As a result of that budgetary change , CHHA payment amounts were reduced significantly. Today, disbursements to elders are based on a ratio of the individual CHHAs average total Medicaid claims per patient in 2009 and the current statewide disbursement average. For CHHAs that provided a great deal of 24-hour care, the budgetary change meant a significant drop in reimbursement and revenue because of the rollback to 2009 reimbursement levels and lower statewide averages.
Here’s the net result to elders and their families: Out of fear that they will not be paid what they expect or need, CHHAs are refusing to authorize 24-hour care, reducing the number of 24-hour care cases, and refusing to reinstate services following a hospital stay.
They are illegally reducing and terminating care without adequate notice to recipients leaving poor and disabled elders without life-sustaining benefits and often in imminent danger of wallowing away in hospitals or being sent to horrible nursing homes.
A Good Idea Gone Bad
The State’s intention was and is good. They are seeking to compel all Medicaid recipients into the State’s Managed Long Term Care Program. However, unlike the CHHAs, this program only provided care as was needed and ordered by the physician. While the State might have good intentions, they simply did not provide a “safety net” for elders to transition from CHHAs to Managed Long Term Care.
Unfortunately, the outcome is far from the intention. The CHHAs are reducing or terminating care even though the patient’s needs for services has not decreased. They are doing so without providing the notices or opportunity for fair hearing or Aid Continuing benefits required by Federal law.
There are numerous examples of CHHAs clearly flaunting the law. The New York State Managed Long Term Care Program is refusing to pick up the cases that have been dropped and they are refusing to give 24-hour care to new cases. These people are being backed up in hospitals or forced into substandard nursing homes. Elders are being destroyed. Many are dying. Remember, that for an elder, even a room change can be devastating.
My Elder Advocate has been at the forefront of this problem dealing with numerous cases where elders and their families are forced to deal with the consequences of this new State policy and the CHHAs reluctance to find a solution. We have seen numerous cases where hospital discharge planners are ruthlessly forcing families to take their elders home even though they can’t afford to pay for home health care privately and don’t have the financial resources to care for the elder.
For example, in one case in Queens, New York, a gentleman was admitted into a hospital with a urinary tract infection. After a few days of intravenous antibiotics, without notifying the family, he was forced into an inferior local nursing home because his CHHA would not take him back. A month later he returned to the hospital with serious bedsores that were infected and smelled something awful. My Elder Advocate forced the hospital to keep him and will get his home care restored.
In another case a woman was forced into a substandard nursing home and provided her family with a nursing home horror story. Two weeks after she was forced into a nursing home, she was sent to another hospital. She had suffered a heart attack, her lungs had water in them, and she was suffering from a urinary tract infection. She now is in critical condition.
The stories are unending… and the outcome devastating and despicable. By illegally reducing hours and terminating existing services, CHHAs are violating the Americans with Disabilities Act because they force CHHA patients into nursing homes even though these individuals could remain at home given the provision of appropriate home health care.
The New York State Department of Health is also violating the above act by not preventing the illegal terminations , ensuring the provision of adequate care in the community, or providing basic due process rights for plaintiffs.
Although the New York State Department has forewarned CHHAs that reductions or terminations are illegal, they have not setup a safety net for elders in the event that CHHAs flaunt the law –– which they are doing in many cases. Similarly, the New York Department of Health has not set up a unit to take complaints and properly investigate them in a timely fashion. Basically New York State is prematurely sentencing elders and the disabled to death row.
Last week, I called the New York State Department of Health investigative unit for home health care agencies to file a complaint about one of the above cases. After relating the story, I asked the investigator for her last name. She told me that what her name was didn’t matter because she is the only one there. She intimated that the investigation would take a number of months. Obviously, the Department of Health is not in a hurry to protect lives.
People are dying and many more will die in the near future. Others will be psychologically scarred for the remainder of their lives.
Families will be devastated emotionally, feeling for the rest of their lives that they abandoned their elders in their hour of greatest need.
Amazingly, the only ones who benefit are the substandard nursing homes that profit by keeping the beds full that would otherwise be empty and imprisoning elders.
From my vantage point as an elder advocate the Certified Home Health Care Agencies are acting like death panels and they are killing elders while New York State and Governor Cuomo are allowing this to happen.
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My Elder Advocate remains at the forefront of all problems that confront the elderly and their families. We are successfully advocating for elders who are caught in the middle of this terrible and extremely dangerous home health care situation and are having benefits restored.
In order to remain independent –– never obligated to any private or public entity –– and to provide support directly and immediately to elders and their families, My Elder Advocate remains a fee-for-service company.
For additional information call My Elder Advocate at 212-945-7550.