I have four peers i have to reply to in a discussion 200 words each 1.In the article “Companies Improperly Cut Home Care Hours” by Nina Bernstein, the author discusses several issues related to Medica

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I have four peers i have to reply to in a discussion 200 words each

1.In the article “Companies Improperly Cut Home Care Hours” by Nina Bernstein, the author discusses several issues related to Medicaid’s policy changes for reimbursement among managed care long-term care insurance plans in New York State.  In 2012, Medicaid began replacing the fee-for-service system with a flat rate reimbursement for each patient enrolled regardless of how many hours of care were provided.  This change created a financial incentive for managed care insurance companies, such as Senior Heath Partners of Healthfirst.  By limiting the provision of services (hours) to clients, Senior Health Partners earned more money by providing less care.  In other words, they profited from unused reimbursement funds.  Furthermore, Senior Health Partners exploited this policy change by systematically reducing hours of home care for disabled and elderly clients without proper notice or legal justification. (Bernstein, 2016, p. 2).  An independent study also found that appeals filed in 2015 disputing home-care reductions from Senior Health Partners accounted for at least 56 percent of the 1,046 fair hearings (administrative law hearings) in New York State. (Bernstein, 2016, p. 2).

As described in Chapter 8 of the textbook, “Pratt’s Long-Term Care”, by Steven Chies, Medicaid is a health care program designed for low income who cannot afford health insurance.  The program is operated by the states under federal guidelines from the Centers for Medicare & Medicaid Services (CMS).  The states are mandated to provide nursing services, home care aide services, and medical equipment and supplies. (Chies, 2021, p. 201).  Overall, home care and community-based services covered by Medicaid has increased as states continue to seek new ways of reducing costs. (Chies, 2021, p. 201).

The issues described above affect Medicaid home care and community-based services in several ways.  First, home care reductions severely impact the Medicaid clients’ access to health care and reduce their quality of life. Some clients are totally dependent on their caregivers for mobility, toileting, meals, etc.  The home care reductions also shift the responsibility of care to friends and family members or force them to pay out-of-pocket for services.  Also, Medicaid clients have limited finances and likely cannot afford legal counsel to assist in disputing the home care reductions.


Bernstein, N. (2016). “Companies improperly cut home-care hours for disabled clients, report says”, Retrieved from http://www.nytimes.com/2016/07/21/nyregion/insurancegroups-in-new-york-improperly-cut-home-care-hours.html?_r=0

Chies, S. (2021). Pratt’s long-term care: managing across the continuum. Burlington, MA: Jones & Bartlett Learning.

Here is an example of someone reply

hi catherine!

Great point about the effect the cuts are having the Medicaid population. They generally do not have the means to afford any kind of extra expense like an attorney or consultant to help dispute the cuts made to their services.  They are already dependent on care givers for their daily activities so just the physical demands of disputing the cuts and going through that process with court would be impossible for them to accomplish on their own.  Also, not everyone in the Medicaid home care pool has family they care rely on to assist in their accommodations.  These individuals are often left at the mercy of the system with only social workers and case managers to help organize all the services they need while helping the patient to maintain their home environment as best they can.  Many of these people end up in long term care facility unnecessarily, simply because they do not have a place to go or anyone to assist them when in the community.  These home care services are vital to many people and allow them to have a quality of life similar to everyone else.  With a few changes, all of these patients could be safely cared for in their home.

2. Based on, Companies Improperly Cut Home Care Hours  and the textbook Chapter 8: Community Based Services, what issues is the author discussing? How do they affect access to home care services and community-based services in general?

The author is discussing in both the “companies improperly cut home care hours” and chapter 8 the affect of companies cutting off hours of home care aides in the home of disabled and aged patients.In the article it explains how important Ms.Negron aide is to both her health care and her family. Senior Health Partners of Health first decided to cut off the hours an aide will be able to assist her throughout the week and this leaves time where Ms.Negron will be completely alone and she cannot adequately help herself. Another issue is that her family can’t provide her with the same care that is required for her.  Another person effected will be her aid who will receive less hours with Ms.Negron and less income. In Chapter 8 it explains that when a patient needs more care and supervision by staff it may be harder to gain some of the services due to it not being cost-effective. Even though home care services are less it can cost the insurance companies a good amount if they are more disabled and need the constant care compared to someone who only needs a aide throughout the week a few hours.

