In addition to fraud, the Brooklyn-based agency was also cited for cheating aides out of their wages.
New York Attorney General Letitia James has reached two agreements with White Glove Community Care, Inc., (White Glove), a Brooklyn-based home health agency that was recently found to have submitted false claims to Medicaid and underpaid its home health aides. The two agreements are with the Office of the Attorney General's (OAG) Labor Bureau and OAG's Medicaid Fraud Control Unit (MFCU).
A joint investigation by the OAG and the United States Attorney's Office for the Eastern District of New York (EDNY) found that White Glove fraudulently obtained over a million dollars in Medicaid funding by submitting false claims and "cheated" its home health aides out of wages they earned. Having admitted to wrongful conduct, White Glove has agreed to pay $2 million in unpaid wages to employees and $1.2 million to the state's Medicaid program.
Of the $1.2 million, approximately $758,425.47 will go to the state of New York, with the remainder going to the federal government.
"Home health aides work tirelessly to provide critical care for our most vulnerable neighbors, and they deserve to receive adequate and fair compensation for their hard work," James said in a statement. "White Glove cheated their employees, and they cheated the everyday New Yorkers whose tax dollars fund the Medicaid program. My office will always stand up against bad actors, and ensure all workers get fair pay for their work."
As part of the agreement, White Glove will revise its policies and procedures; train its personnel on updated policies—subject to OAG's approval—and regularly report staff wages and policy implementations to OAG for three years. Failure to comply with these terms or properly compensating its aides will result in OAG bringing civil action against the agency and $15,000 in damages for "violating its legal obligations."
"The arduous work that these aides do, day after day, ensures that some of our most vulnerable neighbors receive the care and are shown the dignity that they deserve," U.S. Attorney Breon Peace said in a statement. "This settlement—the third in our continuing investigation of certain licensed home care service agencies—reflects this Office's ongoing commitment to providing home health aides the hard-earned benefits guaranteed them under New York law and the Medicaid program."
This is the privately owned home health company's 19th acquistion since 2018.
Care Advantage, Inc., completed its acquisition of Care Perfections Health Services, LLC, Virginia, a client-focused, in-home care company, on Monday, December 19.
This makes Care Advantage's, a privately owned home health company, 19th acquisition since 2018, and its seventh since joining with Searchlight Capital Partners in 2021. The company recently also purchased Lighthouse, Healthcare, Inc., in Reston, Virginia.
Post-acute leaders should pay attention to this increasing trend of private equity companies acquiring healthcare facilities, and consider whether mergers of this type will be advantageous, weighing the pros and cons.
"Our company's passion has always been to serve our communities and offer exceptional services to our clients," Kwasi Anwomea, president and CEO of Care Perfections Health Services, said in a statement. "The vision that Care Advantage holds for our company, coupled with the operational experience, expertise and enthusiasm they bring to the table is both encouraging and exciting in equal measure."
"Knowing that we see the business through the same lens, and that we are both motivated by a passion to care for others has all the making of a successful partnership."
The acquisition of Care Perfections Health Services also extends Care Advantage's geographic reach, with the former having operations in Manassas and Warrenton areas, allowing personal in-home care services in northern Virginia. This builds on the company's existing strategy of adding established personal care providers with strong community presence and profile to its "brand family."
"The timing of the Care Perfections acquisition is perfect and is a lovely way to close out the year. The addition of a personal care company into our ever-growing brand family, has added a lot of excitement among the team," Tim Hanold, CEO of Care Advantage, said. "After a strong year of growth, both in terms of organic and M&A, to add two new markets and ultimately increase the opportunities for us to care for more Virginia residents is very exciting."
Having conversations about a caregiver's capabilities and boundaries early on can save agencies time and money down the road.
With a decade of experience in the private duty sector, Aishling Dalton-Kelly knows the importance of good and effective communication between agency owners and potential caregivers during the hiring process. Having sold the agency she owned earlier this year, she reflects on the importance of understanding the capabilities of potential employees, as well as their limits.
"We have a saying in Ireland that says you shouldn't put a square peg in a round hole," Kelly told HealthLeaders. "We have to stop trying to have caregivers fit what we need. We have to ask them what they like and what they don't like, what they're willing to do and what they're not, because that plays a huge role in servicing the needs of the customer."
During the interview process, good communication with the potential caregiver can help figure out who the candidate is and the person's skill sets. This sets the tone for matching caregivers with clients who will best be served with these skills.
"Many caregivers will come, and they'll send in their resume, references, but more than that, each agency should have a check list of the skills that they know their clients are looking for," Kelly explained. "Having that check list of skills that the agency knows they're going to require at some stage is vital."
