Published by Anjalee Khemlani on NJBIZ
Chrissy Buteas knows New Jersey has long been ranked among the lowest nationwide for the way it cares for its elderly population.
As the CEO and president of the Home Care & Hospice Association of New Jersey, she agrees with reports that show seniors and older adults face costly and unnecessary care at the end of their lives in this state.
Most of all, she knows patients want to remain at home.
So, as the Centers for Medicare and Medicaid Services is transitioning to value-based and bundled payments, meaning it is now in the provider’s interest to keep patients out of costly care, she is happy for the attention on the subject.
“We’re thrilled folks are paying attention,” Buteas said.
There’s just one problem, she added: cost.
Keeping elderly individuals out of nursing homes, out of hospitals and in the homes with home health aides does not always add up. Those home health aides are being paid by the reimbursements from Medicare — notorious for paying out under cost for health care providers.
The result: Home health workers can be paid at a rate comparable to minimum wage.
“We have to try and attract home health aides. If we can’t pay them a wage that brings them to the industry, they’ll go to retail or fast food,” Buteas said. “That’s my biggest message to legislators. We need more aides, nurses and therapists in home care.”
Steven Landers, CEO and president of VNA Health Group, a longtime advocate for the workforce issue, said pay is just one issue.
“The frontline, elder care workforce and the specialized workforce needs to be enhanced,” Landers said. “We need more people with knowledge, skills and training in geriatric care.”
This is especially important for the 85 and older population, he said.
“Maybe I’m biased because I am one, but we train very few (geriatric physicians) in New Jersey,” Landers said. “Beyond the clinical folks, we need businesspeople to know about aging services in a modern and contemporary way.”
In addition to the need for a work force, Buteas said the modernization and use of technology (such as telehealth and remote monitoring) is necessary. But within legal limits, Buteas said.
Though many organizations are operating as qualified Medicare facilities, Buteas said, the startup field is littered with companies operating outside of Medicare.
As is the case with any other health care service, Buteas said, it’s important to find out if the company is operating legally and using trained and certified nurses.
Linda Schwimmer, the CEO and president of the New Jersey Health Care Quality Institute, said the industry needs to make sure the general population is better educated on what to ask for and expect with end-of-life care.
The organization has been working for a few years on developing, through the Mayor’s Wellness Campaign, a program called “Conversation of Your Life.”
“(In New Jersey), we have some of the most aggressive treatment toward end of life,” Schwimmer said. “Often times, it’s not really what the patient wants or the patient hasn’t been appropriately counseled.”
And rather than place the burden on medical professionals, the HCQI is looking to the community wellness effort as a good avenue to disseminate information.
Gloucester City, Princeton and Tenafly were the pilot towns. But Schwimmer hopes to increase participation and help residents better prepare.
Landers said the time has come.
“There is a big opportunity to help people at home,” he said, adding that newer business and training models should also be considered on the provider side.
Especially with more focus on the concept of an older working population, paired with tax incentives for those who choose to enter the home care workforce.
“I’m not that old and I’m just starting to get it,” Landers said. “If you don’t have the life experience of elder care and aging issues, it’s hard to get that perspective.”
“I’d like to see more of that. There’s a big opportunity.”