Here is an example of someone reply.

Hello Jasmine,

The issue that the author is discussing is companies cutting home care hours when they either should not be cut or if the patient is unaware of these cutbacks. Ms. Negron is having trouble with her home care services because she is not able to provide care for herself and she does need assistance. I like how you not only stated the issue with Ms. Negron, but her aide as well. Not many people focus on these issues as well. The staffing issue has been a serious issue as well. The aides hours are now getting cut as well. I am curious to know if there is a way that patients can still get the care they need that is more cost effective? For one, I think a major issue is this issue is not being discussed with the patient. The patient did not know that her services were getting cut back until it happened. It is a law that a patient is supposed to be notified when things change in her services. If a patient has an add on to a medical condition or a change of service, then it is fine for the patients status to change, but the patient always has to be made aware.

discussion 2

3. Based on, 5 Big Issues in Senior Living in 2018   and textbook Chapter 7: Senior Housing, identify and discuss significant trends impacting senior housing.

Based on the article “5 Big issues in senior living in 2018” the key issues that are impacting senior housing is an adequate amount of employees. Since the elderly is growing more the ratio of employees to seniors is impacted. Also the rate of pay is attractive to a lot of people so that is also the reason nursing home does not have staff. Another issue is that assisted living staff are getting additional work on top of the work they already do. In some states aides  now have to administer control substances. Also fraud is something that is so common in the long-term care industry, several CEOS are going to jail for white collar crimes against them. In some states cameras are being installed in the rooms of residents at assisted living facilities. For the most part assisted living facilities allow independent living to its residents, they often include wellness programs but do not provide other care options. A new option that is impacting residents is that they have reverse mortgage for seniors that are already homeowners this can allow them to continue to pay for services(Chies,pg177). Also everyone wants option for lower cost senior options because most people cannot afford the options being given, the cost may cause an effective increase of seniors if it is of a reasonable price.

example of someone reply

Hello Jasmine,

I really enjoyed reading your post and I definitely agree on your ideas and the facts that you have stated. There are major key issues that are impacting the elderly. The major issue is staffing. I have experienced a lot of staffing issues in the assisted living that I used to work out. Staffing issues can be caused due to a lot of reasons that people may not understand. I never understood until I actually became their boss. I think that it is sad because a lot of aides do not feel appreciated or do a lot of work to take care of someone but they do not get paid enough for it. Fraud is definitely another big issue because many places are not following protocol or doing what they need to in order to take care of the patient. I remember that I have experienced that as well because my old boss used to want me to commit Medicaid fraud and sign off on sheets for the residents being taken care of even though I do not believe that they have received all the care they were supposed to receive. I think that it is very important for patients to receive the care they need and for all staff and health care facilities to follow the correct protocol. Think about it, if a place was caught for fraud, look how many patients will be left without care due to the place most likely being forced to shut down.

4.According to Chapter 7 of the textbook, “Pratt’s Long-Term Care”, by Steven Chies, the most significant trends impacting senior housing including a demand for more housing options and a desire to improve quality of life.  Moreover, due to the high demand for senior housing, occupancy levels are up to 90% throughout most of the United States. (Chies, 2021, p. 179).

The article, “5 Big Issues in Senior Living in 2018”, further discussing the struggles of recruiting a high-quality workforce for the senior living communities.  In various states, many communities have partnered with community colleges and universities to develop program curriculums that focus on attracting nurses and business administration graduates specializing in healthcare.  Brookdale Senior Living, the largest senior living provider, also has offered a $7,000 student loan reimbursement for nurses interested in healthcare administration. (Anonymous, 2018, p. 1.).

