A battle is shaping up in the halls of the state legislature, and local home healthcare firms are up in arms.
A bill co-authored by West New York Mayor and State Assembly Speaker Albio Sires and Assemblywoman Bonnie Watson Coleman (D-Mercer) will be soon presented for adoption that seeks to further regulate the large and lucrative home health care industry throughout the state of New Jersey.
And the home health care industry is none too happy about it.
They say they already operate under regulations from Medicaid and other agencies, and that the changes will make things worse for patients.
According to the wording of the bill, “There is a shortage of qualified persons to provide these [home health care] services to state residents, and this shortage is, in part, due to the level and types of compensation and benefits offered to certified homemaker-home health aides, who are authorized to provide these services.”
Home health care aides are people who are certified by the state to enter into people’s homes and render short- to long-term health care. The patients are generally people who have debilitating diseases or afflictions and require assistance from a qualified health worker. Usually, the patients cannot ambulate on their own.
The bill stipulates that there will be four “councils” that will cover all of New Jersey and provide regulation.
According to the wording of the bill, “There are established four Quality Home Care Councils in the Executive branch of government…the councils shall be independent of any supervision or control by the department or board or officer thereof in the performance of their duties.”
And it is this wording that is making those involved with the home health care industry quake in their boots, both for the financial future of the industry and for the greater good of the patients who currently rely on home health care aides.
In New Jersey, these home health aides are required to be employed by agencies. These agencies operate on a local level, and because they receive Medicaid money, they are already regulated by state rules and regulations.
According to many of the owners of these home health care firms, their businesses must operate under strict guidelines as it is. They claim that there is very little room for error or abuse.
According to Rosemarie Howe, Director of Services for Interim Healthcare of Union City, “The bill that they have submitted will change the whole scope of home healthcare. There are many policies and procedures in running a business like this. We follow the strict Medicaid regulations.”
Added Howe, “It’s a bad bill.”
Howe and others say that the regulations of the new councils will supersede existing Medicaid regulations, which are more beneficial for the patients. Patients get a home health aide after they or their families apply.
Howe listed some of the existing regulations that any accredited home health aide must operate under. According to Howe, home health aides must: have yearly physicals, submit to MANII (tuberculosis) tests, and be screened for Rubella and have a Hepatitis B vaccination. The aides also must receive 12 hours of in-service training (infection control techniques, abuse identification, safety in the home, etc.) and they must also sign a HIPAA (Health Insurance Portability and Accountability Act) form, which helps to protect patient’s confidentiality.
In addition to the regulations that home health care services operate under as recipients of Medicaid money, they are also required to be accredited by the CAHC (Commission on Accreditation of Home Care). This Verona-based company has become the industry standard in the regulation of procedures and practices in the home health care field. In business since 1985, the CAHC, according to Executive Director Ken Dolan, was established under the auspices of the New Jersey Department of Human Services and the company has “ongoing state input,” according to Dolan. The CAHC is a private, non-profit company that has federal 401C3 IRS designation. Said Dolan in a recent telephone interview, “Our standards reflect the standards of the industry. Our standards reflect what is good for the patients and for the agencies. We make sure that each of the agencies act in accordance with the standards set forth by state guidelines.”
Added Dolan, “What this bill is going to do is create a DMV or EZPASS-type situation. We can’t afford to institute an EZPASS for healthcare. These people aren’t cars; they’re people.”
The New Jersey bill is based on a similar act that is currently in place in California. And according to many accounts, it is failing.
According to published reports, the current state-run system in place in California is teetering on the brink of disaster. According to Yolo County District Attorney Suzanna Mak in an article in The Sacramento Bee, “This program is riddled with fraud. To me, it’s approaching state-subsidized elder and dependent-adult abuse.”
Another quote had a California legislative staff assistant saying, “It will probably take a high-profile tragedy to change the system.”
The current New Jersey bill states, “Service delivery systems have been developed in other states that allow for: greater consumer control of personnel who provide services to them; consumer representation on the governing boards of the employers of the personnel; and reduced administrative costs.”
What are the changes?
So, is the proposed bill an attempt to protect home health care workers, or the patients that they are supposed to care for? The answer is murky at best.
In an interview with Assembly Speaker Albio Sires last week, the impetus for the bill appeared to be protection of the home health care aides that populate the industry.
“This is a business; make no mistake about it,” said Sires. “The industry wanted us to leave this issue alone. I am concerned with the for-profit agencies abusing their workers by not giving them the proper amount of vacation days and benefits.”
Added Sires, “This bill will evolve.”
So while the state’s reasoning behind the bill appears to be mainly financial in nature, those who work in the industry say they are highly concerned for the people that count the most in the whole equation – the patients.
They say that the regulations that the state might put into place would make things worse for patients, not better.
According to the Coalition for Real Home Care in New Jersey, under current guidelines, home care visits are required for the Medicaid clients every 60 days (though according to industry insiders, the visits are much more frequent). The bill, if passed, would require only two visits per year.
And according to a CRHC handout, “[The bill] does not set up interdisciplinary teams to monitor adherence to each patient’s plan of care, or to handle violations of standards and disciplinary problems. Frail and elderly patients will be required to confront these situations themselves.”
But according to Sires, the industry is employing scare tactics in an attempt to derail the legislation.
“They’ve been doing a full-court press on this,” said Sires. “They’ve been sending out these cards saying that their home health aides will be taken away. This is not the case. A lot of people have expressed concern. Many companies don’t pay benefits and vacations. We are trying to find out what the issues are here. But a lot of the companies don’t do a good job.”
Added Sires, “Our purpose behind this legislation is to regulate the industry.”
According to Greg Karr, director of the Fort Lee-based Loving Care franchise of home health care businesses, “When government attempts to step into an industry, it’s usually the result of an outcry. Nothing of that nature has happened here.”