Unjustifiable Reductions in Home Care Hours

Medicaid Matters and the New York chapter of the National Academy of Elder Law Attorneys released a report analyzing six months of fair hearing
decisions related to reductions in hours for New York home care clients. The
evidence suggests that some managed-care plans are cutting hours without

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A recent New York Times article calls attention to a report documenting challenges being faced by people with disabilities served by New York’s Medicaid Managed Long Term Care (MLTC) system. The report, issued by Medicaid Matters and the New York Chapter of the National Academy of Elder Law Attorneys, analyzes six months of fair hearing decisions related to reductions in MLTC enrollees’ home care hours.

The analysis found a pattern of unjustifiable reductions in enrollees’ home care hours, with a few plans accounting for the majority of cases. The New York Times article takes a look at how these reductions in hours—often reversed during the hearings– affect the enrollees and those who care for them. In the example in the article, the enrollees’ hours were cut in half – negatively impacting the enrollee, her family caregivers, and her paid caregiver.

Impact on Quality of Care

A home care client’s quality of care and quality of life often depends on having a consistent, high-quality relationship with one or more home care aides. When service hours are cut without justification, an enrollee is not only prevented from getting the care they need, but the relationship between the aide and the client may be damaged, disrupting a stable situation and creating cascading problems for both the client and the caregiver.

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Impact on Quality of Jobs

For home care aides, reductions in care hours impacts work schedules, livelihoods, and their ability to form and maintain client relationships. In the example provided in the article, the aide – who has a 7-year-old child at home – was switched to working weekends, rather than Monday through Friday, which negatively impacted her finances and her ability to care for her child.


To avoid future unnecessary reductions in care and create a more accountable system, the fair hearing report recommends:

  • Increased monitoring of managed-care plans, including collecting and publicly publishing data on reduction of hours;
  • The review of previous reductions in care to restore hours for enrollees who were not aware of their rights or unable to go through the fair hearing process; and
  • The publication of fair hearing decisions in a manner that is easier to understand and more transparent.
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Medicaid Matters New York (MMNY) is the statewide coalition dedicated to advancing the interests of Medicaid beneficiaries.

National Academy of Elder Law Attorneys, NY Chapter (NY NAELA) – NY NAELA is the local chapter of a national professional association of elder law attorneys in the private and public sectors who are dedicated to improving the quality of legal services provided to people as they age and people with special needs

REPRINT: Original article can be found at phinational.org


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Remote Monitoring Disappoints in Early Tests

There’s been an increasing focus on remote monitoring in the home health sector as of late, with multinational tech giant Philips (NYSE: PHG) among those betting on these types of devices. However, there’s little evidence, if any, showing they improve health outcomes, according to recent research published in the International Journal of Medical Informatics.

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Internet-linked products and home health monitoring do have the potential to improve care for the elderly, but a review of existing evidence suggests some benefits are quite limited, if they exist at all. In fact, research found no evidence connecting smart homes and home health monitoring technologies to fall prevention, disability prediction and quality of life improvement, according to analysis of 48 relevant studies outlined in the journal.

Providers shouldn’t necessarily discount remote monitoring or smart home systems, but they should be aware of the lack of research into how well they work, said lead author Lili Lui, who works with the Department of Occupational Therapy at the University of Alberta in Edmonton, Canada.

“If a family member would come to me and say, ‘I use the same system on my house for security as I do to monitor a family member who is living on the other side of the country,’ I would say use it, if it works for you,” Lui said.

Get Senior Care Auditing certification for long distance caregiving and monitoring support

Despite a flood of devices and systems in the market, few have been properly studied or vetted, Lui said, indicating a need for research that links health outcomes to technology. For now, a March study from the University of California, Los Angeles concluded health coaching telephone calls and telemonitoring combined didn’t reduce 180-day readmissions for health failure patients, according to HealthLeaders Media. In another recent study, researchers found no cost or utilization benefit for patients using mobile devices and cell phone systems to track hypertension, diabetes and cardiac arrhythmias.