Another major issue impacting senior housing and staffing are states’ changes in regulations and statutes. In some states, aides working at assisted living facilities and skilled nursing facilities will be able to perform more advanced tasks such as administrating routine and controlled substances and helping with medical equipment. Additionally, as of 2018, a new overtime rule remained on hold that could double the salary of workers at facilities that worked more than 40 hours per work. (Anonymous, 2018, p. 2).  This rule was opposed by many senior living facilities.

Fraud had been another major issue involving these communities and their senior executives.  Some of the alleged crimes committed include money laundering and kickback schemes where millions of dollars were misused from investors and healthcare providers.  Residents at senior living facilities have also fallen victim to direct mail solicitations and paying for unnecessary testing. (Anonymous, 2018, p. 4).

The desire to improve quality of life and staffing has increased interest in intergenerational programs. Many communities have partnered with colleges and universities offering residency programs with perks such as boarding in exchange for services such as participating in senior enrichment activities. (Anonymous, 2018, p. 5).

And finally, ride-hailing services, such as Uber and Lyft, have become an increasingly popular way of transporting community residents.  However, a study has also suggested that the car services industry may also have become a means for older adults to supplement their income by also participating in the “gig economy”. (Anonymous, 2018, p. 6).


Anonymous. (2018). “5 Big issues in senior living in 2018”. Retrieved from https://canvas.sjcny.edu/courses/29731/files/2422472/preview

Chies, S. (2021). Pratt’s long-term care: managing across the continuum. Burlington, MA: Jones & Bartlett Learning.

Example of someone reply

Hello Catherine,

There are definitely many of issues that impact senior living but this article only stated five of them. The five major issues are staffing, changes in regulations and statuses, fraud, intergenerational programs, transportation and of course costs. These are all issues that impact the senior living and many people do not realize it. The biggest issues that I faced when working in an assisted living is being short staffed, people committing fraud and not being able to get reliable transportation for the patients. I understand that staffing will be an issue but it is important to make sure that your staff is happy as well. It is always important to know that patients come first and the quality of care needs to be consistent and nothing should ever be taken out on the patient but some people do not see it like that. Staff might not feel appreciated for all the hard work they do and they might not get paid enough which leads to issues of patients not being taken care of the proper way. Another issue is fraud, many staff members will check off that they did something when they didn’t or take money. Fraud doesn’t just have to happen with the staff itself but it can happen with anyone in the nursing facility. The last issue is getting a ride. I have experienced first hand that Medicaid is not the best. Medicaid transportation at that is very difficult and makes things very complicated. I feel like something that will be good is definitely uber or lyft. Even though its not always so expensive, they could receive more reliable transportation.

