Opinion/Bigney and Oliver: Sufficiently funding home care should be top priority at Assembly
Michael Bigney is president of the Rhode Island Partnership for Home Care and the chief executive officer of Home Health and Hospice Care of Nursing Placement. Nicholas Oliver is the executive director of the Rhode Island Partnership for Home Care and a member of the state’s Long-Term Care Coordinating Council.
Rhode Island’s Medicaid home care providers are 35% underfunded to adequately compete in the health-care labor market. Because of years of frozen and insufficient rate increases, patient waitlists have climbed to an all-time high. This has caused a ripple-effect impacting a lack of available workforce to care for our most vulnerable, homebound Rhode Islanders in need, including those with Medicare, private health insurance and those that can afford to pay out-of-pocket.
This legislative session, home care providers, workers, patients, families and advocates have proposed measures to adequately fund home care services and supports, ensure that patients receive and retain health-care services that help them remain safe at home and in their community, expand the workforce by reducing barriers of entry, eliminate labor market competition between home care, nursing homes and hospitals, and propose a licensure moratorium that has the right protections to preserve tax dollars for direct patient care locally.
These reforms support goals for achieving the "triple aim" for health care that “foster a more person-centered, high quality, and resilient continuum of long-term care services that delivers the right support, at the right time, in a cost-efficient manner, while promoting choice, community, and opportunity for older Rhode Islanders and individuals living with disabilities.”
Rhode Island has committed, but insufficiently enacted meaningful reforms toward the "triple aim." Senator Louis DiPalma said during the April 28 Senate Health and Human Services Committee hearing on the subject that our health-care system is "imploding" as a result of our state’s inaction, especially in underserved communities such as those in Aquidneck Island, South County, Northwestern Rhode Island and the East Bay. Home care providers responded to pleas from nursing home residents and their loved ones when they feared COVID-19 exposure and hospitalization if they remained in a nursing home.
Home care providers transitioned nursing home residents back home safely without any state aid or rate increase. In fact, home care providers only received an insignificant amount of CARES Act funding allocated by then-Governor Gina Raimondo in the last few weeks of 2020. This eventually did absolutely nothing to increase the home care workforce or reduce the skyrocketing waitlists for care. Hospitals and nursing homes have enjoyed and continue to benefit from federal and state aid over the last two years of the COVID-19 public health emergency, while home care patients and workers were largely left forgotten.
Home care providers can no longer afford to support those in need without a minimum 35% Medicaid base rate adjustment, as well as separate funding in compliance with the U.S. Department of Labor’s 2017 rule on travel reimbursement for home care workers, especially as gas prices encroach and exceed $5 per gallon. Anything less will continue to drive our most fragile population to frequent utilization of hospital emergency departments and earlier entry into nursing homes instead of being stabilized with home care services and supports.
Three home care providers have closed their operations since the beginning of the year. More closures are anticipated if the General Assembly does not take action immediately. Some home care providers have lost 30% or more of their workforce to date since the beginning of COVID-19. The General Assembly should invest our "once-in-a-lifetime" American Rescue Plan Act dollars toward the goal of rebalancing long-term care, reform the licensure process to allow home care providers to no longer compete with hospitals and nursing homes for paraprofessional health-care workers, reduce the long waitlists for home care by eliminating the approximate 35% underfunding of Medicaid home care services and adding funding in compliance with the federal mandate for travel reimbursement while gas prices continue to climb at record highs.
This article originally appeared on The Providence Journal: Opinion/Bigney and Oliver: Sufficiently funding home care should be top priority at Assembly
