CredentialedCARE is conducting a survey of long term care agencies and facilities to determine the need for workforce management features in practice management software packages. If you work in the industry and participate in managing the workforce, please take this brief survey and we will report the results in an upcoming blog.

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Back in July, we conducted a survey of home care agencies to understand the usage characteristics of their management software systems. Home care and other providers of long term care services use software for many functions, but the key function revolves around scheduling care of their clients by their workers with field and telephony capabilities. Other functions may include billing, receivables, EHR, CRM as well as other important tasks. Here are the results of the survey:

The results indicate that only 1 of 10 agencies do not use one of the available software programs for managing their operations and of the 90% who do, there is a 50/50 split between programs hosted locally or on the web. But the software programs do not include HR and payroll services as seen in question 4 where approximately 38% rely on a program such as Quickbooks and 50% export their data to an online service. For other HR functions such as application management, hiring and on-boarding are all done the old-fashioned way; paper with some computerized payroll and management elements thrown in where available.

The software market for management is extremely competitive with 50 entrants. The figure below shows how the pie is divided.

With 71% of the market served by 3 software providers, it is imperative that in order to survive and thrive, the remainder of the field will have to offer more features at a competitive price that will differentiate their product from the rest of the field. If these new features can make their clients more cost efficient and productive as well as increase their competitive advantage in their local market, then these smaller software vendors will find greater success with the clients looking to succeed in the challenging long term care environment.

Here is the slide presentation in its entirety.

If you are a manager or owner of a home care agency (medical or non-medical) or hospice, please fill out this survey so we can better serve the needs of the long term care industry.

Thank you for taking the time to complete the survey. Subscribe to the RSS feed for the blog to be notified when we report on the results of the survey.

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This week, California’s Senate and Assembly continued the steps needed for passage of SB 411 and AB 899, The Home Care Services Act of 2011.  The Senate Appropriations Committee passed the bill by a vote of 6 to 2 while the Assembly Appropriations Committee will hold a hearing during the week of May 30.  The bill is sponsored by the California Association for Health Services at Home (CAHSAH) and has strong support from groups such as the California Association for Retired Americans (CARA), a statewide nonprofit organization that unites retired workers and community groups and claims a membership of 800,000 Californians.  According to CARA, in California,

“There are no licensure or registration requirements in existing law for private, non-medical, in-home personal care services. The only requirement to provide home care services in a person’s home is a business license. The result is that unsuspecting consumers and family members pay the price as they place caregivers into their loved one’s home believing that the person entering their home has been thoroughly screened and trained, when in reality, the majority of these workers are not properly vetted.”

The legislation in California comes at a time when many other states including Florida, Illinois and New York are also moving forward with legislation to regulate this growing industry.  Many people are unaware that The Patient Protection and Affordable Care Act signed into law by President Obama in March 2010 also includes a section that incentivizes the states to develop programs to conduct state and national background checks for all direct care workers; the paraprofessionals who provide the bulk of the care to the elderly and disabled.  The Homecare Services Act and the actions taken by other states to regulate the industry is a response to this national trend of reducing risk and providing safe, high quality care for vulnerable patients. But while these trends are moving in the right direction, what is not being addressed is the highly fragmented and difficult to navigate environment that will be caused by the variation that will occur as a result of each state’s adopting different laws to regulate these workers. The Act also specifically excludes individual workers who are hired privately and could give the consumer a false sense of security because they may believe the law applies to all long-term care workers who have intimate and often unsupervised contact with their loved ones. With the technology advances available today, CredentialedCARE is dedicated to helping the long-term care industry adapt to these new regulations and operating their business more efficiently while increasing transparency for the consumer to help them gain trust and peace of mind while coordinating care for themselves or a loved one.  A summary of The Home Care Services Act of 2011 can be found by clicking here.

A new report published this week by the California Senate Office of Oversight and Outcomes concludes that California residents can unknowingly hire a private caregiver with a criminal background including offenses such as commercial burglary, narcotics trafficking and prostitution. For the study, ads on Craigslist and other sources used by seniors to find lower cost care, were collected and background checks were performed after identifying the caregiver from the ad. In one case, a caregiver identified as S.K. posted a Craigslist ad in the Bay Area in 2010 offering to work as a caregiver, including personal care, shopping, driving and housecleaning. She claimed to  be experienced in health care and expressed an interest in providing 24 hour care in the client’s home. S.K. described herself as a “kleptomaniac” with “uncontrollable urges” to the Mendocino County Sheriff in 2004 after she was caught stealing more than $2,400 from a garden supply store. She was sentenced to 90 days in jail for that offense and records indicated that she had earlier convictions for drunken driving and shoplifting.