I have four peers i have to reply to in a discussion 200 words each 1.In the article “Companies Improperly Cut Home Care Hours” by Nina Bernstein, the author discusses several issues related to Medica
5 Big Issues in Senior Living In 2018 Looking back on our coverage of the senior living industry and the issues that affected it in 2018, several common themes emerge. Five are detailed in this year-end review. 1. Staffing Senior living operators took several approaches to solutions as they continued to struggle with ensuring an adequate, high-quality workforce in 2018. Ecumen, for instance, conducted a two-year pilot study that exposed CNA, LPN and RN students from community colleges, technical colleges and state universities to the possibility of careers in senior living by welcoming them for clinical rotations at 10 senior living communities in rural areas in three states. Vi at Bentley Village in Naples, FL, served as a clinical rotation location for gerontologic nursing students from nearby Florida Gulf Coast University’s bachelor of science in nursing program. (Pictured above: Vi at Bentley Village’s Sophie Clark, LPN, right, works with FGCU student Caroline Dixon.) Elsewhere in Florida, Edgewater Pointe Estates of Acts Retirement-Life Communities, Boca Raton, was seeing improved retention and performance among new hires and improved morale among existing employees after implementing a new recruitment, interviewing and selection process. Meanwhile, four Michigan senior living communities became partners in a $6 million federal grant designed to address healthcare workforce needs in the western part of the state. They have committed to helping colleges refine and develop program curriculum; offer internships, tours and interviews, and hire participants; and help identify additional positions they need to fill that might require training. In Virginia, a new partnership between senior living community Friendship and Averett University was launched to make undergraduate and master’s degree education as well as continuing education more affordable and convenient for the community’s more than 700 staff members as well as their spouses and immediate family members. The program focuses on nursing and business administration programs. The country’s largest senior living provider, Brookdale Senior Living, launched a new student loan reimbursement program, which provides up to $7,000 for new hires, to attract nurses interested in the business side of healthcare. Juniper Communities implemented its new 15X20 program, which has the goal of increasing hourly minimum wages in its communities to $15 by the year 2020. 2. Regulation and oversight Almost half of the states changed regulations, statutes or policies affecting assisted living between January 2015 and June 2017, according to the National Center for Assisted Living’s 2017 “Assisted Living State Regulatory Review,” issued in October. Utah in March became only the second state, and the first state in more than a decade, to require assisted living communities to grant resident requests to install cameras in their rooms. Missouri also considered camera legislation in 2017, but the effort did not go far. Aides in some states obtained more responsibility under new laws. In Tennessee, for instance, medication aides working in assisted living communities, skilled nursing facilities and Programs for All-Inclusive Care for the Elderly will be able to administer controlled substances as of Jan. 1 under a law passed in April. And in New York, advanced home health aides working at some assisted living communities will be able to perform certain advanced tasks, such as administering routine or prefilled medications and helping with medical equipment. As 2017 comes to a close, senior living operators across the country are awaiting the finalization of transition plans detailing how various states plan to implement a final rule covering the provision of home- and community-based services, which was issued by the Centers for Medicare & Medicaid Services in 2014. All states and HCBS settings must comply by March 2019. To date, only Tennessee’s plan has been finalized. Confusion surrounding the rule could limit the ability of assisted living and memory care providers to serve Medicaid beneficiaries, leaders of the Senate Special Committee on Aging told CMS in a September letter. (Pictured above: Sens. Claire McCaskill and Susan Collins lead a Sept. 7 Senate Special Committee on Aging hearing.) That letter was followed up with one from NCAL leaders in October. In December, CMS issued related guidance about HCBS for those with dementia. Also as the year ends, a court injunction putting a new overtime rule on hold has many senior living operators at a crossroads, wondering whether it would be better to put planned changes in place for affected employees or keep things as they are until the matter is resolved. The rule, opposed by several senior living groups but finalized in May, calls for doubling the salary threshold under which most salaried workers would be guaranteed overtime pay when they work more than 40 hours per week. It originally was set to take effective Dec. 1. Also on hold, at least for now, is a new federal rule that would have disallowed pre-dispute arbitration agreements during