The research conducted, though, doesn’t accurately portray a correlation between these systems’ use and health outcomes, as only 60% of the patients in the heart failure study fully participated, Joseph Kvedar, head of the Partners Center for Connected Health in Boston, told HealthLeaders Media. The traditional research model employed for the majority of clinical trials isn’t entirely conducive to this type of research, either.

“Remote monitoring requires a different way of evaluating effectiveness, which does not fit cleanly into our preexisting notions of clinical evidence,” Kvedar said. “For example, if a patient is not engaged with or using the remote monitoring intervention, should that technology be deemed unsuccessful in managing a chronic illness?”

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Use a certified Senior Care Auditor for loved ones at a distance or if you are too busy to be there!

Plus, the pace that technology is being developed and deployed is far faster than typical research grant cycles, meaning technology might be outdated by the time a study is planned and funded, Kvedar said.

Still, on a smaller scale, providers have been able to track the effectiveness of weaving remote patient care technology into their operations. University of Virginia Health System, for example, saw readmissions for Medicare patients with select conditions fall by 40% over two years with the use of Locus Health’s web-based technology.

Written by Kourtney Liepelt

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How will BREXIT Impact Care: Take the Poll


 20131243153252734_20.jpg (800×450)Thousands of overseas nurses have been drafted into the NHS to ease chronic staff shortages over recent years. Concerns that they may now feel unwelcome and turn their backs on the country in the wake of the referendum result, has prompted senior figures to state how much they are valued and appreciated.

Leading representatives from the UK’s care sector have warned that the vote to leave the European Union could have serious consequences for the workforce in their sector.

While much has already been said about the potential impact on the NHS workforce from a Brexit, care home and home care providers are also at risk, it has been highlighted.

Thousands of overseas nurses have been drafted into the NHS to ease chronic staff shortages over recent years. Concerns that they may now feel unwelcome and turn their backs on the country in the wake of the referendum result, has prompted senior figures to state how much they are valued and appreciated.

Caring for an elderly loved one? Show you really care. Prove you take pride in your work. Get educated and Certified by CertifiedCare.org for elder care.

Leaders from the National Care Forum and Care England have now echoed these sentiments for the large numbers of EU nurses and health and care assistants that their sector heavily relies on.

Professor Martin Green, chief executive of Care England, the largest representative body for independent social care providers, said: “There has been much discussion about the fall out in the NHS.

“However, we need to remind politicians how vitally important the staff in social care are,” he said. “It is essential that regardless of their background they feel valued. Recruitment and retention are essential components of the health and social care system.”

Professor Green said he had met with senior officials from the Treasury yesterday to discuss the issue.

“Whilst we understand that the Treasury, and all other government departments, will be exercised by the implications of Brexit, it is important that they also pay attention to social care,” he said.

Care England said it would continue to “turn up the volume” on social care, noting that it “underpins” the sustainability of the NHS.

“The need to plan for anticipated change needs to start now”

Vic Rayner

In addition, National Care Forum executive director Vic Rayner said that, while the full impact of the vote to leave the EU was currently “unclear”, it would certainly have “far reaching and fundamental effects” on the provision of adult social care.

She suggested that 6% of the overall social care workforce in the UK were EU migrants, equivalent to around 80,000 staff.

“We know that this figure is significantly higher in different parts of the country and, therefore, the need to plan for anticipated change needs to start now,” she said.

“We know that residents will be concerned, both for the staff that they work with and in relation to their own status as EU nationals, and how this might affect the continuation of care that they receive,” said Ms Rayner.

She added that the news was already causing “substantial and ongoing shocks” to the financial markets, which might affect future investment and financing of the care sector.

BY STEVE FORD News Editor Nursing Times

 Prove you take pride in your work. Caring for an elderly loved one? Show you really care. Get educated and Certified by CertifiedCare.org for elder care.

