We have been following the recent Letters to the Editor regarding the article “Elder care to get a lot more expensive” that appeared in the Tuesday October 16, 2017 NJBIZ “Morning Roundup” and the subsequent responses back by Don Winant at the Commission on Accreditation for Home Care, Inc. and Lori Grifa, a partner at Archer & Greiner. We thought perhaps it would be important to hear from health care service firm representatives that are providing home care services to the elderly and what our views are on the “Chapter 29” proposed rules.
It is extremely important to recognize the inherent dangers and increased risk of harm in the delivery of care, by allowing the placement of untrained, unsupervised, or independent nonprofessional caregivers in the home, and services delivered by providers that are not licensed and lack basic corporate financial infrastructure. This includes leaving both the consumer and worker without basic protections. Therefore, we fully support the accreditation provision in P.L. 2014, c.29 which amends the original law P.L.2002, c.126 (C.34:8-45.1).
Accreditation does not substantially add to the cost of service, since the operating requirements imposed in the licensing regulations have been law for many years, and are meant to ensure safe, competent care. The primary function of accreditation is independent oversight, as well as establishing basic standards for care. Those who raise the excuse of increased cost are perhaps those providers who previous to the change in the law, where operating outside any oversight and now must adhere to the same requirements as all other responsible providers, and do not fully understand accreditation. For those of us who have become accredited, although it does generate some additional costs, the benefits certainly outweigh the costs in that, accreditation holds us to a higher standard to ensure a greater quality of service and care to our clients. It is important to remember that the government does have an essential responsibility to protect, and that the fragile elderly home care recipient has the right to safe, qualified care. Accreditation is an indispensable way to help achieve this goal.
To permit untrained and unsupervised nonprofessional caregivers, who operate outside any regulatory restrictions, or care givers not employed by a home care organization to provide care is to allow them to perform any task, including those that would be provided by other licensed healthcare practitioners (RN, PT, OT, etc.). This leaves the consumer, often frail and vulnerable, to assume all the risks and the responsibilities of that care, including assessment of the competency level of the caregiver and providing the clinical oversight needed to ensure safe care. This was one of the critical reasons for the passage of the “Chapter 29” law, and why current long-standing New Jersey regulations require the caregiver to be trained and employed by a provider organization.
Everyone, especially the frail and vulnerable elderly, deserves some amount of basic protection, and the government has a fundamental obligation to protect its citizens. In health care, mitigating harm is often achieved through governmental regulation and licensing, which ensures a basic level of competency by the practitioner, thereby establishing necessary benchmarks for safe care and appropriate care delivery standards for the provider organization. To do otherwise disregards an essential governmental responsibility, deprives the consumer and caregiver of basic protections, and increases the chance of harm.
We understand and support the need for an audit for accountability of public funds. But for home care organizations accepting private pay only, their financial well-being relies solely on payment from the consumer. Not only does our accreditation provide a standard for sound independent financial oversight, but the consumer also provides the necessary accountability, control and scrutiny to ensure the accuracy of the billing, payment, and delivery of service. Likewise, there is no law we are aware of that requires private companies in other industries doing business directly with the consumer to have their financial records audited, unless there is public money involved. Therefore, independent auditing makes no sense, adds no value, and only increases the cost, as well as creating an enormous unnecessary burden on the Division of Consumer Affairs. Likewise, in the private pay market, pricing and other competitive aspects of service are governed by the marketplace and consumer choice. The cost of an audit will be passed along to the consumers who are already financially strained elderly that require care in the home.
Christopher Capobianco, Twin Folks Inc.; Andrew Sussman, SNS LLC; and Julie Shea, Wes & J Company Inc.