nursing home resident admissions. A federal court granted the American Health Care Association’s motion to stop the ban from beginning in late November. The rule originally was set to go into effect Nov. 28. Representatives of AHCA’s sister organization, NCAL, had encouraged its members to comment on the rule when the CMS was finalizing it in 2015, fearing that a ban at the federal level also might lead to state-level prohibitions in assisted living. The fate of a final rule requiring employers to publicly report all union-related communication with attorneys is more clear, at least for now, after a federal judge in November issued a permanent injunction preventing the Labor Department from implementing the so-called “persuader” rule. The Labor Department could appeal the ruling, however, and the rule faces several other pending court challenges, too. Among other regulatory actions in 2017, the Occupational Safety and Health Administration updated its Recommended Practices for Safety and Health Programs guidelines, the Labor Department announced increased maximum penalties for OSHA workplace safety violations, OSHA issued a final rule requiring residential care facilities and community care facilities for the elderly to electronically submit their workplace injury and illness data, and the Equal Employment Opportunity Commission announced that it will begin collecting summary employee pay data from some employers in March 2018. It was our January article about a proposed Environmental Protection Agency rule regarding the disposal of unused medications that garnered the most online readers in 2016, however. Leaders of several organizations representing assisted living providers worried that the government’s apparent lack of understanding of the difference between assisted living communities and skilled nursing facilities could put some assisted living providers “perpetually in noncompliance.” That rule has not been finalized. In the fall, the uncertainty of what a Donald Trump presidency means for seniors housing and care loomed large in the minds of industry leaders. Among topics pondered was how the new administration will affect value-based care efforts. The American Seniors Housing Association said that Trump’s background in real estate development, operations and business in general should benefit the seniors housing industry, but the National Low Income Housing Coalition said that the new administration could bring billions of dollars in cuts to affordable housing and other anti-poverty programs. Yet the NLIHC identified six areas where affordable housing advocates and conservatives might find common ground. LeadingAge and AHCA/NCAL pledged to work to keep aging issues top-of-mind for lawmakers, whereas Argentum said it remains focused on government at the state level. 3. Fraud Alleged fraud involving senior living executives or residents made headlines in 2016. Some of the bigger cases are noted here. In February, Jon Michael Harder, the former CEO of Sunwest Management who pleaded guilty to mail fraud and money laundering, began a 15-year sentence at a federal prison. He had pleaded guilty in January 2015 to one felony count of mail fraud and one felony count of money laundering and admitted to lying to more than 50 assisted living community investors to obtain more than $5 million from late 2007 through February 2008. Legal issues for former Assisted Living Concepts CEO Laurie Bebo continued in 2016 when, in March, the U.S. Supreme Court effectively said that she cannot challenge in federal court the constitutionality of the U.S. Security and Exchange Commission’s use of an administrative law judge instead of a federal judge and jury while a proceeding against her is underway. Bebo’s filing stemmed from a legal case that began in 2014 when the SEC filed fraud charges against her and ALC’s then-chief financial officer, John Buono. The commission alleged that the two directed employees to include phony residents in occupancy rate and coverage ratio calculations for eight properties from 2009 to 2012. Buono settled his case with the SEC in 2015, but Bebo filed a lawsuit against the commission, maintaining that its internal proceedings, using an administrative law judge instead of a federal judge and jury, would deprive her of her rights to equal protection and due process. In July, the federal government announced that Philip Esformes, the owner of more than 30 Miami-area assisted living and skilled nursing facilities, had been charged with conspiracy, obstruction, money laundering and healthcare fraud in connection with a $1 billion scheme that it called “the largest single criminal healthcare fraud case ever brought against individuals by the Department of Justice.” A motion filed by the government alleged that Esformes provided access to assisted living residents “for any healthcare provider willing to pay a kickback,” including pharmacies, home health agencies, physician groups, therapy companies, partial hospitalization programs, laboratories and diagnostic companies. His trial is set for Sept. 18, 2017. (Pictured above: Esformes’ alleged $1 billion healthcare fraud scheme.) In September, a subsidiary of Oklahoma-based BOK Financial Corp. agreed to pay more than $1.6 million to settle charges that it concealed