Marietta Times editorial on in -home care

Proposed changes for in-home care demand careful study

February 13, 2015
05 Marietta Times
About 16,000 Ohioans who have to rely on other people to help them in daily tasks ranging from getting out of bed to cooking meals will have to make different arrangements if legislators approve a proposal by Gov. John Kasich.

Thousands of Medicaid-eligible Buckeye State residents who are disabled or coping with chronic illness rely on an in-home care program. It allows those who do not need full-scale nursing home care to get the help they need in their own homes. But there are two categories of people using the in-home care program. Some use workers from home-health agencies. Others – the 16,000 or so in question – get help from independent nurses, aides and other providers. Citing concerns about the quality of such care, as well as about Medicaid fraud, Kasich has proposed a change. If approved by the General Assembly, it would be phased in over a four-year period. Kasich’s plan calls for Medicaid to refuse to pay costs for independent home health workers. For patients to get in-home care, they would have two options. First, they could obtain the care through home health agencies. Second, they could, in effect, become the employers of those who help them, through something called “consumer-directed care.” Taking that route can be challenging, say critics, even though it amounts only to formalizing arrangements that already exist between many patients and the independent aides who help them. In terms of the safety of in-home care patients, that may accomplish little. Many in-home care patients get excellent, safe care from independent providers. No doubt, given the numbers involved, a few of the independents are not providing quality care, however. Kasich is right to be concerned about that, as well as about the possibilities for fraud. Still, legislators should consider the governor’s proposal carefully to ensure it represents worthwhile change and not just more layers of paperwork and bureaucracy for thousands of disabled and/or sick Ohioans.

These experiments have been tried elsewhere and the outcomes are bad. For the first option, the home health agencies cost the funder more than hiring privately. In one case ( Ontario) the agency charges the province $ 40/ hr and pays the worker $14/hr.  The agency is  motivated to hire inexperienced  foreign workers who work cheap, and not train them adequately. Home health care is skilled work, important work. Patients who are poorly attended will end up in  a nursing home sooner at greater expense in money and suffering.  The second option is also a problem: people who need home health care will not often have the energy or business skills to run a small business involving employees, with the many fussy mandates from the many levels of regulation,  taxation,  and training for those employees.   Jack