Home care providers operate with little oversight, fewer consequences

Many of New York’s home health care providers operate with little oversight from the state, and even fewer consequences for providing poor care, an investigation by the Albany Times Union found.

Aleydis Llovet, 42, was burned by scalding water that her home attendant gave her at her Staten Island home. Llovet sued the agency that sent the attendant—Margret Ultra Home Care, Inc.—for negligence; the case settled out of court in 2010.

"The past decade brought booming business for more than 1,300 home care agencies registered with the state. Between 2007 and 2010, companies received more than $5.2 billion in Medicaid reimbursement, according to state records. In the same time period, more than 345,000 New Yorkers received home care through Medicaid — the largest payer for home care services in the state.

"But along the way, cases of negligent and substandard care for patients have piled up. An analysis of thousands of pages of state inspection reports at 40 of the state’s poorest-performing and most frequently reviewed agencies found that many suffer from similar problems."

Matt Drange covered home health care as his beat last fall. He started reporting this story for his master’s project, and completed it this spring with support from the Toni Stabile Center for Investigative Journalism.

Breathless with stress

Asthma sufferer John Leaman and his inhaler.

Photo| Maïa Booker

by Maïa Booker

The rules for John Leaman’s guests are precise and unyielding: no perfume of any kind, no pets, and no colds. The 84-year old former journalist lives in a large, breezy Lower East Side apartment with his wife. Upon entering, one of the first things you see is a large blue oxygen tank. Rosie Leaman suffers from Chronic obstructive pulmonary disease (COPD), while John Leaman suffers from adult-onset asthma. He speaks in a deep, winded voice, breathless after only a few words. The serenity and quiet of the apartment stand in stark contrast to his tense face as he rushes up, wheezing, to get a glass of water.

Leaman has been a New Yorker for over 60 years, and though dense urban environments are generally a breeding ground for people suffering from asthma, New York City in particular is home to clusters of asthma sufferers. Nationally, the burden of asthma on the public health system has increased in the last two decades and is the cause of approximately two million emergency department visits every year, as well as being a leading cause of school absenteeism, according to a Centers for Disease Control and Prevention article. Over the past decade, asthma rates have declined only very slightly after having steadily risen between 1980 and the late 1990s. 

 Northern Manhattan and the Bronx have the highest asthma numbers in all of New York City. According toNYC Healths Community Health Survey Atlas database, up to 21.6 percent of the entire population of those areas suffers from asthma, compared to about 4 to 9 percent in lower-Manhattan, Staten Island and most of Brooklyn. Children’s asthma is three times above the national average according to the database. This can partially explain why many of the programs aiming to combat asthma in these areas and around the city target children. Through education and prevention, the hope is to raise awareness of asthma triggers, and prevent severe asthma attacks, which lead to emergency room visits, costing thousands of dollars to the city. The average cost per asthma hospitalization increased from $7, 399 in 1998 to $14, 107 in 2007, an adjusted cost that increased 31 percent in a decade.

But what is actually making these children and adults sick?

Working for the patient

The HelloHealth homepage.

Photo| Maïa Booker

by Maïa Booker

Sheri Stockman, a stay-at-home mom, sounds chipper on the phone despite having experienced an onslaught of health problems in the past several years. At 45, she suffers from lupus and rheumatoid arthritis, and underwent a hysterectomy five years ago. She has also been on anti-depressants, but found herself at odds with her doctors and wanted to find alternative treatment, a different way of doing things.

Many people are searching for new ways to access easy and affordable health care, as the economy falters and insurance premiums and prescription medication costs rise. A growing number of physicians are using social media and electronic communication to interact with and diagnose their patients, cutting office and transportation costs.

In April, Stockman set out on a search for a new doctor and new medical options, in an attempt to be less dependent on prescription medications. She began, as she usually does when looking for something, with online research.  For years Stockman has done most things online. She formerly worked as a corporate travel manager for Zimmer Corp, a manufacturer of orthopedic products and says she’s accustomed to receiving hundreds of emails a day.  Moreover, like many consumers, she wanted to take control over managing her health.  According to a the Pew Internet & American Life Project, a study conducted with the help of the Department of Health and Human Services, 83 percent of Internet users have accessed health information or done on-line research related to a medical problem. Patients search for everything from a specific disease to exercise tips to alternative treatments. Moreover, 57 percent of online health seekers claim they found answers they had sought.

Stockman found several doctors online and decided to make an appointment with Dr. Jeffrey Gladd.  He advocates a holistic approach to medicine, and replaced her piles of prescriptions with natural supplements to treat her lupus and arthritis. He also emphasized nutrition and detoxification, the process of purging the body of noxious substances. Stockman appreciated another aspect of his practice: the electronic communication.  Gladd is a member of New York based HelloHealth, a patient management system with several functions. Created in 2007, the platform heavily uses social media tools like video chats, instant messaging, and Facebook to disseminate information and facilitate communication between patients and doctors. The doctor can also diagnose a patient via video chat, for example. The HelloHealth platform can save time for the patient, who does not have to travel, and can schedule appointments online, as well as track prescriptions. All transactions are made through the site, and before that were made through Paypal.

Nurses, and contractions in labor

Nurse Sharon Gayle in one of the delivery rooms at Brooklyn Hospital Center.

Photo| Maïa Booker

by Maïa Booker

Sporting blue scrubs and blue eye shadow, Nurse Sharon Gayle sits behind the desk in the post-operative recovery room of the Labor and Delivery floor in Brooklyn Hospital Center. After more than 20 years of experience as a nurse, she has seen it all, from patients coming in with no prenatal care, to serious complications in the operating room.  As she recounts these experiences, and talks about the different rotations on the floor, a patient who just gave birth via C-section, still groggy, requests cheesecake from her visiting family.

