NYS Home Health Care Crisis: Problem, Progress & Possibility June 2017

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1 NYS Home Health Care Crisis: Problem, Progress & Possibility June 2017

2 Campaign Goal To seek adequate, accessible, affordable, and available home care for those who need it, regardless of payer.

3 Inadequate Home Health Aide Services: Both the Medicaid and Non-Medicaid populations are underserved. Regardless of a person s income, there simply are not adequate home health aide services available to provide care to those who need it and are authorized to receive it. Elders face delayed discharge from hospitals or require costlier institutionalizations

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5 The Age Wave It s Coming It s Here! By 2035 the number of elders over the age of 85 in Essex and Franklin county will increase by 30 percent. Today more than 13 % of the population in Franklin County and 20% in Essex County are over age 65 one-fifth of the population! By 2030, the number will be 21% and 30% respectively almost 1/3 of the population in Essex County.

6 Between January and August 2015, North Country Home Services, the major provider of home care assistance in Essex and Franklin Counties, had 6500 hours of unfilled but authorized hours of care. NYS Home Care Crisis Why a Campaign?

7 Decreasing numbers of available informal caregivers Aged Dependency Ratio Ratio of persons aged 18 to 59 years to persons aged 60 years and over Aged Dependancy Ratio Year: New York State Essex County Franklin County Source: Data Source: Woods and Poole Economics, Inc State Profile Fewer family member caregivers are available than in the past especially here in the Adirondacks where a high portion of the younger generation have been moving away for education and career, leaving their parents behind.

8 The Increasing Need for Home Care Services in New York State By the year 2030: fully 25% of NYS s population will be 65 years of age or older; the Age Dependancy Ratio in New York State will be down to 2.1 and decreasing as time passes

9 Partners Seeking Solutions Building a Coalition Caregiving Working Group of Essex and Franklin Counties responded to the crisis. A statewide coalition was launched to raise awareness and seek solutions. Coalition partners now number more than 100 individuals in dozens of organizations throughout the State.

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11 2017 Home Care Campaign Media Headlines Tri-county area grapples with home aide crisis Sun Community News Advocates: Homecare workers shortage is a crisis Adirondack Daily Enterprise Mercy Care: Far too few home-care aids for aging populations Press Republican Home Health Care Crisis in the Adirondacks Tupper Lake Free Press Home health aide shortage leaves some lacking care Press Republican End the Waiting Lists. Help New York Seniors Stay in their Homes. AARP New York Ad, Press Republican I m overbooked, says caregiver, distressed over future Valley News Sun Wage hikes could up health aide shortage Adirondack Daily Enterprise Home health aide shortage could worsen Press Republican How to Solve the Aide crisis? Valley News Sun

12 Progress North Country Home Services (NCHS), the major provider of home health aide services in Essex and Franklin Counties, was awarded a NYS Vital Access/Safety Net Provider Program grant from NYS DOH through the Blue Line Group a partnership of the only four non-public, not-for-profit nursing homes in the 6-million-acre Adirondack Park.

13 Progress Results: Mileage reimbursement was reinstated for home health aides $100 bonus for home health aides completing the training class was established $200 bonus established for new home health aides after completing 3 months of employment with the Agency. On January 1, 2016 wages for all Aide staff were raised by an additional $1.00 / hour for a total raise of $2.40 / hour since October 2015 In 2016 a total of 85 individuals were recruited and trained as home care aides. In January more individuals were trained bringing a total of 247 home care aides for the North Country Home Care Services. Turnover rate at North Country Home Services (NCHS) has been reduced from 35% to 4% in the past year. As of 1/1/17, there were 230 unfilled service hours of care per week, down from 503 unfilled hours in October 2015.