information from investors in municipal bond offerings to purchase and renovate senior living facilities, according to the U.S. Securities and Exchange Commission. The case is tied to that of Atlanta-based businessman Christopher F. Brogdon, who was charged with fraud in November 2015 and was ordered to repay $85 million to investors after reportedly misusing investor funds raised to buy and refurbish senior living facilities. In October, the former CEO of American Senior Communities and three others were indicted for their alleged roles in a $16 million fraud, kickback and money-laundering scheme. CEO James Burkart’s home originally had been raided by the FBI in September 2015, and ASC subsequently fired him and Chief Operating Officer Dan Benson, also named in the indictment. A defendant in the case agreed to plead guilty in December, putting him in the position of possibly testifying against others accused in the case. Also in October, the Justice Department and several additional government agencies announced the charging of 56 individuals and five call centers for allegedly scamming more than 15,000 seniors and others in the United States out of hundreds of millions of dollars. Assistant Attorney General Leslie R. Caldwell said the announcement was the “first-ever multi-jurisdiction enforcement action targeting the India call center scam industry.” In December, a New Jersey woman plead guilty to playing a role in a $1 million Medicare fraud scheme through which residents of affordable seniors housing complexes were convinced to submit to unnecessary genetic testing. She faces up to 15 years in prison and $500,000 in fines. Earlier in the year, in June, U.S. and Dutch authorities simultaneously took action against a man and two companies accused of defrauding thousands of older adults in the United States of more than $18 million a year through direct mail solicitations. The mass mailings falsely had claimed that the seniors had won, or soon would win, cash or prizes or otherwise would come into a large fortune, the governments alleged. Illuminating such scams was the purpose of a new guide issued by the Senate Special Committee on Aging in February. Read more about senior living-related fraud here. 4. Intergenerational programs Seniors housing and care providers continued to see financial and resident quality-of-life benefits — and perhaps some future staffing benefits — from programs stressing intergenerational relationships in 2016. A program at Deerfield, a Lifespace Communities continuing care retirement / life plan community in Urbandale, IA, enabled a Drake University vocal performance major to receive board in exchange for performing twice a month for residents. Haley Jenkins enjoyed her experience so much, we later reported, that she decided to stay an additional semester and began contemplating using her musical talents in a career in senior living. In February, Jim Lay, executive director of Twin Towers, part of Life Enriching Communities in Cincinnati, wrote about about his community’s student artists-in-residence program with the University of Cincinnati’s College Conservatory of Music, which he said has blossomed into a depth of kinship and connection between unlikely acquaintances. (Pictured above: Alyssa Griffith, left, and Annie Barr, students at the College Conservatory of Music at the University of Cincinnati, are roommates at Twin Towers.) And senior living communities Butler, PA; Kansas City, KS; and South Bend, IN, were home to professional baseball players during baseball season this year. In July, a new collaboration between senior living organization Judson Services and the Frances Payne Bolton School of Nursing at Case Western Reserve University in Cleveland was announced. It aims to improve the health of older adults, educate students about the elderly and conduct research to benefit other retirement communities and educational programs focusing on issues related to aging. And in August, Michigan retirement community Clark on Keller Lake announced that it would be serving as a research setting for the next 19 months as three college students majoring in occupational therapy call it home. Meanwhile, in Connecticut, Masonicare at A​shlar Village this fall welcomed the first two participants in its new Students in Residence program, believed to be one of the first such programs to focus on assisted living. The participating Quinnipiac University students, one in the pre-med program and one studying occupational therapy, are required to write blogs and spend at least eight hours a week “fully engaged” with their fellow assisted living residents. In September, Juniper Communities CEO and President Lynne Katzmann and Vice President of Business Development, Sales and Marketing Cindy Longfellow returned from their first Burning Man festival with a conviction that the celebration of individuality, sharing and “open-heartedness” that defines the event is applicable — and necessary — in senior living. Juniper organized the trip, featuring multiple generations although no residents, to “write a new story of aging in America.” Some senior living/university efforts are set to get underway fully in the future. Arizona State University, for instance, plans to develop a continuing care retirement / life plan community on its campus, within steps of downtown Tempe restaurants and cultural venues. Construction on the collaboration between the ASU Foundation and Pacific Retirement Services may begin in 2018, according to the university, with occupancy predicted in spring 2020. And a New York University program, beginning in fall 2017, will see students moving in with seniors in a pilot project designed to make college more affordable for students. 