Private duty must prepare to carve out its slice of state and federal funds
States redistributing funds to home-, community-based services
Private duty managers nationwide have the chance to capitalize on a new trend that has states redesigning the way federal funds are distributed for home- and community-based care. Innovative programs in Wisconsin, Washington, and Oregon are leading the way, making it easier for private duty agencies to get referrals.
"I don’t know of a state that is not planning some sort of redesign for the distribution of state and federal funds to include home care," says Stephanie Sue Stein, director for the Milwaukee County Department on Aging. "All types of home care agencies must ready themselves for these changes."
Private duty agencies should seek more information about the redesigning process in their state. "Agencies should not sit back and wait for this to happen," says Stein. "They need to build relationships with the people who control the dollars and understand the politics behind the funding stream." She emphasizes that agencies who take the first step to understand their state’s progress will ultimately be at an advantage when a redesign is implemented. Stein says in Wisconsin the highest need for services are for personal care, such as bathing, chore services, homemaking, adult day care, and transportation.
Wisconsin mirrors future for other states
What is happening in Wisconsin may be a precursor to what other states implement. Wisconsin is redesigning how long-term care funds are distributed in an effort to reduce the number of people entering nursing homes and to increase referrals to home care providers. The program is set to be implemented in 1998.
The redesign would pool the state’s long-term care funding and roll it into one umbrella program to stretch more services to people who need them, creating a choice program. For example, a consumer who needs home health services would select the agency he or she wants to use, giving the consumer the opportunity to stay with current providers. This, says Stein, is the strength of the program. "We want to impact the lives of people in our community and offer them a choice to age and live where they want to. We think that our system will allow people to do this."
The goal is to divert people from entering nursing homes and opt for home care-based services, which most people prefer. Under Wisconsin’s current system, only nursing home funds are available immediately for elders who need assistance. Home care services are not eligible for immediate use, but this would change with the implementation of the redesign. "When money is available to people at the point of need, it can be diverted for care in the most appropriate setting," Stein says.
The Aging Resource Center
The first phase of Wisconsin’s redesign is an innovative center that provides information on all providers in Milwaukee county to anyone who calls. The Aging Resource Center is a 24-hour information line staffed during regular business hours with seven social workers. The center helps older people and their families weigh their options by providing information on a range of services available in the community, including home health care, adult day care, and other private duty services. Separate centers are being piloted in eight counties in the state. Although the Milwaukee Department on Aging has several Medicaid waiver programs, the Aging Resource Center is state-funded.
Providers in these communities are placed in a reference database that case managers and social workers draw from to make recommendations for home care and private duty services. "We have $44 million in public funds to work with now," says Stein. "If our clients need help cleaning or preparing meals, or need a personal care attendant, we will help them pay for these services through the state program if they qualify." Stein further explains that although there is a waiting list for assistance, her department wants to make sure clients are getting proper services. "If a person needs more hours of a service than is approved by Medicare or Medicaid, our program will pay for those extra services," she says.
Even if consumers do not qualify for funding and must use their own money to pay for services, the Aging Resource Center can help them begin the process of identifying the services needed and refer them to providers who can help.
Getting referrals
How can you get your slice of this business? "We work with agencies we can count on," Stein says. "We build experience and trust with an agency and know the ones that will help work out problems and follow through with clients." The following criteria do not guarantee referrals, Stein says, but meeting them certainly raises the chance that an agency will receive more if it proves to be dependable on short notice and does so consistently. There are several essential factors that can increase referrals, such as:
• having a state license;
• hiring competent staff;
• having bilingual staff;
• providing 24-hour staffing availability;
• informing the program of capacity and geographical coverage;
• being consistently dependable;
• showing low turnover in staff;
• sharing quality data;
• understanding all community services and options for elders;
• being visible and active in the community;
• taking part in educational forums and seminars;
• providing supervision of staff in the field and office.
Stein encourages agencies that offer private duty services to contact her office to get placed into the database. "It is to the agency’s advantage to let us know it exists," she says. Agencies should provide a complete profile, including:
• services offered;
• pricing schedules;
• availability;
• response time to needs;
• number of staff members;
• new services;
• new products.
Acting as a gateway
Although the center’s current mission is to equip callers with the information they need to get proper care, its eventual role will be to serve as the entry way to the state’s long-term care and home care system. The center is undertaking a project to collaborate with health care providers in the community, including hospitals, home care agencies, nursing homes, group homes, and so on, to implement a 20-page functional and financial assessment tool that would determine funding eligibility and gather data on how the system is used.
The center is affiliated with three health care systems that represent the 14 hospitals in the community. "Most seniors enter the long-term care system through these hospitals," says Stein. "We have a partnership with them to train their staff on the center’s services and how to use the assessment tool so consumers are given appropriate information at discharge." The information from the assessment tool will be transmitted electronically to the center so data are analyzed to show the use of the long-term care and home care systems and their associated costs. Stein anticipates the data will eventually influence policy changes and increase funds for the program.
Washington implements a similar program statewide and also has an information gateway for seniors. The state went through its redesign in 1995 when the legislature mandated that more funds be funneled into home and community-based programs.
"There will always be a place for nursing homes to continue the continuity of care," says Pamela Piering, director of Seattle-King County Division on Aging in Seattle. "But the state recognized that we needed to equalize the distribution of funds."
The long-term care budget in some states, she says, includes a distribution of approximately 90% nursing home to 10% home care. "In Washington, we are witnessing a shift to even out the funding with roughly 73% of dollars going to nursing homes and 27% to the community," says Piering. "There’s more work to be done to make this equal."
The state provides two modes of how a senior can get private duty home care services, she says. Services can be obtained through a home care agency for which Medicaid will pay an hourly rate. The other, and an area experiencing growth, is called individual providers (IPs) self-employed workers who are selected by the client to be a contract worker.
"For a senior who wants more hours of care, the IP is the choice, even though they are paid at a lower rate," says Piering. The IPs must pass a screening and criminal background check. They must also have 22 hours of training in the first 120 days of employment. IPs are paid to attend the training, and a substitute worker is scheduled. To get paid, the IP submits his or her hours to the state for reimbursement. The client is not responsible
"We are looking at a trend in the redesign of long-term care budgets among states," says Piering. "Washington has a program; Oregon and Wisconsin are moving forward on their programs as well." Piering adds that the overall feeling for these programs have, at heart, the best interest for the consumer to stay at home. "We want to redistribute the funds so that the options for community and home settings are more plentiful for people to choose from. Most states must look at these options from a financial point of view. They will be more cost-effective in the end."
Private duty agencies should now find out more about the progress being made in their states. Agencies should contact their local or state Department on Aging and ask about long-term care programs. Stein suggests that agencies meet with staff in these offices and find out how they can become involved.
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