Home Care Provider Shortage in Ohio Leaves Disabled People At Risk
People with disabilities often need the help of others to stay in the community. Many states have adopted programs known as home and community based waivers. These waivers help with services to keep people independent in their communities. Personal case and homemaker services are just a few of the major needs people can have met by community based waivers. Other services include nursing, transportation, home delivered meals, emergency alert systems and much more.
In Ohio there are several types of home and community-based waivers. There are waivers operated by the state Medicaid office and waivers administered by the County Board of Developmental Disabilities. These waivers help people with activities of daily living like dressing, bathing and eating. Ohio allows both independent providers and agencies to care for Ohio’s most vulnerable and complex populations. While there is a home care agency on every block in some cities, many lack staffing or providers that have flexible schedules to serve individuals and families.
Over the last few years, many challenges have negatively impacted consumers, families and providers. People need to hear about the challenges home care providers are facing, the barriers people who get services are dealing with and lastly what a shortage of providers means for the disabled community.
In Ohio, home care providers go through audits by Public Consulting Group, otherwise known as PCG. Their auditors do not have a medical background. They go over paperwork and files kept by providers on consumer care. They go through time sheets, documents, nursing notes and much more. They also make sure nurses and aides have the required education and continuing education credits to work as a provider. First Aid and CPR certification are required for providers to practice in Ohio.
If a provider falls short in an audit, PCG gives them time to do a plan of correction. If an overpayment is due back to the state, a provider sets up a payment plan. Providers have reported they are dinged on some of the most tedious things and forced to pay back wages they earned.
Every provider I know strives to be up-to-date and accurate on their paperwork. But one of my providers was cited because I didn’t know I had to date my signature. He worked the hours and got paid, but because of the rule that says both the consumer and provider must date their signatures, he had to pay back several months of pay. This is one example of how the auditing practices work in Ohio.
Another provider of mine was cited because of how something was worded in his notes. I have to do orthostatic blood pressures. I do them myself, but my providers sometimes assist me to stand up to do these blood pressures. They are on standby so I don’t fall. The way he worded his notes made the auditor think he assisted with taking my blood pressure. Home care aides are not allowed to do diagnostic tasks. Even though he didn’t do it, the state tried to make him pay back 15 minutes of every shift. This is another example of how people have worked but have unjustly been criticized on their work and had to pay back money.
These auditing practices are extreme and don’t help anyone. It’s just another way to push out independent providers and leave us without care. Through social media I have seen providers walk away from an audit with no mistakes, only to find months later they owe money to the state. This angers people, and it also causes challenges for the people they care for.
We want our providers to show up to work. When managed care plans or Medicaid decide not to pay our providers, we have problems. When managed care rolled out in 2014, many nurses and home care aides went months without pay. This left some of them with loss of homes, cars, and high credit card bills. In 2017, there were additional challenges for providers to get paid. This drove away lots of providers. People eventually got fed up and left the field or got jobs through agencies.
There are many rules to be a provider beyond the auditing practices. For those on waivers provided by the county boards of DODD, providers must pay a $125.00 application fee, pay for extra training and have their own auditing processes. The pay rates are different. There are rules about overtime and the number of hours a provider can work. People who are receiving more than 60 hours of care have to hire a second provider. In some Ohio counties, providers were limited to 40 hours a week and no more. These rules have left the consumer with less care and no ability to find new providers.
Home care is complicated in Ohio no matter what system people are on — Ohio Home Care through Medicaid, My Care Ohio through managed care or I/O and Self through the Ohio Department of Developmental Disabilities. These systems all lack providers to care for people who need to to stay in their home and in the community. The SSA or Case Manager’s role in all these situations is to assist consumers in finding providers. Those with behavioral health challenges find it most difficult to find workers. But the biggest issue is that there simply aren’t enough home care workers in the state of Ohio to meet the need.
Through Facebook groups I polled individuals and families on various topics. I found that people have called hundreds of agencies and independent providers. The state is required to keep up-to-date directories of provider listings, but many of these directories are full of disconnected phone numbers and providers who left the field. One time I called a provider whose husband said he had been trying to get the Ohio Department of Medicaid to remove his wife’s name for a year after she passed away, but had no luck. This is what we get in Ohio because no one wants to take the time to follow the rules set out by CMS that say these directories must be up-to-date. We must follow rules, but the state doesn’t do the same.
One mother in Akron, Ohio whose child is under the Self Waiver through Summit County DODD had called over 500 agencies and independent providers. She has advocated tirelessly trying to get her son a caregiver since May. She went through the provider directory to find dead ends. She called agencies, but they couldn’t fulfill her son’s needs. One company even drove a few hours to meet, then turned her down after making false promises. She is exhausted, but she continues to look for care for her son every day.
I heard from Theresa Sweeney, whose son Noah is on a waiver through My Care Ohio. He had been on Buckeye for several months. She tried to find nursing care with little results. When Sweeney pursued agency nursing, companies would actually tell her to switch to Caresource because they paid more. She ended up switching to Caresource out of desperation to meet her son’s needs. She has been on Caresource a few months now and still doesn’t have nursing for her son. These companies don’t want to take managed care plans because of how little they pay, and how they sometimes don’t pay at all. They also don’t want to take cases that are high risk, or they don’t have staff to take on cases with lots of hours. The shortage is real and it goes beyond independent providers — it affects agencies too.
I am on a home care waiver through My Care Ohio. I have 45 hours of home care authorized. Since July I have only been getting 20-25 hours of my allotted home care. The provider shortage is so real to me. It is more than a provider shortage. I have found from my own experience there are a few providers who want to work. The challenge is getting an established Medicaid provider credentialed under managed care.
Ohio has chosen to privatize their Medicaid plans. These Medicaid plans are not contracted with all of the same providers as Fee for Service Medicaid. This includes home care workers. The state has forced people in 23 major countries into managed care, but has failed at providing assistance to providers with contracts under these managed care plans. Some managed care plans will contract easily, but with others it’s a fight.
The lady whose son was on Buckeye found that providers were waiting six months or longer to be credentialed under the MCO. I’m on United Healthcare; providers I have interviewed that can take on my care have waited 30 to 60 days. This is ridiculous! Most caregivers will not wait that long for employment. This is why we continue to have problems with finding providers. The state fails to address our concerns. The case managers’ hands are tied. They email provider advocates and anyone they know to try to help, while we sit without care and find ourselves at risk for hospitalization or nursing home stays. Some case managers have already started referring people to do respite or rehab at nursing homes for short-term care. Many of us know this “short-term” institutionalization could get us stuck there.
So where do we go from here? I don’t want to go to a nursing home. It is supposed to be my right to choose, but without the care I need, I could lose that choice and end up there. I am not alone; hundreds of people across my state have gone without care for 30, 60, 90 and even 120 days or more. The state has to be held accountable somewhere.
Right now their focus is EVV — Electronic Visit Verification. They would rather GPS track people with disabilities then to take care of the pressing need for more providers. As advocates, consumers, families and providers, we want fair access to care. Putting surveillance on us does nothing but create more barriers to care. It creates more loss and denies us our right to be independent in our communities.
I started an online petition to ask CMS to review what is happening in Ohio. The shortages of providers is a nationwide issue, but currently it’s a mess in Ohio and we need someone to do something our behalf. Advocates have reached out to state representatives with little to no help. We must continue to fight and unite to be heard.
We need CMS to declare a state of emergency over the shortage of home care workers. We need our state representatives and state senators to listen to us. Ohioans deserve the right to live independently in their communities and homes.
Getty image by Doble D.