Considering other factors about the potential caregivers' homelife like children and childcare is paramount and can help agencies avoid staffing issues in the future, Kelly said.
"There's a lot of things that have to come in to play because its being driven by the workforce of today and the post-pandemic scenarios that we're faced with," Kelly said.
In addition, "the interviewer needs to be asking, 'Are you prepared to drive within a 15–20 mile radius and if [the candidate] says no, that's something that needs to be listened to. Ultimately if you're stuck and somebody doesn't show up [for a client], that caregiver you think is going to drive because they're a new hire already told you no."
"The success of any good business is through communication, and when you have bad communication, we all know what happens; it's a road to disaster," Kelly said. "We need to understand our people and our people need to understand us."
There's a need for more resources to help navigate care options, says researchers.
A new national survey found that 24% of adults ages 50 and older said either they or a loved one needed long-term care in the past year. Commissioned by Nexus Insights, the survey was conducted by the nonpartisan and independent research organization NORC at the University of Chicago.
"Making a decision about long-term care is a maze full of emotional twists and turns, dead ends, and setbacks," Robert Kramer, founder and fellow of Nexus Insights, said in a statement. "The lack of a consumer-friendly system to help families navigate the staggering array of decisions that must be made quickly during a healthcare crisis boosts families' stress."
Kramer added that this can result in families making decisions that could lead to "poorly coordinated, lower-quality care."
The survey also found that 53% of older adults felt anxiety during the process of selecting long-term care, and 52% felt frustrated. Only 23% said they felt confident or at peace, and 14% said they felt happy while making a choice.
Sixty-nine percent of older adults said it was extremely important to have additional information about the cost of care and options to pay for it, and 63% said it was important to have additional information about the different types of long-term care services.
Researchers said the findings show a need for more consumer-friendly resources to help families navigate care options.
"Many families reckon with a long-term care system that's nearly impossible to navigate and provides little-to-no support for families making life-and-death decisions," Caroline Peterson, senior vice president at NORC, who also serves as a Nexus Insights fellow. "Most people will eventually have to make decisions about long-term care for ourselves or a family member, so creating a consumer-friendly long-term care navigation system should be high up on the nation's list of to-dos."
Long-term care leaders can take these findings and be part of the solution to make long-term care easier to navigate, creating ways they can work with the healthcare industry, patients, and families to streamline services.
A solution on a national scale for easier navigation of long-term care services has been suggested in a report released earlier this year, calling for a national long-term care navigation hub that would help the aging population with long-term care options and funding and ways to connect with resources.
In related news, Katie Smith Sloan, the CEO of LeadingAge, the association of nonprofit providers of aging services, has urged the Biden administration in a letter to develop an Office on Aging Policy that provides "centralized leadership and cross-government coordination to address the needs and ensure resources are delivered to older adults and families."
Quach's efforts will focus on growth and professionalizing the caregiver role.
Help at Home has announced James Quach, PharmD, as its market leader for Illinois.
In this role, Quach will lead state operations for the in-home care provider, executing a growth and innovation strategy to professionalize the role of caregiving and transform the delivery of in-home care. This will include providing over 20,000 caregivers in the state with upskilling and career advancement opportunities.
"We're excited to have Quach's expertise and leadership, as well as his proven track record for managing and growing operations across complex, large-scale organizations," Ray Smithberger, the organization's chief operations officer, said in a statement.
"His clinical experience and large-scale operation background with companies like Walmart/Sam's Club, for example, will further advance Help at Home's long tenured Illinois operations."
In addition to being a leading national provider of in-home care, Help at Home is also one of the largest employers in the state of Illinois. As market leader, Quach will support the organization in its efforts to continue growing business throughout the state, with a focus on providing quality services and programs that can improve the quality of life for seniors and underserved populations who want to age in place in their own homes.
In a letter, Katie Smith Sloan, president and CEO of LeadingAge, stated that the nation isn't prepared for the aging population that's coming.
With people over the age of 65 anticipated to make up 21% of the nation's population by 2030, the healthcare industry is beginning to prepare for the influx.
In a letter to the Biden administration, Katie Smith Sloan, president and CEO of LeadingAge, the association of nonprofit providers of aging services, urged the development of an Office on Aging Policy, which would provide "centralized leadership and cross-government coordination to address the needs of and ensure resources are delivered to older adults and families."
