Side effects

The move to place the county’s home health agency into an LDC could cause trouble for the public health department

By ANNEMARIE SCHUETZ
Posted 9/23/20

MONTICELLO, NY — For the county, it’s a clear case of new management improving a service. 

But moving the county’s certified home health agency into an LDC with the adult …

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Side effects

The move to place the county’s home health agency into an LDC could cause trouble for the public health department

Posted

MONTICELLO, NY — For the county, it’s a clear case of new management improving a service. 

But moving the county’s certified home health agency into an LDC with the adult care center could have “numerous, costly and substantial implications,” argued a letter from the county Health Services Advisory Board.

The letter—and more discussion—came up again in public comment at last Thursday’s executive committee meeting and the following full board meeting. Here are some of the concerns that were aired.

The impact of the loss of staff

The public health department is about much more than geriatric care, Dr. Larysa Dyrszka, a member of the advisory board, said. It’s vaccines, “it’s maternal and child health, it’s the pandemic, it’s opioids, it’s rabies and it’s follow-up for post-operative care.” And CHHA staff help with these other services.

If transferring the CHHA includes losing the staff, that means fewer people to help. And some of those services are mandated, said Dyrszka in an interview.

So, new staff would have to be hired, said former county public health director Carol Ryan at the meeting.

Although there are private CHHAs in the county, they are focused on special needs, Ryan said. They wouldn’t be able to take those services on.

County residents can choose not to go to the care center. 

 “Under the law, people do have a choice,” Ryan told the legislators. Patients, like those receiving rehab, might prefer to go elsewhere.

Under private management, would the CHHA’s role change?

No management team, public or private, has been chosen, but the overriding concerns about costs, which could be reduced under private management, have received pushback. 

Would private management turn the CHHA into a funnel into the care center, rather than focus on in-home care? That seems to be the overriding concern. 

The point of a public CHHA, said Dyrszka, is that it tries to keep people out of nursing homes. Repeated studies have shown nursing homes to be more expensive than in-home care, but there are other reasons to keep people out of group settings.

Namely, disease. Of course, it’s not just COVID-19, it’s other “hospital-acquired infections,” Dyrszka said. The more people who touch you, “there’s a greater chance of infection.” 

She also pointed out, “We’re quite isolated here... to have someone come to you is a blessing,” especially for people who can no longer drive and who don’t have family to help. 

Not only is in-home care less expensive than a nursing home, but it can be better for the patient, especially someone with dementia. “A CHHA keeps patients at home and provides continuity,” said Dyrszka. 

The county may end up paying more in the end.

“Once you divest of your public CHHA, there are responsibilities that you still need to fulfill that will no longer be paid for,” because the CHHA is certified to bill the government or private insurance, Ryan said. “You won’t have that, but you’ll still have the responsibility of doing many of the same activities without the benefit of remuneration.” 

Legislature chair Rob Doherty announced that there would be a meeting with the advisory board. 

Dyrszka called that a step in the right direction. Because, after all, “the legislature,” she said, “is ultimately responsible for the health and safety of their constituents.” 

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