According to the report, titled “Caregiver Roulette: California Fails to Screen those who Care for the Elderly at Home,” [PDF] California is one of “only a few states in the country that doesn’t regulate its in-home care agencies, which provide non-medical support such as bathing, eating, and basic hygiene to the elderly. While day care centers and nursing homes are subject to state oversight, independent caregiver agencies only need a business license to operate.” (http://bit.ly/esTh6d) While most home care agencies perform a background check on new hires, there is a great degree of variability in the reliability of these background checks because there are no reporting standards by the County court systems throughout the states. California enacted a law in 2008 to help seniors and their families conduct their own background checks on caregivers but the law has never been implemented.

The state is offering proposals to remedy the situation but the answer is available today as a private enterprise based in San Diego. CredentialedCARE Corporation created CredentialedCARE.com as a neutral  3rd party resource to verify, pre-screen and credential caregivers and other health workers in order to provide a marketplace for Care Seekers and Long Term Care Providers to connect in an environment of trust and transparency. The company recently launched their service and uses one of the most comprehensive systems available to retrieve court records and query national databases in order to give consumers the peace of mind they desire and help the employers of these workers save time and resources. They have established state by state guidelines to apply the hiring criteria and they have established The Center for Home Care Excellence as a forum to bring together the various stakeholders to develop policies to mitigate these problems in the future. CEO Jerry Flanagan is leading the effort and he can be reached by email for questions at jflanagan@credentialedcare.com.

The New York Times recently published an important editorial on the serious problem of elder abuse in this country. This was a result of the testimony before Congress of actor Mickey Rooney’s recent experience where a family member took advantage of him, leaving Mr. Rooney feeling “trapped, scared, used and frustrated…But, above all, I felt helpless.” As the Times stated in the piece, “Congress should seize the moment to help repair their (the elderly) threadbare web of protection.” The statistics surrounding elder abuse reveal the depth of the problem. According to the National Center on Elder Abuse, “Estimates of the frequency of elder abuse range from 2% to 10%.” Furthermore, NCEA reports “It is estimated that for every one case of elder abuse, neglect, exploitation, or self neglect reported to authorities, about five more go unreported.” The Times rightly recommends that Congress establish policies to begin “filling the gaps in data collection and services. The Government Accountability Office found that in 25 of 39 states surveyed, financing for adult protective services had fallen or flat-lined in the last five years.” The GAO also concluded that “Case workers are poorly trained and overwhelmed” and that “federal programs to fight abuse are scattered ineffectively across the Department of Health and Human Services.” Thankfully, with all of the attention spurred by Mr. Rooney’s experience, Senator Herb Kohl and the Senate Committee on Aging are proposing legislation to create an Office of Elder Justice in the Department of Justice to help states enforce protections for older Americans in this country.

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United Health Group recently published a report where they observed, “by 2020, an estimated 52 percent of the adult population will have diabetes or prediabetes. Yet shockingly, the vast majority—more than 90 percent—of people with prediabetes, and about a quarter of people with diabetes, are unaware of their condition.” The report estimates that health spending associated with diabetes and prediabetes will approach “$194 billion this year (approximately seven percent of total U.S. health spending). That cost is projected to rise to $500 billion by 2020.” The medical literature confirms that diabetes is a strong predictor of ADL limitation, worse self-rated health and hospital admissions so these statistics suggests that the shortage of direct care workers to provide services to these patients will be magnified beyond the already dire forecasts of the impending crisis facing the American public. Compound this with the demographic wave, longer life expectancy and pressures to keep patients out of acute care, high cost facilities, the epidemic demands that the healthcare industry, policymakers and the American public work together to support and promote policies to improve recruitment and retention of this very important element of the health care workforce.

-Jerry Flanagan

Starting in January 2011, we will begin to see the first signs of Public Law 111-148, the Patient Protection and Affordable Care Act, which President Obama signed this past March.  One of the key plans to start will be the Community Living Assistance Services and Support Act (CLASS Act).  This plan is being enacted for people that may need cash assistance if they become cognitively or physically disabled on a limited capacity.  Click here for full details.

There are two outstanding benefits to this provision from my perspective.  First, people who are 18 and older will be able to participate.  This is good because young people need to be given the opportunity to start preparing for their futures, particularly retirement and beyond, as soon as they can.  When I was 18, there were no programs such as this that dealt specifically with the planning for possible future events such as long-term illness or disability.  That young people are being given this opportunity is significant.  The second benefit is that this plan will be available to all “actively at work” Americans.   If you are employed part-time or self-employed, you are still eligible.  For those who are working part-time, they will have the option to participate.  Part-timers have long had difficulty finding any type of insurance that would cover their basic needs and not bankrupt them in the process.  The same can be said for the self-employed.  This plan will at least help this segment of the population and it doesn’t seem as though it will cost a whole paycheck to participate.