"We are not prepared for the demographic change that is fast approaching. The federal government's focus on aging has developed from bottom up, without designated leadership," Sloan said in the letter. "The result of this scattered approach is severely inadequate support for older adults in our country, which impacts quality of life and takes extraordinary tolls on communities and families—particularly those of color."
The brief accompanying the letter details the concerns and challenges for older adults, their families, and caregivers, which includes the need for long-term care (LTC), as well as these other areas:
Preventing poverty and ensuring retirement income
Shifting patterns of employment, access to jobs for older people who work, and retirement
Ensuring equitable access to adequate housing
Services and housing
Food security
Elimination barriers to transportation
Protecting seniors against abuse, including financial scams
Environmental threats may harm older people first
Inequity for older people, particularly those of color
Incomplete data to support policymaking
LTC facility leaders should consider how they can get involved to address the needs of the growing aging population.
Within the federal government, the individuals responsible for polices related to these concerns are spread throughout more than 25 agencies. While some aging policies within those agencies are robust, Sloan noted, there are also policy redundancies, gaps, and an inconsistent distribution of resources.
"It is time for our leaders to step up and take action … by intentionally coordinating the government's focus on aging," Sloan said. "The Biden Administration has the opportunity to both drive change and demonstrate its commitment to the value of a growing population of Americans."
The theme for the annually observed week reflects the compassion and safe nursing care provided to millions of patients.
The American Health Care Association (AHCA) announced the theme for National Skilled Nursing Care Week 2023: "Cultivating Kindness."
Observed annually, National Skilled Nursing Care Week (NSNCW) is dedicated to celebrating the essential role that skilled nursing care centers play in providing safe and effective care to millions of patients each year. According to a release, 2023's theme is meant to encourage skilled nursing care centers throughout the country to host events that recognize those who live, work, and volunteer in nursing centers, while also adhering to COVID-19 safety guidelines.
"We are thrilled to share that 'Cultivating Kindness' is the theme for next year's National Skilled Nursing Care Week," Mark Parkinson, AHCA president and CEO said in a statement. "Every day in nursing centers there are acts of kindness that go above and beyond the call of duty."
"The theme we have chosen captures these acts of kindness that can be transformative for staff and the residents they care for. Kindness is contagious, so let's continue cultivating and spreading it to improve lives."
Since 1967 when the celebration was established by AHCA, NSNCW begins on Mother's Day. 2023 follows that same tradition, and NSNCW is slated for May 14–20.
AHCA will issue a planning guide and related products in February on ways to celebrate NSNCW 2023. Participants are also encouraged to share their acts of kindness on social media leading up to the week, using the hashtag #NSNCW.
Here are three HealthLeaders articles from the past year that provide a closer look at hiring and retention practices for solving staffing issues.
Staffing and retention in the home health and long-term care market continue to be difficult, forcing post-acute leaders to get innovative in their recruiting efforts.
With skilled nursing facilities having been severely impacted during the pandemic and home health agencies trying to ensure they have the staff they need to meet the demand for their services, HealthLeaders continues to survey workforce issues and provide actionable insights from industry leaders and executives.
Here are three articles from the past year on hiring and retaining practices that offer suggestions as to what organizations can do to recruit and keep staff members.
Recent graduate nurses who want to work in the home health setting can now become home health nurses through supplemental training at OSF Health. In the past, there was a requirement that a nurse who wanted to work in the home health setting had to have prior nursing experience. OSF Health's training varies according to the individual's experience and skill level. The training focuses on wound identification, assessment, and care; in-home IV therapy; pediatrics; and different components of case management.
"We want to make sure that the nurses that we onboard are here a year from now, given the staffing crisis we find ourselves in with nurses in healthcare in general," J.J. Guedet, vice president of business development and strategy at OSF Health, said. "The emphasis is less on rushing someone out to see a patient, and a lot more intensive on building that experience where clinicians feel they're set up to succeed."
Due to the worker shortage, many organizations raised employee wages to be more attractive in the competitive market. Out of all sectors of the industry, nursing homes increased their wages the most, seeing how staff absences and turnover were heavily impacting them.
Holly Harmon, senior vice president of quality, regulatory, and clinical services for the American Health Care Association notes that nursing homes also offer an array of benefits such as flexible or self-scheduling, mentorship programs, and career development opportunities, and are continually innovating and developing others to improve their marketability.
"We have a number of other ideas of how we can help really elevate the nursing home profession for individuals that are out there and want to serve our elders."
Taking a closer look at the competitive labor market, HealthLeaders spoke with Leigh Davis, a post-acute healthcare consultant, about ways home care agencies can improve their recruitment and retention efforts to stand out.
