News Briefs
News Briefs
Support services allow elderly to remain at home
Covenant Retirement Services, a Lynchburg, VA-based business, now offers its clients home care support services that include raking leaves, cleaning gutters, shoveling snow, sorting medications, balancing checkbooks, and giving baths.
According to Patricia Howell, case manager for Covenant, providing those services can mean the difference between clients remaining in their own homes or having to move into an assisted living facility. "You see a lot of depression in older people who are uprooted and put in retirement communities," says Howell. "There is often a rapid deterioration after such a move."
Covenant’s president, Tulane Patterson, says the firm’s clients can choose from an a la carte menu of services. "It is up to our clients and their families as to what services they want to purchase," Patterson says. "They can add services or get rid of them at any time."
Patterson, a former retirement community administrator, opened Covenant with managing partner Whit Gravely last year to fill a void he saw in care for the elderly. "The over-65 population in this country is growing," he explains. "We aren’t going to be able to build enough facilities to take care of everyone who will need help in the future. It makes sense to cater to seniors who choose to stay at home."
A client who needs his lawn mowed, for example, calls a case manager, who arranges for professional landscapers to keep up the yard. If a client wants some light housekeeping, the manager will send over a housekeeper. People who merely want some company and perhaps help with running errands might want to hire a companion, who will visit a couple of times a week or more.
Offer good salaries
The company attracted 240 clients during its first year of operation, offering a competitive fee of about $500 a month that covers most of its services. In the Roanoke area, nursing home care costs about $120 a day, and many assisted-living facilities charge between $1,500 and $3,000 a month. Most of the care is provided by certified nursing assistants working under the supervision of registered nurses.
Covenant’s certified nursing assistants earn between $9 and $12 an hour. "Not only do we pay competitive salaries, but our assistants like the fact that they get to spend quality time with their clients in a relaxed atmosphere, " Patterson says. "Typically, their biggest complaints of work in the nursing homes and assisted living communities are that they are asked to care for too many people at once. They get frustrated at not being able to do as much as they would like for each person."
At a time when many retirement communities have difficulty finding enough staff, Covenant not only staffs home services, but provides nursing assistants people in retirement homes. The company tries to match assistants’ personalities to clients’ needs. Covenant also screens all of its employees, running criminal background checks. and insuring them against any accidents that occur in the home.
A study conducted by the Virginia Employment Commission illustrates Patterson’s point about growth in the elderly population. The study showed that in Roanoke County alone, there were 10,706 residents in 1990 who were over the age of 65. By 2010, that number is expected to nearly double to 18,958. "The Roanoke Valley is an aging area," Gravely said. "We have some of the oldest demographics in the state. A lot of young people are moving away and they are not coming back, so we know there is a need for our services here."
New living wage ordinance benefits home health
Fifteen months after Chicago’s Living Wage Ordinance was unanimously approved by the City Council, home health care workers across the city are receiving their first payouts.
Approximately 200 home health care workers with city clients received retroactive back pay for work since January 1, 1999. The ordinance requires city contractors to pay home health care workers at least $7.60 per hour — enough to support a family at the federal poverty line. They previously earned an average of $5.45 per hour for their city clients.
The ordinance is the result of a grassroots campaign representing a citywide coalition of over 200,000 people that included more than 40 labor, religious and community organizations, as well as numerous elected officials. Service Employees International Union (SEIU) Local 880, the Chicago Coalition for the Homeless, and the Association of Community Organizations for Reform Now (ACORN), which is coordinating the national effort in cities, counties, and states across the country, led the effort.
Sammie Simms, a steward of SEIU Local 880, says, "This windfall for so many dedicated home health care workers signals the first tangible outcome of a huge victory. Because we hope the Illinois General Assembly will adopt a similar measure, we intend to introduce legislation to achieve that in the coming legislative session."
Near the bottom
Home health care workers are among the nation’s lowest earners, with average annual incomes ranging from $7,000 to $9,000. In addition to the hourly raise, Chicago’s home health care workers will receive a lump sum representing back pay for city clients starting from Jan. 1, 1999. Payouts for home health care workers range from approximately $150 to more than $1,200, depending on the number of city clients.
Similar living wage ordinances are being considered in dozens of other cities, counties, and states. For more information on the national living wage movement, visit ACORN’s Web site at www.acorn.org.
Push’ model gets validation for eHealth Web sites
ProMedex Inc., a Raleigh, NC-based company, presented the first large-scale "push" model eHealth solutions at the recent eHealthcareWorld conference in New York City. "Push" refers to proactively contacting Internet users instead of relying on users’ initiative. The approach targets users and directly presents information, products, and services. This makes it possible for health plans and care providers to communicate with even those who do not know what to look for or ask for.