FULL ORIGINAL ARTICLE REPRINT: http://www.nursingtimes.net/7005990.article?utm_source=newsletter&utm_medium=email&utm_campaign=NT_EditorialNewsletters.Reg:%20Send%20-

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There need not be a single approach to solving most problems.  It could be argued that taking the one approach stance tends to create more problems than it solves.  Certainly, the single approach tactic results in the tendency to leave fundamental elements of complex problems unaddressed or unresolved.

Those of us who are immersed in the LTC industry know there is a looming shortage of Personal Care Aide (PCA) workers for the home care and assisted living segment.  We also know there is a persistent shortage of PCAs available for the work who are really of the caliber we would want working for our own loved ones. We also know that costs of providing even the most basic level of customer care are in delicate balance and are being threatened with escalation.  We know that escalation will prove catastrophic for our industry.

I own a Long Term Care (LTC) business, and as a business person I am deeply aware of the juggling the impact of operating costs and managing realistic payment options.  These are issues any business owner must constantly dwell upon when navigating the ever changing waters of providing services in a complex and changing society.

I am not a union representative nor do I own an agency or facility.  My work involves finding ways to make the LTC / home care industry better for everyone involved in it.

Much thought and experience leads me to propose a combined approach to solving the PCA shortage of both quantity and quality of workers.  This combination consists of a simple, fast and easy three pronged approach. The three pronged approach takes into account the three constants of modern LTC in either the domestic or residential facility environment.

Note the solutions proposed result in zero cost to agency / facility owners.

1 Require self-pay PCA certification.  Why should an agency have to pay for someones’ education?  In what other field does this happen? Because the requirements for PCA education are only going to increase over time, PCA self-pay will help agencies keep costs all around down.

2 Require primary family/informal caregivers certification as PCAs.  This better prepares them from the beginning for home care responsibilities.  This front end requirement will result in their involvement in care being more helpful than stressful to them, other care staff, and the frail elder.

3 Combine the use of technology for appropriate tasks with PCAs (professional or informal) for the ‘human touches’ so necessary to wellness and quality of life. This can reduce stress and overload of caregivers as well as improve quality of life for the frail elder.

Advocating for the use of this three pronged approach to solving the PCA shortage and low quality problem can check off three boxes rather than just one and might well result in a ‘low to no’ impact resolution of the problem.


Dr. Cathleen V. Carr, Executive Director, CertifiedCare.org


Posted in Advocacy, Aging at home, Caregiving Education and Credentialing, Certified Care.org, Certified Caregiving, Elder Care Goods and Services, Elder Law and Finances, Government, Home and Health Care Agency, News, Professional Eldercare | Tagged , , , , | Leave a comment


The minimum wage was never meant to serve as a means for a single individual to support a household.

I believe it is ill advised to allow minimum wage workers to be encouraged to cling to this unrealistic expectation of independence. I believe it will be catastrophic for businesses.  I believe is will render most members of the public unable to afford to pay for the service.  I know it will cost many PCAs their jobs.

Raising the minimum wage will simply serve to trigger the escalation of wages for everyone; then produce an uptick in the cost of living for all for us. This is an obvious pattern, born out time and time again.

Advocating for a higher minimum wage is an antiquated, unimaginative, knee jerk, cusping on irresponsible, approach to ‘solving the problems’ of the working poor.  It is one which has historically not in the best interest of the workers it claims to protect, nor the rest of society that has to pay the freight.

Raising the minimum wage will not solve economic woes.  The cost of living simply goes up, leaving workers trapped in the same place they find themselves. That’s how economics works in a capitalistic society.

When will labor learn this lesson?

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Raising the minimum wage will result in lost job opportunities when the country – and global society- needs them most.  Real world customers and typical employers simply cannot afford to raise – and then pay- higher workers’ wages.

In this day and age, here is another reality to consider.  Technology in the form of telemedicine, remote monitoring, medication reminders and administration, etc., is quickly approaching the level of quality that will result in robots competing with humans for personal care jobs.  This is not science fiction anymore.  It is science fact.  This reality coupled with our reflexive action of the last 40 years – the action of selecting lowest cost over long term quality – is unfortunately tied to our contemporary societies mindless mantra that one choose ‘whatever is cheaper’. Now, what does that tell you?  It should tell you that customers and agencies/facilities will choose to replace human workers with technology at every fiscal opportunity.