Davis' suggestions include:
Developing a recognition and promotion program where talent see that they have a future with the organization
Use the BEAP tactic when you talk to applicants about the benefits of the job, explaining B is for broader mission, E is for education path, A is for advancement, and P is for promotion
Getting rid of "behind the desk" mentality and bringing everyone into a team mindset
HealthLeaders spoke with MedStar Health elder care directors about what the industry must do to prepare for the influx of an aging population.
It's predicted by 2030 that senior citizens will make up 20% of the nation's population. In a 2018 press release for its 2017 National Population Projections, the United States Census Bureau stated that, for the first time ever, there will be more older adults (over the age of 65) than children.
"By 2034, there will be 77 million people 65 years and older compared to 76.5 million under the age of 18," the release said.
With the anticipated influx of older adults just eight years away, there's much to be done to bolster healthcare services to match up with demand.
HealthLeaders spoke with George Hennawi, MD, physician executive director of geriatrics and senior services at MedStar Health, and Lauren Bangerter, PhD, scientific director of health, economics, and aging research at MedStar Health Research Institute about what the healthcare industry needs to do to prepare for the "silver tsunami."
HealthLeaders: How did the pandemic impact older adults?
George Hennawi, MD: It became extremely challenging during COVID, devastatingly challenging, but the learning piece is that we need to invest in a better infrastructure to not only support our nursing facilities but support our older adults aging in place and living in place during or after hospitalization, and during or after illness.
Lauren Bangerter, PhD: COVID disrupted the idea that congregate living for older adults is safe. I think a lot of families assume that if an elder loved one is in a nursing home or some sort of facility that there's a level of safety because there's oversight. COVID disrupted that whole idea and hit home that care in the home is often going to be safe, its often going to be preferred, and that we need to adapt the way that we've been thinking about what that care looks like and invest in the infrastructure so that older adults can age in place. There's quite a bit of infrastructure that is needed for this to happen and there's certainly an appetite and desire for that, not only for the older adults themselves, but for their family members who care for them.
HL: The Centers for Medicare & Medicaid Services have recently strengthened their monitoring of nursing homes through a series of revisions to the Special Focus Facility Program, keeping those facilities accountable for the quality of care they provide. Will adding and improving regulation and accountability measures be enough to take care better care of the elderly?
Hennawi: I think it's a good step, it's well intended, and it's what we need, but I think it's difficult to achieve success with regulations when those folks do not have the proper support. I can ask nursing facilities, for example, to do a COVID test two to three times a week on every employee, patient, and visitor that comes in and out of that facility. But did I support them in recruiting and maintaining their workforce? Did I come up with a better infrastructure for if they got hit with a COVID situation and it became bigger than expected and impacted multiple staff members and multiple patients? Did I support them with the infrastructure to find staff to keep the operation running? Did I improve their reimbursements so they can spend money on preventive measures?
The regulations are extremely needed, the oversight is definitely part of the way to go, but it should come with an understanding of what happens on the ground and investments to make those folks that we're putting under a lot of regulations and holding them accountable successful in the mission they're trying to achieve.
Bangerter: There's a lot to be said for integrating the perspectives of different stakeholders in the development of new policies, and that's something that can't be overstated enough. Talking to the folks who are going to have to implement whatever these polices are, making sure they're involved in conversations from the beginning, can help to build that infrastructure and make sure that's part of those new regulations as well.
HL: Many individuals prefer to age in place in the comfort of their own homes, so do you think it's possible that we'll see a pivot in senior services from skilled nursing facilities to home health?
Bangerter: We may see a few different things. We're likely to see older adults stay in their homes for longer periods of time before making a transition to a facility that provides more intensive care. We're starting to see more opportunities to provide care in the home and more and more opportunities to provide health care in the home at smaller levels.
The other thing that is interesting is that we're seeing in private industry quite a bit of startup companies and new businesses that are aiming to fill this gap and aiming to enable that care to be provided in the home, so that's an interesting space to see some innovation. We certainly are seeing it more, and the COVID-19 pandemic opened new opportunities as far as telehealth and remote care and an openness to that both from the individuals receiving care as well as the providers.
Hennawi: [When the pandemic began], we started with heavy telemedicine, virtual visits. [Digital health] is something that had been talked about forever but it was implemented in a speedy way because of COVID. But then the concept of hospital at home, a theoretical approach to acute care in the home, was implemented in many states during COVID. That model was able to make its way into mainstream services and it's going to continue.