14 Crisis Across NYS December 2016 Group List Serve to all Area Agencies on Aging Stories from a total of 14 counties describing cases and system issues 10 additional counties supporting the statements of the 14 counties with the stories

15 Statewide Systemic Issues More people on wait lists than being served; people are dying on the waiting list Shrinking workforce as the years pass, inability to accept new cases Direct Care Worker Grant paperwork obstacles Goal in reducing skilled nursing beds, hospital beds and expanding Medicaid have placed an enormous burden on home care Many of the agencies only hire part-time workers with no benefits this leads to high turnover rates Some of the rural counties only have one service provider for the entire county Managed Long Term Care agencies not finding care workers for hours that they have approved. Lack of living wage; lack of mileage reimbursement EISEP, Title IIIe and Alzheimer s respite funding may be authorized but not spent due to not being able to use the hours due to lack of aides.

16 Sustainability of Home Care Agencies at Risk 70% of Certified Home Health Agencies and Long Term Home Health Care Programs had negative operating margins in 2013 and One-half of home care agencies have had to use a line of credit or borrow money to pay for operating expenses over the past two years. Home Care Association of New York

17 Shortage Impact across NYS All the areas have the same thing in common: There is a shortage, it doesn t matter which program is paying for it. The workforce is shrinking. Counties from across the state responded with stories of unfilled EISEP and Medicaid home care cases

18 AAAs What Can We Do to Advance the Campaign? Find case examples of: Medicare, Medicaid, Private Pay & EISEP clients that we can highlight in the Campaign Keep track of the unmet need: How many approved hours of care have gone or are going unfilled due to the lack of workforce Identify a cadre of spokespersons: clients, case managers, professionals, who can speak to the issue Share your stories with our coalition and with your local media Meet with your local elected officials and share your stories

19 Area Agencies on Aging Case Examples Numerous stories of clients passing away before care ever being obtained although authorized Repeated instances of failed nursing home discharges due to lack of direct care professionals Home care agencies closing, or refusing to open a case unless a minimum hour requirement was met Veterans aide and attendance also not filled based on lack of available providers

20 What s the Campaign Up To in 2017? Our Coalition asked for NYS Legislative Hearing on the home care workforce shortage problems. Four NYS Assembly Committees joined to host hearings: Health, Aging, Labor, and Assembly Task Force on People with Disabilities. Two hearings scheduled: New York City on February 22, 2017 Albany on February 27, 2017

21 Tools for Testifying Our Coalition distributed tips for testifying and sample testimony to help partners prepare.

22 Assembly Hearings Participation Exceeded Expectations In NYC, an overflow hearing room had to be opened to accommodate hearing participants In Albany, testimony was presented until almost 9PM. Overall, more than 80 testimonies were presented by individual care recipients and home care workers, organizations, trade associations and providers. The NYS Department of Health testified in Albany.

23 Albany Times Union (2/27/2017) Lawmakers hear of crisis in home care Marathon Assembly hearing says state's support is lackluster as pay increases in other sectors faster

24 Assembly Hearings Hearing Focus: Obstacles to recruiting, employing, and retaining a sufficient workforce including but not limited to: training, wages and benefits, and geographic coverage of services. Payment rates from Medicaid managed care, funding for Expanded In-Home Services for the Elderly Role of managed care organizations in directing the resources toward patient-centered care, and the increasing demand for home care

25 Read or Watch the Testimony

26 Jason Helgerson, State Medicaid director and Deputy Commissioner, NYS Department of Health We think at this moment, the networks are adequate. I would argue particularly in rural upstate counties, the advent of managed care, managed long-term care has actually increased the supply of homecare services and actually brought to counties that didn t previously have that access and we are pleased by that. I believe the rates we pay the plans are in fact adequate.

27 Rebecca Leahy, President/ CEO, North Country Home Services, Inc. North Country Home Services is paid from five to $9 per hour less than the cost of providing the service for Medicaid patients. The reason for our losses is an inadequate Medicaid rate to cover our direct care costs. The rate didn t allow us to pay our aides for their time, travel time and mileage. Within one month, we had lost over 40 aides because they could not continue to subsidize Medicaid by shouldering the costs themselves.

28 ASSEMBLY MEMBER BILLY JONES: There was a question presented, do we have the workforce in the home healthcare field.. Travel is a big issue. People in my area, healthcare workers are traveling 60, 70 miles each way for one visit to get to their visits, adverse road conditions. and the expense on their own vehicles for doing that and other issues. The key component is to have the home healthcare workers in place, because without that, our constituents are going to emergency room visits, the re readmissions to hospitals. It s compounding the cost of that, not to mention the human effect of that. So I would say that we are in crisis mode here in rural areas and please we need to address this, because without it, we re in a real bind.