So, how can we keep our economic feet on the ground, stay calm and carry on?

How do we get a better workforce without having to price them out of service?

I humbly suggest ‘self-investment’.

Self-investment, especially in this instance consists of the elements deemed most important: it is cheap, fast and easy.  Self-investment is a low cost option for PCAs and a no cost solution to employers.

Self-investment  is a worthy solution to this problem.  Here’s why:

  • Self- investment and improvement is key to respect and success in any field of employment – not higher base wages. If you are better at your job than your competition you will naturally be more valued- whether that competition be a robot or another person.
  • Self-investment in developing oneself into the best PCA possible is the right value focus for getting better paying jobs.  Why?  The law of supply and demand.  A better developed PCA can even make more than the minimum wage since you will be more than a minimum employee; you will be of more value to employers and clients.

Self investment by PCAs in their own professional education and development
(like all the rest of us had to do) is the answer to the problem, not raising the minimum wage.


Dr. Cathleen Carr, Executive Director, CertifiedCare.org

Posted in Advocacy, Aging at home, Caregiving Education and Credentialing, Elder Law and Finances, Government | Tagged , , , | Leave a comment

About online PCA Certification…

Professional credentials (not state minimum low bar qualifications)  help caregivers be worth the $15 /hr more PCAs desire. They also give informal caregivers the confidence and respect they deserve.

With the growing awareness of the importance of properly educated elder caregivers, certification for caregivers of the elderly is available online making the cost lower and access more convenient to the quality minded or ambitious caregiver.

Now that LTC agencies have to focus on the 5 Star Rating imposed by CMS employers of professional caregivers are having to scrutinize applicants with an eye toward cost savings and quality of care. Did you know that:

  • Agencies do not pay for PCA advanced education or real professional credentials.
  • Increasingly, agencies and clients are looking to weed out the less desirable candidates from the start.
  • Increasingly agencies are moving toward requiring certification as a pre-application requirement.

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State governments and better agencies hungry for growth in a crowded field are finally appreciating what better prepared care providers can bring to the table.  This awareness has resulted in more demand for credentialed caregivers.

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Professional credentials (not state minimum low bar qualifications)  help you be worth the $15 /hr more PCAs desire. Ambitious caregivers can also get Senior Care Auditing certifications now at CertifiedCare.org

If you owned a home care agency, who would you choose, the state minimum PCA or the CertifiedCare.org registered PCA?

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It is a no brainer.  

No more excuses.  

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CertifiedCare programs are:

  1. Accredited
  2. Standardized
  3. Online
  4. Comprehensive
  5. Affordable

Get certified and registered at CertifiedCare.org now while prices are within reach.  Voted #1 – 5 years in a row by Caregiver Certification.com.

Posted in Advocacy, Aging at home, Caregiving Education and Credentialing, Certified Care.org, Certified Caregiver, Certified Caregiving, Elder Care Goods and Services, Home and Health Care Agency, Professional Eldercare, Senior Care Auditing, Uncategorized | Tagged , , , , , , | Leave a comment

How Agencies quickly save time,money, and get better care staff

Dear Colleague,

I am writing to you today to show you how- with no work and no expense on your part -you help ensure the caregivers you hire are dependable and qualified to provide top quality care and make your business richer.

By taking this simple step you will achieve these results:

Your business benefits naturally

You have lots more time to do tasks

Your in-house headaches are greatly reduced

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How to quickly save time & money

plus attract and retain a better Personal Care workforce

Research conducted by the agency, Leading Home Care, shows that home care companies that recruit and select the best caregivers are able to grow faster, have higher client satisfaction ratings, and earn more profits.  This seems an obvious outcome, but there exists proof now (for those who need that extra reassurance):

Research shows that the typical cost of making a bad hiring decision is over $1,500.  If you have 100 caregivers and half of them leave, that will cost you over $75,000 per year.

