Home care industry workers in midst of big changes in Pennsylvania
February 8, 2016 6:31 AM
Christina West, right, helps 82-year-old Roosevelt Turner fold his clothes Thursday at his apartment in Garfield.
By Gary Rotstein / Pittsburgh Post-Gazette
When Christina West stops by Roosevelt Turner’s Garfield apartment to clean and tidy it for the sometimes-forgetful 82-year-old and escort him to appointments, the Superior Home Care aide is aware of the greater significance of the modestly compensated work.
“I would want the independence we give our clients for myself,” said Ms. West, 39, of Wilkinsburg, who spends at least 20 hours a week assisting Mr. Turner. “Your reward maybe isn’t always monetary — it’s knowing your client is rewarded by not being pushed out of their own home.”
She is among the army of thousands of direct care workers making $10 or so an hour on the front lines of Pennsylvania’s efforts to increase services in frail people’s homes, which reduces Medicaid costs by minimizing the number of beneficiaries in costlier nursing facilities. At the same time, home care agencies are facing new financial challenges in 2016 and wondering about the impact of bigger shifts that lie ahead.
Many agencies are taking on employer health insurance costs for full-time aides for the first time, due to a federal Affordable Care Act mandate that took effect Jan. 1 covering businesses with more than 50 employees. Providers have long contended that the economics of the home care industry — including the level of government reimbursements they receive for subsidized clients — prevented them from offering health insurance to home care aides, many of whom are part time.
The agencies in southwestern Pennsylvania face uncharted territory, meanwhile, in transitioning next year to a new managed care system covering government-financed recipients of long-term care. The local region will be the first part of the state in which managed care organizations become responsible for wide-ranging health care needs of an elderly individual — or younger adult with disabilities — who qualifies for government assistance.
But no one yet knows what those organizations will be willing to pay agencies for home help for such individuals, compared to the present $17.52 hourly reimbursement rate, which providers complain is less than several years ago and doesn’t meet rising costs. A worker’s wages, employer taxes, administrative salaries, office expenses and other costs such as the insurance mandate must all be paid with that reimbursement, which is typically several dollars an hour less than regular private-pay rates.
The new changes affecting the home care industry come on top of chronic problems of finding, training and retaining competent aides willing to do essential but menial, sometimes difficult and dirty work in people’s homes without receiving much in pay and benefits.
“Looking back over 20 years, it’s not any harder now to attract and retain workers, but it sure hasn’t gotten any easier,” said Becky Thorne, owner of The Thorne Group, based in Youngwood, which serves some 500 clients in Allegheny and Westmoreland counties.
The finances may not indicate it, but home care services that keep people out of institutions represent one of the most vital, fastest-growing sectors of the economy. Baby boomers are annually swelling the ranks of the elderly while fewer non-working family caregivers exist than before. The federal Bureau of Labor Statistics predicts 26 percent growth over the next decade in the 1.8 million personal care aides presently doing work in people’s homes.
One change affecting compensation for such workers in most states, but not Pennsylvania, was a new federal pay standard Jan. 1 requiring minimum wages, overtime pay and travel time compensation for workers going between multiple clients during a shift.
Such provisions were already in place under state law and practice, and agencies generally feel compelled to pay more than minimum wage anyway to attract workers, with $9 to $11 per hour common. The one type of Pennsylvania worker affected Jan. 1 were some 15,000 in a program in which they work directly for government-financed consumers who hire them, instead of agencies. Those aides, often related to the client, may now be paid overtime at time and a half, which state officials say occurs with more than 4,000 of the workers and amounts to some $6 million more a year in state costs.
Many aides work second jobs to make ends meet, and Ms. West already had health insurance from employment at a hospital. But another aide at Superior who has worked in the field for 25 years, Barbara Hall-Thompson of Clairton, is happy to have employer-provided health insurance for the first time, even at a bite of $115 out of her bi-weekly paycheck.
“It’s a big stretch, but with what you get for it, you’re much better off,” said Ms. Hall-Thompson, 51, who sees four clients in working nearly 40 hours a week.
Kimberly Pirilla-Scalise, executive director of McKeesport-based Superior, doesn’t begrudge her full-time employees the right to health insurance but objects to agencies being saddled with at least several thousand dollars in additional monthly costs without any commensurate increase in government reimbursements.
“We have survived by the skin of our teeth” while assisting more than 100 clients, most of them government-subsidized, Ms. Pirilla-Scalise said.
She, Ms. Thorne and others in the industry are anxiously awaiting the details of the Wolf administration’s transition to managed care of 400,000 such consumers statewide. The managed care organizations entering contracts with the state later this year would receive a fixed payment to coordinate all of an individual’s home, medical and long-term living services. The MCOs would each establish a network of providers, including home care agencies, to partner with them.
“We hope the program’s intent is realized, and that is to provide necessary services to seniors needing them in a more seamless fashion,” said Ms. Thorne, while noting too few details are known yet about how agencies and clients will be affected.
The state Department of Human Services plans to spell out more specifics this month in issuing its request for proposal to the dozen MCOs that have expressed potential interest in participating.
Gary Rotstein: firstname.lastname@example.org or 412-263-1255.
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