Flat Medicaid impeding hiring

AT HOME: Jennifer Fonner, left, CNA with South County Quality Care, works with patient Janet Beauvais in Beauvais' Narragansett home. / PBN PHOTO/MICHAEL SALERNO
AT HOME: Jennifer Fonner, left, CNA with South County Quality Care, works with patient Janet Beauvais in Beauvais' Narragansett home. / PBN PHOTO/MICHAEL SALERNO

Home-care providers for the elderly say hiring and retaining certified nursing assistants have become more difficult as patient needs increase and Medicaid reimbursement rates have been flat.

VNS Home Health Services, a nonprofit that is part of the South County Hospital Healthcare System, has seen an increase in visits to patients age 66 or older across Washington and Kent counties of about 10 percent, according to Susan Jamison, director of business development at VNS.

In fiscal 2014, VNS recorded 84,093 visits, up 8,437 visits compared with a year earlier, when the number was 75,656, she said. The number of patients likewise has been steadily rising from 2,336 in 2013 to 2,523 in 2014 and to an estimated 3,528 for 2015, based on patients seen through April, she said.

“The older clients require more visits and follow up,” Jamison said.

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At South County Quality Care, a private duty home-care service that is also part of the South County health care system, CEO Pam Jeffrey said of the number of clients at her facility has climbed from 150 in fiscal 2013-14 to 175 in 2014-15. Her firm is not large enough to take Medicaid rates paid by the state, she noted.

“We did have this year a substantial increase in volume,” she said. “We’re always hiring. We’ve had to turn work away because we haven’t had enough staff.”

As the needs for home care for the elderly grow, there is a shortage of CNAs to meet that need, said Nicholas Oliver, executive director of the Rhode Island Partnership for Home Care. The partnership counts 34 agencies as members, including Cowesett and VNS, Oliver said.

“With multiyear rate freezes for Medicaid, it has become increasingly difficult for home-care agencies to hire and retain staff,” said Oliver.

The average pay for a CNA in 2002 was $3 above the minimum wage of $6.25, but today the average pay is $11 an hour, while the state is proposing $10.10 as the minimum wage, he said.

“Without [Medicaid] reimbursement increases, we’re not able to have wages competitive to jobs in hospitality, restaurants and retail, or to nursing homes and hospitals,” he said.

Unlike a retail or restaurant worker, for instance, a CNA must go to school to become licensed and then update their skills with continuing education, as well as provide their own transportation, which not only covers visits but tasks such as runs to the supermarket or pharmacy, he said.

Laurie C. Ellison, a registered nurse and administrator at the Cowesett Home Care in Warwick, noted Cowesett’s fluctuating patient census is about 90 today, roughly the same as it’s been for the last few years, but hiring has been “very difficult in the last year,” she said. (Ellison is president of the partnership’s board of directors.)

“If we were able to hire and retain more CNAs it would allow us to increase [patient volume] at a better rate,” she said.

R.I. Senate Bill 839 proposes increasing by 10 percent the standard average Medicaid reimbursement rates, based on services from providers that the state contracts with, said Sen. Louis P. DiPalma, D-Middletown.

Those rates range from $19.16 to $22.22, varying based on the accreditation level of the provider. In addition, the rates are paid directly to providers, and as such, cover not only staff wages, but also insurance, utilities, medical supplies and other operating costs.

DiPalma, who relied on CNAs to care for his late mother, who passed away in 2002, said he appreciates that care, which enabled his mother to stay out of a nursing home or hospital until the last two months of her life.

Paying CNAs better “is how we expect to reduce our Medicaid cost and keep people in their homes as long as they want,” he said.

Heather Cole, 38, of Providence, a CNA with H&T Medical Inc. of Cranston, earns $12.10 an hour working full time caring for the elderly, and has been doing that work for 16 years, she said.

“Not having a pay increase in the past seven years, it is a struggle,” she said. “Knowing I’m making a difference in someone else’s life is what keeps me doing the job.”

Christopher Sears, 48, of West Warwick, a CNA working at South County Quality Care in South Kingstown, would not disclose his hourly rate and noted he is not dissatisfied with his wage. However, he said he’d like some incentives for staying in this field, since he would like to become a registered nurse and supervise CNAs someday.

“What I would like to see is more opportunities to educate myself more and be compensated for it,” he said.

He also works full time but has a second job at a nightclub to make ends meet.

“While I could survive without working the second part-time job at the nightclub … in order to maintain my current standard of living, yes, working both jobs is necessary,” he said.

Jeffrey said the skills CNAs need include confidentiality; accuracy, dependability, compassion, a love of caring for people and for the work itself.

“We’re looking for excellent CNAs who have experience and the right attitude from home care that we can mold and train,” she added. “It’s got to feed your soul.” •

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