Debate Centers on Regulation and Oversight of Home Healthcare Services

Andrew Kitchenman | September 5, 2013 | Health Care
Firms providing health aides seek oversight of ‘companion care’ companies, which call proposed rules unnecessary

Sen. Nellie Pou (D-Passaic)
Two different types of home healthcare providers are sparring over a bill that would increase regulation of the least intensive level of care available to older New Jerseyans.

The dispute centers on the difference between “companion care” providers, who generally are smaller companies and are not supposed to perform medical duties, and larger employers of home health aides, who are more closely regulated, offer more hands-on care, and are authorized to serve Medicaid recipients.

Proponents of the bill recently passed by the Senate, S-2100 (A-3133 in the Assembly), argue that the state should require “companion care” companies to be accredited by a state-recognized body.

They say workers supplied by these companies – who are supposed to spend time with elderly residents but not engage in physical contact or provide medical care — are sometimes going beyond their level of training.

Ken Wessel, president of the Home Care Council of NJ, said some companion care providers are performing nursing services – like giving residents shots and medicine – that even more highly regulated home health aides aren’t allowed to perform.

The council serves as the statewide association representing nonprofit home care providers, which employ many home health aides who perform duties such as changing bandages. Council members generally provide care to Medicaid patients, which means that these companies already must be accredited under federal law.

Wessel said the bill would close a loophole that allows some companies to provide care without effective oversight and would improve the financial standing of these companies by requiring annual financial audits.

But opponents of the measure say that state and federal regulators and law enforcement already have the ability to provide oversight by cracking down on fraud.

They contend that the bill would benefit larger care providers at the expensive of smaller businesses that provide companion care.

Jean Bestafka, CEO of the Home Health Services Association of New Jersey, represents 250 predominantly small providers. She would like to see the Legislature introduce a different bill, which would recognize companion care providers but wouldn’t require accreditation.

“It’s very expensive to have care at home” and the new bill would increase those costs by introducing accreditation and audit fees, Bestafka said.

Bestafka estimated that the annual costs could be $10,000 to $20,000 for accreditation and $15,000 to $30,000 for an audit.

Supporters of the bill contest these numbers.

Barbara Cording, executive director of an existing accreditation body — the Commission on Accreditation for Home Care — said her organization charges businesses between $1,792 and $4,704 for annual accreditation, depending on the amount of service provided.

Cording said state and federal fraud investigations don’t have the same purpose as accreditation, which sets standard that require care providers to follow the industry’s best practices.

“What we’re looking at is the quality of the home care services,” Cording said.

She said her organization requires that aides have training and be regularly tested, and that accredited providers allow patients to file grievances over allegations of faulty care.

Zach Demopoulos, owner of a franchise of the non-medical home care provider ComForcare Senior Services, said many such providers are “mom-and-pop” businesses that can’t afford the additional fees for accreditation and audits.

He said the current Medicaid requirement for accreditation is appropriate, but shouldn’t be added for companies that don’t serve Medicaid patients.

“I chose a franchise that has better internal control than accreditation ever would have,” Demopoulos said.

He added that problem of the cost of care for older residents will only grow in the coming years.

“It’s going to be a huge problem five to 10 years from now, when we baby boomers are going to need a lot more care. Who’s going to be able to afford it?” he said.

Wessel said all residents who receive home care deserve to know that their providers are regulated.

“Yes it’s going to cost businesses a little more money but it’s also going to provide oversight,” he said of the legislation.

The bill’s sponsor, Sen. Nellie Pou (D-Bergen and Passaic), said during a June hearing that the bill would reduce incidents of abuse.

“It was indeed my intention and purpose was that we have trained certified licensed individuals in the homes and making sure of that was the primary concern,” Pou said.

Republican opponents of the bill have cited the cost, with Sen. Steven V. Oroho (R-Morris, Sussex and Warren) saying that small businesses aren’t in a position to afford the annual audits required by the measure.

The Senate passed the measure 21-13 on August 19, with only one Republican senator, Sen. Samuel D. Thompson (R-Burlington, Middlesex, Monmouth and Ocean) voting in favor. The Assembly version of the measure has been referred to the Assembly Health and Senior Services Committee. Both supporters and opponents of the measure said they are unsure where Gov. Chris Christie’s administration stands on the issue.