2016 also brought news of plans for what the Los Angeles LGBT Center says is the country’s first project that will include affordable housing for both older adults and youth. The $100 million Anita May Rosenstein Campus is scheduled to open in early 2019 in Hollywood. Read more about intergenerational programs and senior living here. 5. Transportation 2017 seemed to be the year that ride-hailing services came to senior living as a way to address transportation issues for both communities and residents. It started in August when Canada-based senior living provider Revera, which also has communities in the United States, announced the testing of a new Uber platform in Toronto as a way to improve resident and staff satisfaction. UberCentral, like the Lyft Concierge tool announced later in the year, lets businesses order rides for people who don’t necessarily have the smartphones and Uber accounts usually required to order a ride from Uber’s independent-contractor drivers. (Accompanying photo courtesy of Uber.) Later that month, GreatCall and ride-hailing service Lyft announced a pilot program whereby older adults in select markets who use Jitterbug cell phones would be able to arrange for transportation. In September, Sunshine Retirement Living announced that it had partnered with Lyft to test the ride-hailing service in nine of its communities across three states. Also in September, Uber and healthcare transportation platform Circulation announced a partnership to test a nonemergency medical transportation service at a Program of All-Inclusive Care for the Elderly as well as acute-care and children’s hospitals. Senior living communities may factor into future plans, they said. In October, Brookdale announced that it was piloting the use of Lyft in one of its communities in California. The operator also is testing the service in Arizona. In December, Ascension announced that residents of its Ascension Senior Living communities will be among those who will be able to arrange for rides under a new partnership with Lyft. Also in December, Lyft and CareLinx announced a partnership designed to ease transportation challenges for many seniors. Interestingly, a JPMorgan Chase Institute study we reported in September suggests that many senior living residents who order a car through Uber or Lyft may find a fellow older adult behind the steering wheel. An increasing number of seniors are supplementing their income “in non-trivial amounts” by participating in the “gig economy,” which includes ride-hailing and other services, according to the research.
I have four peers i have to reply to in a discussion 200 words each 1.In the article “Companies Improperly Cut Home Care Hours” by Nina Bernstein, the author discusses several issues related to Medica
Companies Improperly Cut Home-Care Hours for Disabled Clients, Report Says: [Metropolitan Desk] Bernstein, NinaAuthor Information. New York Times, Late Edition (East Coast) [New York, N.Y] 21 July 2016: A.19. Full text Abstract/Details Turn on hit highlighting for speaking browsers by selecting the Enter button Show highlighting Abstract Translate Abstract […]a detailed report by a coalition of more than 100 nonprofit groups shows that the crisis in Ms. Negron’s family has been repeated in hundreds of households covered by Senior Health Partners. Since January 2015, that company and at least two others have been systematically cutting the hours of home care for their disabled clients, typically without proper notice or legal justification, the study found. Full Text Translate Full text Turn on search term navigation Widowed and disabled after a lifetime of New York factory work, including decades making baby dolls with glue that proved to be toxic, Alejandra Negron depends on a little help for nearly every step she takes. For years, she has had just enough help to stay safely in her own tidy one-bedroom apartment in Manhattan, despite pulmonary disease, asthma, diabetes, arthritis and a heart condition. Medicaid, the state and federal health care program for the poor, covers the cost of a home-care aide during the day, and Ms. Negron’s two daughters and a granddaughter take turns staying over at night and on weekends, despite their own jobs and family obligations. But last winter, that carefully stitched web of caregiving was abruptly torn apart by a call from Senior Health Partners of Healthfirst, a managed care insurance company that has been one of the beneficiaries of Medicaid’s overhaul of long-term care for disabled and aged people in New York. The company informed Ms. Negron that her home care was immediately being cut to 25 hours a week from 50, and her aide, the mother of a 7-year-old, was rescheduled to work from Thursday through the weekend, not Monday to Friday. “I panicked,” Ms. Negron’s daughter Carmen Hernandez said, recalling the scene she found at her mother’s apartment that day. The aide was in tears, and Ms. Negron, 72, was petrified that she would have to go to a nursing home. “My mother said, ‘If you put me in a home, I’m going to commit suicide.”