It is a ‘no brainer’ that PCAs who are better educated for the profession and are polished caregivers will get better word-of-mouth advertising from delighted clients and are less likely to quit a job due to finding our they just do not like Personal Care.


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How you quickly save Time and Money:

Let’s talk about the goodness in the approach we advocate for you and your home care, home health, or Assisted Living business.  Why should you pay for someones’ education and credentials?  Candidates who have taken the initiative to improve themselves will do a better job of working professionally for you.  Requiring applicants to already have education and certification helps weed out the less desirable and less committed candidates from the start.

Require CertifiedCare.org PCA certification as a pre-application condition of employment.


How’s this possible?

If a caregiver will apply themselves to the program, it demonstrates their ability and determination to be the best.  It reassures that they know what they are getting into with Personal Care. Less time will be spent dealing with caregiver issues, the morale of your office staff will improve, and you’ll reduce your operating costs (from referrals and less employee turnover) while increasing your profits. You can require it as condition of employment and it costs you nothing.

Here’s how You benefit:

  • Differentiate your company from your competitors. The 24/7 free public CertifiedCare.org Registry has established itself as a must have quality control tool. Consumers are seeking private duty home care companies that are leading the way in establishing best practices and highest standards in the marketplace. They check our registry for credentials verification..credentials which exceed minimum state requirements.
  • Increase your client base. By hiring more qualified caregivers from the start you secure better representatives of in-home care, and your business will grow. Not only will you save money associated with caregiver turnover, you’ll also earn a reputation as a trusted provider of desirable PCAs.
  • Reduce time and money spent on problems with unqualified caregivers. How much time is spent dealing with a variety of unprofessional caregiver issues or unhappy (or angry) clients?  Make high caregiver turnover a thing of the past.
  • Get More Referrals. Your CertifiedCare.org Certified Personal Care Aides (CPCAs) are listed on the Registry on our web site at CertifiedCare.org.  This helps you market your PCAs as the superior choice in your community.  Customers appreciate the ability to confirm credentials themselves prior to hire.

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How does this work?

You do nothing for administration.  Our registration and education process is seamless, no portal, self- contained.  Students quickly and easily register online, and are automatically processed through our system as tests are passed.  The registry is automatically upgraded with each credential earned. Retakes of tests are free. Students, as a member of CertifiedCare.org, have access to both basic and advanced education, testing, and certifications. They study online (mobile, tablet, PC, whatever…) and at their own pace or your in-house deadline. You can sip your coffee or tea while you check our registry to confirm credentials earned.

You pay nothing.  Student pays.  First year membership affords 4 full professional certifications (family, professional, Alzheimer’s-Dementia, and Special Needs.

PLUS— You get another service to offer your community

Students who complete our full PCA certification program are eligible to apply for Senior Care Auditing certification.  This is a new service you can offer your community.  Lots of people do not have the time to check on elderly loved ones.  Your more experienced PCAs can enjoy career advancement via this service.  You offer a new service and retain workers who feel they can grow in place.  Your community gets a new service.

It is a win/win/win.

With no work on your part you help ensure the caregivers you send into a client’s home are trustworthy, dependable and qualified to provide top quality care. Your business benefits naturally. A more effective and efficient caregiver is our promise.

It is that simple and easy.

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CertifiedCare.org has been ranked #1 for 5 years in a row for efficient, comprehensive online Personal Care Aide certifications.  We do not settle for less for ourselves or for you.

Find out about the Senior Care Auditor service for your agencies service growth here…

Very sincerely yours,

Dr. Cathleen V. Carr, JD PhD



Leading Home Care and Caregiver Quality Assurance Study https://ceoforum.leadinghomecare.com/welcome-home-care-ceo-forum/?category=Client/Caregiver%20Satisfaction

Posted in Advocacy, Caregiving Education and Credentialing, Certified Caregiver, Certified Caregiving, Elder Care Goods and Services, Home and Health Care Agency, Professional Eldercare, Special Needs, Uncategorized | Tagged , , , , , , , , , , , , , | Leave a comment