In my opinion, Health Care Reform addresses two issues that have been overlooked by Washington for a long time.  Our young people need to understand and have the ability to start taking care of their long-term futures.  There are very few us, thirty years past our high school graduation, who are adequately prepared for post-retirement, or for a long-term health-related catastrophe if one were to happen.  It has also opened up an opportunity for the self-employed and part-time worker to access benefits similar to those of a full-time employee of any company. Roll out for this will not start before 2012, but in January many of the provisions of CLASS will become effective.  I think it’s a good change for everyone.

-Elle Terry

In a survey conducted by CredentialedCARE Corporation, 22% of  home care agencies were found  to use Better Business Bureau accreditation to promote their business. Why do long-term care agencies and facilities use  the BBB brand for their  business?  It’s a means to differentiate their  business from the local competition and to convey a sense of  trustworthiness and credibility  to their target customers; the LTC consumer and their families and friends. It was quite an irony then that ABC’s 20/20 program  broadcast a segment  exposing the BBB as being a self-serving, biased judge of business character that is heavily influenced by the fees it collects from its membership. What, you have a C grade from BBB? No problem, just pay us $500 for a 12 month membership and we’ll bump it up to A+. What the providers of LTC services want and the uneducated consumer needs is an unbiased and objective source of data and information that the consumer can use to make sound judgments as to the qualifications of the individual, agency and facility that can provide the needed services for their loved one. The advantage to technology  and the web today is the freely available sourcing of information that makes an industry more  transparent and increases the  accountability of those about whom data is available. And when it’s time to place a grade on a business, let the consumers who have used the services grade it and don’t compromise your ethical and moral  authority by tying it to the fees you collect. Here is a link to the 20/20 clip.

Jerry

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This week, ProPublica.com posted an article titled “ Docs on Pharma payroll have blemished records and limited credentials”.  According to the article, written by Charles Ornstein, Tracy Weber and Dan Nguyen, a ProPublica investigation “…uncovered hundreds of doctors on [pharmaceutical] company payrolls who had been accused of professional misconduct, were disciplined by state boards, or lacked credentials as researchers or specialists.”

Go here to read the full article: http://www.propublica.org/article/dollars-to-doctors-physician-disciplinary-records

ProPublica states that this will be the first of “several” stories to run on the site looking at the “high stakes pursuit” of our country’s doctors and physicians and their “prescription pads”.

So what, you may ask, does any of this have to do with credentialing, particularly direct care workers, nurses, aides, even dietary technicians? Just this….as a country we look to doctors, lawyers, and educators when it comes to the standards that we hold everyone to.  If your law school professor said it, nine times out of ten, you’re going to believe it. If your law school professor has a slant on a particular law, more than likely, his students are going to adopt some of that attitude also.

The same can be said about our doctors.  If pharmaceutical companies are searching out physicians to sell their products, and pay them to do so, then it is a safe bet that the patients (former or current) of those doctors are going to buy in.  That is indeed why pharmaceutical companies pay doctors to help them brand and sell certain products.

But if the doctor’s that are helping the pharmaceutical companies sell their products have been before the “review board” for misconduct, or if they don’t actually have the certifications and licensing in neurology and they are helping Eli Lilly sell one of their antidepressants, how can we, as the doctors patients’ expect the nurse’s aide – who by the way, is in and out of our hospital room more times than the doctor himself – to have the certifications necessary to do what he/she does?  How can we be sure that the other direct care workers that are busy checking serum levels and making sure IV drips are dripping correctly haven’t been before the state’s review board?

Yeah, I know, you credential them before they get hired, blah, blah.  But in a state like Georgia, where ProPublica found a Dr. Ronald Taylor, who had been kicked off of the staff at an area hospital for giving young female patients vaginal and rectal exams without documenting why, where direct-care workers are not required to have background checks done, how do you really know for sure who’s taking your temperature?

Healthcare is a system that is based on trust between the caregiver (doctor, nurse, dietician, etc.) and the patient.  No matter how much research you do on what ails you, you still  trust that your doctor (and his staff) is doing what is in the best interest of the patient. If doctors are at the head of the food chain in medicine, and they aren’t doing the right thing, how can we expect the rest of his/her staff to do the right thing? We need our doctor’s to lead by example so we as patients can be safe in knowing that the rest of the staff is being led honestly.

-Elle Terry