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New York City Summit Examines Home Care Jobs as Medicaid Transitions to Managed Care

April 25, 2013

Home health care providers, workers, and experts convened at a New York City home care summit on April 22 to discuss how best to support home care workers as the New York State Medicaid program transitions from a fee-for-service home care system to managed long-term care and the demand for a quality home care workforce grows.

Home Care Aides: Building the Care Delivery System for the Future” (pdf), sponsored by City Council Speaker Christine Quinn (pictured above) in conjunction with 1199 SEIU Healthcare Workers East and PHI, focused on three issues to better understand how the transition is impacting workers, providers, and residents in New York City:

  • upgrading home attendants to home health aides for the new managed-care system;
  • promoting quality training and staffing support; and
  • expanding the aide’s role to meet consumer needs.

In explaining the state’s need to transition the Medicaid fee-for-service program to managed care, New York State Medicaid Director Jason Helgerson, the summit’s keynote speaker, said that Medicaid comprised 40 percent of the state budget — two times the national average — so “business as usual cannot continue.”

Helgerson added that home care workers must be paid a living wage because the state is not going to “build the long-term care system on the backs of workers.” There are more than 150,000 home care workers in New York City, making home care aide the largest single occupation in the city — and one which is projected to have future growth.

Investing in the Home Care Workforce

“Home health aides care for our most vulnerable residents — they are a group of dedicated workers that this city needs and cares about,” Quinn said. “Taking care of our growing aging population also means taking care of their caretakers, and investing in this workforce could lead to an overall reduction of health care spending, fewer hospitalizations, and better outcomes for the most vulnerable New Yorkers.”

Promoting Quality Home Health Aide Training and Staffing

Investment in quality training — and training in specialty areas such as dementia, diabetes, multiple mclerosis, and rehabilitation care — equips home care workers for the array of challenges that arise on the job, concurred presenters on the panel entitled, “Promoting Quality Home Health Aide Training and Staffing.” Quality training results in less staff turnover and better continuity of care for consumers, said the home care providers on the panel, which was moderated by PHI New York Policy Director Carol Rodat, who is a member of the Medicaid Long Term Care Implementation Workgroup.

Mark Andaya, RN, of Partners in Care reported that his organization has relied on PHI to train the supervisors and was trained by PHI, which dramatically changed the culture of the organization, reduced turnover, and increased employee satisfaction and engagement. He added that the communication skills they developed through the PHI Coaching ApproachSM foster respectful relationships on the job — and are useful outside the workplace as well.

Home care aides are “hungry” for training in specialized topics, said Russel Lusak of Selfhelp Community Services, Inc. However, specialized training has to be meaningful for aides to take on the responsibility, and has to be supported. Aides must be trained to the highest level in order to meet the changing needs of their clients and provide continuity of care.

At Best Choice, a licensed home care services agency within the CenterLight System, peer mentoring is an essential component of how the agency supports aides on the job, said peer mentor Zena McKenzie. For example, if management knows of a person with problems, they will assign a mentor to problem solve, she said.

Expanding the Aide’s Role to Meet Consumer Need 

Another panel, “Expanding the Aide’s Role to Meet Consumer Need,” moderated by Helen Schaub of 1199 SEIU, examined ways that home care workers are being trained to take on more responsibility and better meet their clients’ changing needs in a delivery system that values care coordination and better management to prevent decline and costly acute episodes.

Matt Kudish of the Alzheimer’s Association, New York City Chapter, said that the association’s 50-hour specialized dementia training program and follow-up sessions not only helped aides to build skills in caring for clients with dementia, it also helped them to develop critical peer support. Kudish reported that of aides who completed the training, 78 percent wanted to stay on the job, compared to 38 percent of aides who didn’t have the specialty training.

Bridget Gallagher of Jewish Home Lifecare System discussed how aides in her agency have had training in telehealth technology, which led to better compliance and use by the patients. The home health aides support their clients’ use of the technology in order to monitor pain, ensure medication compliance, and prevent falls. Gallagher said that the home health aides have been instrumental in getting clients to take advantage of the telehealth program, calling them “cheerleaders” for the program.

Rick Surpin of Independence Care System suggested leveraging the value of aides in the Medicaid managed long-term care system by training them to become senior aides. With knowledge, experience, and good communication skills, aides can play a critical role in care teams, he said. Yet to play that role, aides need to have the skills to communicate what they observe with the client, and they need to be respected and considered a part of the team. A trusting relationship with other providers of the care team is essential,” Surpin said.

Panelists agreed that quality training and specialty training require an investment. Yet under Medicaid managed long-term care, reimbursement for such training is not included in the rate. In the absence of reimbursement for quality and specialty training, Kimberly Smith of the Robin Hood Foundation said foundation support has been instrumental in supporting these objectives and monitoring the outcomes.

PHI Tracks the Medicaid Transition

PHI released its latest issue of PHI Medicaid Redesign Watch, which is tracking the changes that emerge as New York State shifts from a Medicaid fee-for-service system toward a managed-care system, with a particular emphasis on the impact on home care workers — the backbone of New York’s long-term care delivery system.

The brief was released at the summit. PHI is calling for a dedicated funding stream for training since there no longer is direct funding with managed care.

The most recent edition, Medicaid Redesign Watch #2: The Impending Threat to the NYC Home Care System, examines the increased labor costs that will emerge from the transition.

— by Deane Beebe

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