29 Campaign Holds Briefing Our Coalition held a conference call to: debrief following the legislative hearings encourage visits to legislators in local offices hear from NYS Assembly Health Committee staff on budget proposals to address home care workforce shortage concerns.

30 NYS BUDGET Assembly and Senate both propose language to improve transparency in rate setting for Medicaid Managed Long Term Care to ensure funds are going to home care agencies to support recruitment & retention of home care workers. Governor s office REJECTED this approach. Increased COLA for direct care staff in OMH, OPWDD and OASAS agencies. Large investment in funding for staff in developmental disability services to meet minimum wage. Increased funds for CSE in NYSOFA budget - $875,000 added

31 Legislative Health Committee Chairs introduce Medicaid home care rate transparency S4848 Sen. Hannon PASSED SENATE A6706 Assy. Gottfried

32 North Country Legislators introduce Medicaid rural home care rate adjustment S5479 Sen. Little A6791 Assy. Jones increasing Medicaid reimbursement rates for rural home health care providers to cover actual costs of delivery.

33 Working Together Produces Results The Campaign and Coalition Members will continue seeking to create systemic change that will help consumers, providers, and the rest of the community around the state.

34 Going Forward The New York State Home Care Crisis Campaign will continue to work to: Raise awareness and seek solutions to the lack of home health care in the New York State. Together, we will seek: More qualified home health care workers Improved quality of the home health delivery system in NYS Improved quality of life of consumers who access home care

35 Next Steps in the Campaign for adequate, affordable, and accessible home and community based care Evaluate the impact of NYS budget adopted on adequate, available, accessible, and affordable home care Share Progress Reports with Press Educate the public about the need for adequate, accessible, and affordable home and community based care services for all people needing care regardless of payer source Advocate for additional incentives to recruit and retain an adequate home health aide workforce Continue to network with DSRIP Workforce Committee Working with partners, analyze alternatives for noninstitutional care related to housing options

36 Summer/Fall 2017 Sign on to our Coalition If already a member, encourage your community partners to sign on Participate in our Coalition Conference Calls Add your Ideas and your Voice Brief your local media

37 Workforce Investment Program $245 million through March 2020 The Department of Health (DOH) will require MLTC plans to contract with DOH designated workforce training centers, to: Invest in initiatives to attract, recruit and retain long term care workers in the areas they serve; Develop plans to address reductions in health disparities by focusing on the placement of long term care workers in medically underserved communities; Consistently analyze the changing training and employment needs of the area that the program serves; Provide for broad participation and input from stakeholders; Support the expansion of home care and respite care, enabling those in need of long term care to remain in their homes and communities and reduce New York s Medicaid costs associated with long term care.

38 Summer/Fall 2017 Provide Comments to NYS Dept of Health on the workforce shortage issues that need to be included in the Workforce Investment Program. In June, 2017 DOH to post application and eligibility criteria. Application and eligibility criteria available for a minimum of fourteen (14) calendar days for public comment. MLTCWorkforce@health.ny.gov Complete our Campaign Questionnaire Meet with State Assemblymembers and Senators to describe the problem Focus advocacy on the Governor s office and state agencies to prepare for FY18-19 Budget solutions.

39 Talking Points Both the Medicaid and Non-Medicaid populations are underserved. Regardless of a person s income, there simply are not adequate home health aide services available to provide care to those who need it and are authorized to receive it. Adjustments in rates must be accountable and transparent. A public campaign is essential to overcome a negative image of home care workers and rebrand the workforce as paraprofessionals. Convene a Stakeholder Task Force including consumers to brainstorm and make recommendations.

40 Thank You Becky Preve, Director, Franklin County Office for the Aging / Donna Beal, Executive Director Mercy Care for the Adirondacks Gail Myers, Deputy Director NY StateWide Senior Action Council