‘That’s all you want, the cheesecake Mami? You want some chuletas too?”’

‘No’ she moans.

At that moment, a doctor comes to check on the patient, and another nurse comes in to take Gayle’s place. Gayle was simply covering for her. “On a day like today when we’re just a little bit short because of meetings and the charge nurse is not on the floor, I’m covering another patient, ” she says in her slight Jamaican inflection.

There are usually seven nurses on the floor, rotating in four areas: the labor rooms, the operating room, the recovery room and triage. This is true for all the day shifts, but there tend to be fewer nurses during the night. She sighs nostalgically, recalling better times a few years ago when the seven-bedded triage area had two nurses instead of one, and when the night shifts always had seven nurses, never less.  It is, she says wistfully, “When things were wonderful”.

Another nurse on the floor, Carlene Marshall, agrees.  She adds that a number of their patients are very sick when they come in, often because they’re unaware of the free prenatal services available, and already suffer from ailments, such as diabetes, that pregnancy exacerbates.

Still, Gayle counts herself lucky, and protected, by the fact that Brooklyn Hospital Center is a unionized hospital in a time when nursing is proving be a profession susceptible to economic downturns. Ever since graduating from nursing school in 1988, after giving up her job as a buyer at Saks Fifth Avenue, she has always had a steady job in hospitals around the city.

The Natural High of Nursing

An interview with Nurse Sharon Gayle, who works in the Labor and Delivery floor of Brooklyn Hospital Center, on why she became a nurse.

Finding Home from Matt Drange on Vimeo.

After a pair of knee replacements, Emmanuel Reyes, 63, needed home care services to help him get around. Five years ago he enrolled in a managed care plan in the Bronx. Since then, Reyes has had his Social Security benefits slashed, and services offered by the agency have been cut. Now, Reyes worries he will lose his home attendant as well.

After a pair of knee replacements, Emmanuel Reyes, 63, needed home care services to help him get around. Five years ago he enrolled in a managed care plan in the Bronx. Since then, Reyes has had his Social Security benefits slashed, and services offered by the agency have been cut. Now, Reyes worries he will lose his home attendant as well.

Home care providers could grow after state lifts moratorium

Industry opposed to move, which some say will allow big agencies to get bigger

By Matt Drange

After a series of budget cuts and reimbursement caps put the squeeze on New York’s home health care industry this year, a policy change could open the door for something not seen in nearly 20 years:

Newly formed Certified Home Health Agencies (CHHAs).

On Thursday the New York Department of Health granted an emergency ruling permitting managed long-term care providers to apply to form new CHHAs. The move ends a nearly 20-year moratorium on submitting applications, and signals the final step in the state’s shift to managed care.

In April, anyone receiving more than 120 days of home care services will be sent a list of managed long term care plans. If they don’t select one in 30 days, the state will assign them to one. A spokesman for the Department of Health said the criteria for what plan to enroll people had not been made final, but that the department would try to “limit any disruptions” during the transition.

After a pair of knee replacements, Emmanuel Reyes, 63, needed home care services to help him get around. Five years ago he enrolled in a managed care plan in the Bronx. Since then, Reyes has had his Social Security benefits slashed, and services offered by the agency have been cut. Now, Reyes worries he will lose his home attendant as well.

Of the more than five million New Yorkers enrolled in Medicaid, 3.6 million were enrolled in a managed care plan in 2009, according to the most recent data available from the federal government’s Medicaid Financial Management Report.

Although the push for managed care – a cost saving option preferred by Gov. Andrew Cuomo over the current fee-for-service model – has been in the works since January, the decision to lift the moratorium came as a surprise to many in the industry when it was announced as a possibility late last month. Providers and patient advocates say it could actually reduce the number of agencies in the long run.

Number of home health aides rising fast

As Americans live longer, the need for home care services is rising rapidly, according to a story in the Huffington Post last week.

Between 2008 and 2018 the number of home health aides is expected to grow 50 percent in order to keep pace with demand for care, from 921,000 to 1,382,000, according to the National Health Statistics Report from the Centers for Disease Control and Prevention. By 2050, the number of people who need long-term care is expected to double.

The vast majority of home attendants, meanwhile, are women, especially in New York. In the story, Marki Flannery, president of Partners in Care, discusses why home aides and attendants work in a field that generally pays very little.

Earlier this fall we wrote about Margaret Passley, a longtime home attendant who works for Kind Care in Brooklyn. Passley moved to New York from Jamaica, and recently had to pick up a second job in a nursing home to supplement her income. (To read the full story, go here.)

Carmelo goes to the store from Matt Drange on Vimeo.

Carmelo Gonzalez lives with cerebral palsy. He receives 24-hour home care services through Independence Care System, a nonprofit Medicaid managed care provider out of New York City. Emily Burch is one of five personal assistants who works for Gonzalez, and has been with him for eight years.

Ahead of the game

With many home care agencies bracing for managed care, some are already prepared

By Matt Drange

Carmelo Gonzalez likes being his own boss.

After a brief foray into acting and a stint in film school, the 43-year-old started an online distribution and marketing website almost five years ago. Gonzalez runs the business – ccenterprise.biz – from home with the help of his partner, Carlos Sanchez. The pair say business is doing well, and they have plans to expand.

“When you have your business, no one can fire you,” Gonzalez says with a smile.

But the company isn’t the only aspect of Gonzalez’s life that he’s taken control of. Above all else, he values his independence.

Born with cerebral palsy, Gonzalez has extremely limited use of his arms and legs, and lives with a severe speech impairment. For help with daily activities he relies on a team of personal attendants who work round the clock in his home. Gonzalez receives his home care through Independence Care System (ICS), a nonprofit Medicaid managed long term care program based in New York City.