For us, specifically in geriatrics at MedStar Health, we intensified our home health services whether it was sending out providers to care for older adults in the home through our MedStar home care and Med Star primary care services, and now we're thinking of venturing into the [skilled nursing facility] at home model, which is providing the services of post-acute rehab in the home rather than sending folks to a nursing facility.
HL: What needs to be done to prepare for the influx of older adults in the healthcare infrastructure? How can health systems and physicians work with state or federal organizations to prepare for this?
Bangerter: There's a tremendous opportunity to have more emphasis on evidence-based policy, so that requires a bridge between the scientific research community and policy-makers. This is true at the federal level, as well as the state level, and we can draw from both federal and state policies. We're trying to improve that broader federal infrastructure that's going to be needed as well—the innovative, boots-on-the-ground work that happens at the state level. There's different ways to do this, but that's a huge area of opportunity to improve not only the policy development side but to understand policy implementation and whether policies are working the way they're intended to from the perspective of patients and providers.
Hennawi: It's important that we start advocating and educating the public, policy-makers, and the media on what's coming. If you ask Americans what some of their concerns are, in older adults, aging is not a concern for them or it's not ranked high as a concern for the country. We should start thinking about the silver tsunami, a term I've heard, and so we should start thinking about this and making it a big part of our public knowledge, public policy advocacy, etc. That's one piece we need to change.
Out of the folks that I see as a physician, and I see a lot of patients who want to stay at home, I don't have the support structure to keep them there because they can't afford to stay there. The key issue, from my perspective as a physician, is we need to change the paradigm of long-term care.
When we say ''long-term care,'' what we think about is nursing homes, but I think long-term care starts by supporting folks to stay at home when they need that support. Supporting them by having caregivers that are trained, qualified, and well-compensated to take care of them at home in an affordable way. Many people cannot afford caregivers in the home. [We need to] create or support more long-term care insurance that is affordable to everybody, that is easily accessible, that is subsidized for those folks that we care for who don't have much of an income, and that will allow them to tap into this insurance if they need to stay at home.
A big part of the message is changing the paradigm of long-term care from a reactive approach—you end up in a nursing home, we'll support you when you run out of money—to putting the investment up front, create bridges that will support you when you need the support so you can live at home for as long as you need to, in the hands of trained caregivers that will care for you. I think that's the paradigm that we're talking about, and today I believe that paradigm is reactive. I think we need to move to a paradigm that will allow people to invest in this early on and stay at home as long as they desire to.
The nation's poorest-performing nursing facilities will now be under increased scrutiny by the federal agency.
Keeping with the Biden-Harris administration's mission to improve the safety and quality of nursing homes, the Centers for Medicare & Medicaid Services (CMS) announced it will increase its monitoring of facilities with poor performance through a series of revisions to the Special Focus Facility (SFF) Program.
Eighty-eight nursing homes participate in the SFF Program, which is 0.5% of all nursing homes in the country. The Program was created to help nursing homes improve compliance and quality, however, some facilities have not been able to achieve the necessary standards to graduate from the Program, or they fail to sustain compliance.
The revisions will increase facilities' requirements for completion of the SFF Program and increase enforcement against facilities that do not demonstrate improvement. With these actions, the Biden administration aims to create accountability and improve quality of care and safety in the nation's nursing homes.
"Let us be clear: we are cracking down on enforcement of our nation's poorest-performing nursing homes," Xavier Becerra, Department of Health and Human Services secretary, said in a statement. "As President Biden directed, we are increasing scrutiny and taking aggressive action to ensure everyone living in nursing homes gets the high-quality care they deserve. We are demanding better because our seniors deserve better."
The four revisions to the SFF Program are:
Program requirements will be strengthened, with the addition of a threshold that will prevent a facility from exiting based on total number of deficiencies cited. Facilities will no longer be able to "graduate" from the program without "demonstrating systemic improvements in quality."
Facilities cited with Immediate Jeopardy deficiencies on two surveys may have their federal funding terminated.
CMS will begin imposing more severe enforcement actions on facilities with continued noncompliance and making little progress to improve performance.
To provide an incentive for improvements, CMS will extend the monitoring period for facilities in the program. Enforcement actions for facilities that decline in performance after graduating from the program will be imposed readily and progressively severe.
"People in this country's nursing homes deserve access to safe and high-quality care, and facilities that aren't providing that level of service need to improve their performance or face the consequences," Chiquita Brooks-LaSure, CMS administrator, said in a statement. "Poor-performing nursing homes have the opportunity to improve, but if they fail to do so, the changes we are making to CMS' Special Focus Facilities Program will hold these facilities accountable for the health and safety of their residents."
