlier patterns among home health agencies and affiliated physicians, but also identifies 27 “hot spots” in 12 states where home health care fraud is prevalent. Massachusetts is not among the states shown in the map below where much of the home health fraud activity is occurring.
Recently, Massachusetts has been included in a planned “pre-claim review” demonstration starting “no earlier” than January 2017 that will, according to CMS, test whether such a process improves methods for the identification, investigation, and prosecution of Medicare fraud occurring among Home Health Agencies. Among the five states involved in the demonstration, Massachusetts is the only one not on any target list for the Medicare Fraud Task force known as HEAT (Health Care Fraud Prevention & Enforcement Action Team). For many years, the Home Care Alliance has repeatedly advocated for a temporary moratorium on new Medicare home health providers in response to recent growth in the number of new agencies, but such efforts have been denied by Medicare.
Home care had a prominent place in this year’s “Salute to Nurses,” a special section published every year in the Boston Globe recognizing the work of nurses in every health care setting.
The compassionate and high-quality care of nurses from several home care agencies were recognized, including CareGroup Parmenter Home Care & Hospice, Comfort Home Care, Emerson Hospital Home Care, Hallmark Health VNA & Hospice, and Home Health VNA. Many more stories from patients, their families and nurse colleagues highlighted cases where a nurse from a setting other than home care arranged for post-acute services or follow-up in some way.
Although it wasn’t from a traditional home care agency, another article was dedicated to Allison Neff, a nurse in Boston Medical Center’s “Elders Living at Home” Program. The article explains:
Neff joined the Elders Living at Home Program, which prevents homelessness among seniors, in 2008. Her job is to conduct home visits to ELAHP patients who don’t qualify for visiting nurse services provided by the state, but who need assistance with some aspect of their health. Many of her patients are at imminent risk of losing their housing, or were homeless and are now transitioning into housing.
The Home Care Alliance will be recognizing all levels of home care staff at the annual Innovation Showcase & Star Awards on June 14th. Clinicians, aides, managers, physicians and other home care champions can be nominated for recognition at the event’s website.
Return to www.thinkhomecare.org.