Testimony Presented by
Patricia O'Malley, Esquire
General Counsel
SPECIAL CARE & GRISWOLD SPECIAL CARE
Before:
The Commission on Affordable Housing and Health Facility Needs for
Seniors in the 21st Century
Regarding:
Consumer Model of Home Care
Monday, July 30, 2001
Syracuse, New York

Good Morning Assistant Secretary Bernardi, Congressman Walsh, Commissioner Lynch, Executive Director Holder and the members of the Commission on Affordable Housing and Health Facility Needs for Seniors in the 21st Century.

My name is Patricia O'Malley, I am General Counsel for GRISWOLD/SPECIAL CARE, a consumer model of home care delivery company which has as its mission helping keep seniors and disabled members of the community independent in their own homes for the lowest cost possible. We currently have over 60 offices in 10 states, South Korea and Mexico. Today, I am representing our Office Directors, their thousands of caregivers and tens of thousands of older and disabled clients. We thank you for the opportunity to testify at this regional hearing today. We were excited to hear of the Commission and its quest to gather information on current and future needs of older Americans.

I was born in Rochester NY and began my working life as a registered nurse after graduation from Community Medical Center in Scranton PA. My bachelor's degree in community health is from St. Joseph's University in Philadelphia and my Master's in Gerontology issued from Gwynedd Mercy College. My law degree is from Temple University in Philadelphia. I have worked in the field of aging and health law for many years and enjoy advocating on behalf of disabled adults through my work with GRISWOLD SPECIAL CARE - the company I have the pleasure of representing here today.

GRISWOLD SPECIAL CARE was founded by Jean Griswold in 1982 in Philadelphia, Pennsylvania. The idea for GRISWOLD SPECIAL CARE developed when a member of her husband's church, lost the help of a fellow parishioner in performing her activities-of-daily living. There was no service like GRISWOLD SPECIAL CARE for her to call in those days, she progressively began to forget to drink and eat properly, fell ill as a result and died. In order to try and prevent this type of tragic incident from recurring, and in order to meet what was perceived as a growing need in the community, Jean Griswold began GRISWOLD SPECIAL CARE. The mission of GRISWOLD SPECIAL CARE clearly articulates how we do business: "GRISWOLD SPECIAL CARE is dedicated to maintaining the dignity, comfort, safety, independence, well-being and happiness of each Client by referring the highest quality Caregivers at an affordable cost to the Client." Since 1982, GRISWOLD SPECIAL CARE has helped thousands of families in need of care. We have been featured on the NBC Today Show, Forbes Magazine, Success and more. Our client population consists primarily of private pay but we are approached more and more by third party payer insurance companies, county agencies, and others attracted by our low rates, high quality, excellent reputation and overall philosophy of client-centered services.

GRISWOLD SPECIAL CARE utilizes a non-medical approach to support of activities-of-daily-living in this region. As a result we are able to provide personal care, homemaking and companionship services to the elderly and disabled in most states where over-regulation does not make it impossible to do so. Increasingly onerous regulations in states where we already do business cause us to approach the legislature and other interested parties to educate them to the needs of elderly and disabled persons who wish to remain independent at home rather than enter facility based care. Some legislative responses to the perceived needs of the elderly fail to recognize that over-regulating the matter is not necessarily the best response. Most persons needing assistance at home do not need the skills of a nurse to help them remain independent in their own home. The average senior citizen seeking to remain independent in their own home needs help getting bathed, dressed, fed, to appointments, light housekeeping tasks completed, shopping and errands performed. These services could and would be independently performed if the individual remained capable of doing so; or they would rely upon the assistance of a family member if a family member was available to them to help when the service was needed. These services rarely need the involvement of a nurse or other medical professional.

We regularly service state contracts in States which have Medicaid funded programs for personal care attendance because such programs, often spearheaded by the disabled community, recognize the primacy of activities-of-daily-living to keep a person independent and at home. Medicaid removed the RN supervision requirement from personal care provision in 1996 and thereby made consumer models like ours viable cost-efficient candidates for service provision in their programs. It has been our experience that voucher programs are an excellent method of decreasing the government's costs while simultaneously involving the consumer in the vendor selection process, thereby helping to improve quality of service delivery. It has also been our experience that even very modest co-pays by the voucher holder are an excellent way to vest the consumer in the home care process. Administrative oversight is at least partially, and in some programs, completely privatized by involving consumers in the vendor selection process by voucher issuance.

In her state-of-the-state speech on 01/12/99, then NJ Governor Christine Whitman proposed a state-funded program specifically designed to keep frail elderly out of costly institutions - literally seeking to return tens of thousands of disabled elderly to community-based living. Commissioner Len Fishman of the New Jersey Department of Health and Senior Services in his Report on the Budget (April 28, 1998) said that, "…seniors want long-term care options that allow them to live as independently as possible." What came of that "Senior Initiatives" proposal was a $60 million program (funded by tobacco settlement monies) that set rates of compensation at such a low level of reimbursement that few agencies even bid for the work - the successful bidders were often programs with charitable funding or grants which could supplement the state stipends. County to county use of Medicaid funds varied widely because of NJ's "freeholder" system of governance which permits each to set up their systems differently. GRISWOLD SPECIAL CARE has offices in thirteen NJ counties yet few do Area Agency on Aging work because of the NJ State Board of Nursing's insistence that bathing and continence care are skilled services requiring RN supervision. On the other hand many of those same offices do Personal Care Attendance Program work for the disabled community in NJ because that program does not harbor the same pre-conceived notions concerning personal care services as the Board of Nursing does.