ProMedex provides the connecting link between health plans, their members, and physicians, tests and supplies. Health plans contract with ProMedex for services for members with chronic conditions.
ProMedex first collects health information from people and analyzes it to assess health status and self-care knowledge, then uses that data to reduce health risks and improve self-care abilities by creating personally designed health interventions. The company also provides feedback and guidance to the patient’s physician by comparing the current care to generally accepted standard. Patient information is organized and presented to the health plan’s case managers via the Internet.
Increasing internet use
Since January 1998, ProMedex has enrolled over 100,000 patients in various programs, with 10% to 35% choosing the Internet over telephone and paper to complete their health profiles. The company uses the Internet exclusively for its reporting and on-line case management. Pieter Muntendam, founder and president, says his company’s approach "centers on the patient being in charge, with the physician and health care system in supportive roles. The communication opportunity presented by the Internet allows patient-centered health care to become even more powerful, because we can accomplish communication in multiple directions and use direct, proactive outreach affordably."
For further information, contact James Jones of ProMedex Inc., (919) 719-2850, ext. 4401. Web site: www.promedex.net.
First PA audit finds deficient agencies not given sanctions
The Pennsylvania Department of Health failed to impose sanctions on home health care agencies that had been cited for serious deficiencies, according to a recently released performance audit.
Auditor General Robert P. Casey Jr. says his department found no cases in which home health care agencies received sanctions, even though half of the agencies sampled had been cited for deficiencies. "The absence of sanctioning sends a signal to home health agencies that they will face no adverse consequences for failing to provide quality care," Casey said. "With almost 250,000 Pennsylvanians receiving home health services paid for with tax dollars, the Ridge administration must ensure that quality care is provided."
Casey recommended that the health department employ the full range of available sanctions. These include civil monetary penalties. "Not only will the use of sanctions bring direct consequences to bear on agencies for noncompliance, but it will assure home health care patients that the Commonwealth is acting to protect their health and safety," he says.
The Department of Health agreed to develop a strategy to implement sanctions consistent with the Health Care Facilities Act, which allows the Health Department to suspend, revoke, refuse to renew or limit licenses, suspend admissions, and issue provisional licenses.
The severity of the deficiencies found at 28 agencies audited by Casey’s department varied. In one case, a young girl died while in the care of a home health nurse. In others, patients’ records lacked skilled nursing assessments or plans of care or doctors’ orders were not followed. In one agency with 10 deficiencies, a nurse repeatedly failed to follow acceptable infection control procedures. Not only were no sanctions imposed, but no one from the state conducted on-site visits to verify that corrections were ever made.
The audit covered the period from July 1, 1996, through April 20, 1999. It was the first performance audit of Pennsylvania’s home health care system. In Pennsylvania, nearly 400,000 children and adults who live in their own homes require some type of nursing services for short-term acute needs or long-term chronic conditions; nearly 250,000 receive services paid for with government dollars. In July 1999, there were 72 home health care agencies in Pennsylvania that were state-licensed only, and 341 agencies that were both state-licensed and certified to participate in the Medicare/Medicaid programs.
"Although our audit found that the Department of Health generally ensured that minimum standards were met," Casey says, "it must go beyond those minimum standards to ensure better care and safety for home health patients."
In particular, the audit noted that:
• The Department of Health did not stagger the timing of its surveys, resulting in home health agencies being able to predict when they would be surveyed, and prepare for those surveys.
• There were inconsistencies in home health aide competency evaluation program, and the department did not appear to enforce adherence with inservice training requirements for home health aides (12 hours of inservice training during each 12-month period).
• Surveyors did not retain documentation from certain survey areas.
• Home health agencies were not required to cross-check the names of potential home health aides with the existing Nurse Aide Registry.
However, Casey noted that the Department of Health ensured nearly 100% compliance in its monitoring of the requirement that home health agencies conduct criminal background checks of all employees, and that all complaints filed against home health care agencies during the audit period were investigated in a timely manner and in accordance with the new policy.
The audit found that the Department of Public Welfare (DPW), which administers the Medicaid program, ensured the appropriateness and accuracy of home health care claims and payments under its fee-for-service component and the Pennsylvania Department of Aging Waiver program. However, DPW did not ensure the appropriateness and accuracy of home health care claims and payments a program that allows Medicaid to pay for services to homebound children who depend on a medical device to replace or compensate for a vital body function and to avert an immediate threat to life.
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