‘ “I started to cry,” Ms. Hernandez added. “I didn’t know what to do.” Now a detailed report by a coalition of more than 100 nonprofit groups shows that the crisis in Ms. Negron’s family has been repeated in hundreds of households covered by Senior Health Partners. Since January 2015, that company and at least two others have been systematically cutting the hours of home care for their disabled clients, typically without proper notice or legal justification, the study found. By law, only a change in a client’s medical condition or circumstance is supposed to allow a reduction. The study was co-sponsored by Medicaid Matters, which is an advocate for Medicaid beneficiaries, and by the New York chapter of the National Academy of Elder Law Attorneys. It independently confirms similar allegations made earlier this year in a federal class-action lawsuit filed against Senior Health Partners and the New York State Health Department on behalf of disabled and aged clients threatened with cuts in home care. And it echoes the patterns explored in articles in The New York Times about the pitfalls of managed long-term care, which beginning in 2012 replaced a fee-for-service system with a flat rate for each patient enrolled, regardless of how much care was provided to them. The flat rate “creates a perverse incentive” for Senior Health Partners, the lawsuit says. “The less care they provide to each individual, the more they earn.” Between June 2015 and December 2015, the study found a sixfold increase in hearings that challenged home-care reductions. In more than 90 percent of those 1,042 hearings, the companies lost or simply withdrew proposed cuts when challenged. Though Senior Health Partners is only one of more than 20 such plans in New York, serving about 12 percent of managed long-term care clients, it accounted for 56 percent of those hearings. Not counting settlements, managed care companies prevailed only 1.2 percent of the time. But the report said that many of the most vulnerable clients had no way to fight cuts, unaware that they could appeal. And even those who prevailed at hearings have often faced new cutbacks, said Elizabeth Jois, a lawyer at the New York Legal Assistance Group. That was what happened to Ms. Negron, who is one of the named plaintiffs in the lawsuit. Her daughter turned to Ms. Jois, who appealed. When Ms. Hernandez, 54, showed up at the hearing to testify for her mother, taking time off from her job as the newborn screening coordinator at Mount Sinai Beth Israel, the company withdrew its proposed reduction. But in May, despite its own finding that her mother’s condition had worsened, the company cut her mother’s hours of care to 40 from 50. At a hearing last week, Ms. Hernandez was astonished when the company’s lawyer argued that her mother could urinate or defecate in a “pull-up” diaper and wait in a chair for two or three hours until a family member could leave work and come to change her. The decision is pending. Senior Health Partners, which calls itself “a not-for-profit managed care organization sponsored by some of the most prestigious and nationally recognized hospitals and medical centers in New York,” said it could not discuss pending litigation. “Senior Health Partners’ primary concern at all times is the health and well-being of all our members, who are among the most vulnerable citizens of New York,” it added in an emailed statement. The State Health Department initially declined to respond to the report’s findings, citing the litigation, but then issued a general defense of managed long-term care. It pointed to a survey in which 87 percent of all members said their plan was good or excellent, and it said that members could change plans. But advocates said most plans shun anyone with many needs and are reluctant to increase hours for patients who need more. The Legal Aid Society is preparing its own litigation against Senior Health Partners on behalf of a woman who is in a wheelchair and whose request for more hours of help was repeatedly denied, even after she was seriously injured in a fall, said Patricia Bath, a spokeswoman for Legal Aid. That client’s experience reflects Senior Health Partners’ pattern of denying requests for more home care hours, Ms. Bath added, citing a Legal Aid review of more than 135 state decisions issued in the past year for people appealing such denials. Senior Health Partners’ denials have been overturned 80 percent of the time, she said. At Ms. Negron’s apartment, Ms. Hernandez fought back tears. “It’s like mental torture,” she said, as her mother dozed after a breathing treatment. “I don’t want her to be by herself if her last breath comes.” Photograph Alejandra Negron, 72, Was Helped by Her Daughter Carmen Hernandez at Ms. Negron’s Apartment in Manhattan On Monday.; Amnys Pena, a Home-Care Aide, with Ms. Negron On Monday. Senior Health Partners has Tried to Reduce Her Hours of Care. (Photographs by Hiroko Masuike/the New York Times) Word count: 1084 Copyright New York Times Company Jul 21, 2016

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