In order to keep costs down, all factors driving the payment system must be assessed. The Balanced Budget Act of 1997 decreased the Medicare-paid availability of medical model home health care. These cuts were, in part, driven by over-utilization of the home health care system to perform tasks more efficiently provided by non-medical (consumer) home care service companies. Medicaid, on the other hand, has increased the number of dollars to be spent on assistance with activities-of-daily-living (ADLs - assistance with dressing, bathing, grooming, cooking, etc.) and in so doing has seen a decrease in the number of dollars being spent on nursing home beds during the same period. An estimated 7.3 million older adults require assistance with non-medical activities-of-daily-living or substantial supervision because of cognitive impairment (e.g.: Alzheimer's) in order to remain independent in their own homes. (Congressional Research Service, Long Term Care, December 1996). Assistance with daily living tasks and supportive supervision are completely non-medical services. They can be most cost effectively provided by home care companies which do not provide expensive skilled or certified home health agency services. Once you add skilled or health-based medical model services like RN supervision, physician oversight, etc. the cost increases. It is an absolute reality that consumers with fixed incomes and decreasing resources look for the best available help at the lowest cost. Imposing additional pass-through costs cuts into the dollars available to pay for the help needed to keep consumers home - a factor which requires scrutiny in determining what requirements one is going to impose on this workforce and the agencies which supply them, in order for them to be available to the clientele. Unfortunately consumers often think that "saving the office fee" through private hires is a safe alternative to utilizing agencies to screen and schedule personnel as well as monitor the care being given. Imposing too many unnecessary costs on the agencies through over-regulation is a surefire way to increase the overhead administrative costs the agencies must pay and pass through to the clients.

Access to high quality, low-cost non-medical home care impacts not only older and disabled consumers and their families, but also the Caregivers providing the services. According to projections by the Department of Labor, the home care aide, or companion occupation is growing at a rate of one-hundred and nineteen percent (119%). The demand for this class of worker is increasing, not decreasing. The demand for placement of these workers is constant, not seasonal or short-term. There is always work available for qualified high quality home care workers.

The lack of available caregivers is impacting the long-term care service system throughout Pennsylvania and nationwide. The Pennsylvania Intra-governmental Council on Long Term Care targeted this as an issue in need of further investigation before making recommendations which would help form legislative response. Dr. Lori Griswold, Vice President of GRISWOLD/SPECIAL CARE, is a member of the Long Term Care Council and chairs the Work Force Work Group, a committee charged by the Long Term Care Council to look at issues affecting the long term care work force in PA and provide policy recommendations to the Governor for consideration. The Work Group ascertained that most of the information that existed was anecdotal therefore a formal research study was necessary. The Work Group secured monies from the Administration on Aging and others to study the labor force problem in PA. As of July 1, 2000, the Work Group initiated a state-wide study on work force issues in long term care. The study included a survey of providers from the long term care service continuum, structured focus groups with direct care workers and a comprehensive literature and study review. A copy of the study is included in your information provided by GRISWOLD/SPECIAL CARE. We included a copy of the studies for your review because the shortage of caregivers in the long term care service industry is a major problem for providers throughout Pennsylvania and the rest of the country. The study results are not surprising to a consumer model company like GRISWOLD/SPECIAL CARE. For nearly twenty (20) years GRISWOLD/SPECIAL CARE has focused on optimizing the dollars paid to the workers by cutting administrative overhead demands and working to streamline our business system to comply with applicable state regulations but still do the job. The Pennsylvania home care workers who participated in the State's focus Groups told Pennsylvania they valued flexibility and optimized pay rates for quality work more than benefit availability. These issues along with being respected and appreciated by the agency were important retention and recruitment issues. The workforce shortage throughout the country is a critical one that is receiving increased attention as it continues to impact the long term care delivery system.

In summary, the long-term care delivery system is evolving and will continue to do so for years to come. Consumers from all payment streams: private, third party, state and federal funds will continue to want and need high quality, low-cost non-medical home care. This niche of the home care system is often the missing puzzle piece for many older and disabled Americans who wish to remain independent and at home for as long as possible. With the wealth of information that will be gathered by the Commission on Affordable Housing and Health Facility Needs for Seniors in the 21st Century, we hope that the trend towards institutionalization will become the exception and that home and community based care, with specific focus on cost effective consumer models of care, will become the norm for seniors in the future. Our seniors benefit, the community benefits and families have the opportunity to continue to incorporate seniors into family life and the growth of the next generation.

Assistant Secretary Bernardi, Congressman Walsh, Commissioner Lynch, Executive Director Holder and The members of the Commission on Affordable Housing and Health Facility Needs for Seniors in the 21st Century, GRISWOLD/SPECIAL CARE is grateful to you for holding this hearing and focusing your attention on the work of these important issues. Again, thanks to the Members for your time and interest and we look forward to working with you to better the lives of older and disabled adults.