The way some advocates see it, there's a gap in the oversight of home healthcare workers -- specifically those who offer "companion services," visiting people in their homes without providing medical care.
To address this apparent shortcoming, the Legislature last week passed a bill that would increase the regulation of firms that supply these services.
But while some in the industry believe tighter rules are essential, others argue that it will put these companies out of business.
Companion services have grown to fill a niche in home care: residents older than 60 who need nonmedical help at home but aren’t eligible for Medicaid. Ken Wessel, president of the Home Care Council of New Jersey, said there have been a “flood” of these new services in the state but that “our elderly and frail disabled deserve better.
The bill (/A-2207) recently reached Gov. Chris Christie’s desk. It would expand the definition of healthcare services firms to include those that provide companion services to residents who are disabled or 60 and older. It also would require all firms to be accredited by an organization that vets Medicaid providers and to have an audit every three years. Of the more than 1,000 home care agencies in the state, more than 700 aren’t accredited. Christie hasn’t signaled publicly whether he will sign the measure.
Home Care Association of New Jersey CEO Chrissy Buteas said accreditation would ensure that a registered nurse oversees the care provided by agencies and that home health aides undergo criminal background checks.
“Certainly, nobody wants to have a case where an aide is in a home, that has not been properly checked ahead of time,” she said.
While Jean Bestafka, CEO of the Home Health Services and Staffing Association of New Jersey, said she supports the concept behind the bill, she said it would have the effect of driving many franchise owners out of business if it isn’t changed.
She noted that all of the measure's supporters already meet the standards of the bill because they are larger organizations that receive significant government funding through Medicaid and Medicare. Her association’s members, however, are smaller businesses and rely on private payment since their customers largely aren’t eligible for Medicaid.
Bestafka said some firms would not be able to afford the audits, which she estimated would cost $10,000 to $25,000. She added that a 2009 law required these businesses to provide annual financial reports to the state, but that the state hasn’t done anything with the reports. “If you’re going to make us spend this money, do something with it,” she said.
Bestafka commented that the bill wouldn’t affect the “black-market” home care providers, and she called on the state to increase its enforcement of existing regulations against these unlicensed providers.
Bestafka asked legislators to allow franchise owners to submit audits that are already being done by their national franchises to satisfy the auditing requirements in the bill, but legislators didn’t agree to the request.
Bayada Home Health Care state government affairs director Louise Lindenmeyer said her organization supported the bill.
“We believe that it will raise the bar for home care in New Jersey,” she said.
Bill sponsor Sen. Nellie Pou (D-Bergen and Passaic) said there must be more oversight to ensure that seniors and people with disabilities are receiving appropriate care.
“These aides spend a significant amount of time in the homes of some of our most vulnerable residents,” she said in a statement. “It is vital that our residents feel safe and that their families know that their loved ones are protected.”
Assemblywoman Caroline Casagrande (R-Monmouth), who voted against the measure, questioned whether it would drive more residents into the black market by making accredited companion services unaffordable.
“One of the biggest challenges anybody who’s ever had to find a companion for a loved one faces is the cost -- it is so extraordinarily expensive to get somebody to be a companion for your loved one,” she said. “And so I think what you find a lot of people do is go off to some of the websites that are available -- care.com -- and individually connect with people for a reduced price.”
On June 26, both houses of the Legislature passed the bill by large margins, 35-1 in the Senate and 59-17 in the Assembly. Every opponent but one – Assemblyman Bob Andrzejczak (D-Atlantic, Cape May and Cumberland) -- was a Republican.
An earlier version of the bill, but never received an Assembly vote after the Senate passed it on a largely party-line vote.