The system that provides home care for New York's ailing, elderly and disabled populations is in crisis due primarily to economic pressures, including a state reimbursement formula that has pushed some rural care providers to the brink of not being able to make payroll.
That was the message conveyed by dozens of witnesses who attended a Capitol hearing Monday called by the Assembly committees on health, aging, labor and health. The Legislature returns to Albany on Tuesday to begin the final month of negotiation of the budget.
Issues discussed at the session included managed long-term care rates under the state's Medicaid program. Funding flows from the state to the managed care plans to regional agencies, including many nonprofits, that pay the care workers.
The first witness was state Medicaid Director Jason Helgerson, who expressed confidence that New York's rates were sufficient to meet the needs of the nonprofits who in many cases serve as matchmakers between individuals in need of care, known as consumers, and workers. "Overall, we stand by the fact that the rates are actuarially sound," said Helgerson, who added the prospect of certain plans pulling out of specific regions represented outliers in an otherwise "robust" market.
Helgerson said Gov. Andrew Cuomo's budget proposal called for $480 million to cover the costs of helping entities that pay direct-care workers meet the obligations of the state-mandated rise in the minimum wage. The state Health Department, he said, has taken an active role in ensuring that the funds intended to boost the hourly pay of care workers was ending up in their pockets.
Others disputed Helgerson's confidence in the level of support, and complained that the state's reimbursement rates have remained stagnant.
Assemblywoman Donna Lupardo, chair of the aging committee, said she was concerned at the prospect of care workers switching to working in fast food, a sector in which a panel convened by Cuomo imposed minimum wage increases that are outstripping those for other fields.
Several witnesses said the problem was especially acute in rural areas such as the Adirondacks, where widely distributed population and rough terrain and weather make it logistically challenging to serve consumers.
Rebecca Preve of the Franklin County Office for the Aging said it was "a daily occurrence" for her to have to inform families and hospitals that an individual eligible to receive in-home assistance would have to wait because "there are physically no individuals to provide the care."
She described the case of a 91-year-old World War II veteran who was deemed eligible to receive 23 hours a week of personal care services, a job that remained unfilled for two months despite the efforts of two nonprofits to staff the post, and regular entreaties from an 88-year-old friend who had been assisting with the man's care. By the time a worker was found to fill less than half of the authorized hours, the man had been brought to the local emergency room four times without being admitted. It took another five months before the agencies were able to staff the full 23 hours.
"I would say we are in crisis mode in rural areas," said Assemblyman Billy Jones, D-Franklin County.
"The bottom line is the bottom line," said Jim Lytle of the state Coalition of Managed Long Term Care and PACE Plans. "If adequate rates are not paid to the managed long-term care plans, it is not possible to provide the level of financial support to the providers of these services as they require. Simply put, plans only have the resources that the state's Medicaid program furnishes them."
Several speakers noted that while the salary issue was most immediate, the longer-term challenge was ensuring that enough workers go into the field to meet the burgeoning need for care as the baby boom generation enters the ranks of the elderly and infirm. Some of the proposals offered to ease the situation include better opportunities for career advancement, bonuses for entering the field and remaining in it, and funding to help care workers in remote areas maintain vehicles capable of handling inclement conditions.
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