The Director of Public Health has resigned after only 14 months in her position. She made a lot of changes during her time there that have diminished the capacity of the Certified Home Health Care Agency (CHHA) to serve the public. 

We heard last month from Commissioner Liddle about the increase of productivity in the CHHA—up to five visits per day—but we didn’t hear anything about the average 80-plus hours of overtime it costs to achieve that. Nor did we hear that there are only six CHHA road nurses left, when there were 20-plus in 2018. 

This is camouflaged in the monthly report by only including the number of so-called “clinicians.” Obviously, including contract and per diem workers is another way to camouflage the true state of staffing. How are those productivity numbers meaningful with so much less staff? 

We have been given no information about revenue. Not a single CHHA R.N. hired after 2019 was retained and we’ve been looking at a consistently high vacancy rate at Public Health Services (PHS). The CHHA used to have four nurses working every weekend but now is closed on weekends.

It’s not that nurses haven’t been hired. The monthly reports glorifies all hires but doesn’t mention anyone leaving the positions, except for transfers of positions within the department. Why did they all leave?

The overemphasis on productivity has had an inverse effect on retention of staff and quality of care, but the public ratings of the CHHA aren’t included in your monthly report as one might reasonably expect. Just like the Adult Care Center, the CHHA is also rated nationally by Medicare Home Care Compare on a scale of one to five with three being average. The 2.5-star quality performance rating is to some extent balanced by the four-star rating from the patients’ reviews, showing how much our community appreciates the CHHA. See here.

Another equally important consumer guidance rating from the New York State Department of Health’s Health Profiles for the CHHA is only one star overall because of patient outcomes that are way below average. The one-star rating in this case includes a five-star rating from the patients’ surveys. See www.profiles.health.ny.gov/home_care/view/13998#quality.

These quality of care ratings are not included in the report, nor are any quality improvement efforts, analysis or a plan to improve staff retention. The misguided attempt to convert the CHHA into a for-profit model has emptied the building of two-thirds of the experienced and dedicated nursing staff that had been built up with so much care over many years to serve our needy community, while the remaining nurses are treated like they’re still on probation. The culture at the CHHA under the current director has changed to one that is impersonal, militaristic and authoritarian, so that many key staff have left PHS. 

I had heard that it took several weeks for a new CHHA patient to receive a therapy visit, and noticed in June that the CHHA’s start-of-care statistics are no longer included in the monthly report. I emailed the commissioner about my concerns about the CHHA and the report and he told me not to worry because the director was doing such a great job and to FOIL for any further information. 

I can’t tell you how tired I am of the culture of secrecy when I read that monthly report and listen to the commissioner. Legislators are free to blindly trust whatever they’re told by county management and to vote without understanding what they’re voting for, like how they voted recently to outsource Public Health’s policies and procedures. That resolution showed the true lack of capacity Public Health now has to perform its own basic departmental functions. It was part of the agenda of the last legislature to sell the CHHA, and although that project was forestalled, the effect of the former chair’s actions to deliberately undermine the public health department has taken its toll. A sure way to destroy any organization is to appoint incompetent leadership. The CHHA is a major resource for the community to receive health care at home, to improve health outcomes and to avoid costly hospitalizations or placement in a nursing home. It’s the only certified home health care agency that serves the entire county. It’s up to this legislature to ensure that the public service the CHHA has provided for the last 50 years continues.

I hope that we get a competent and qualified Director of Public Health this time around instead of a wrecking ball, and that the commissioner is held accountable for the condition of the CHHA. 

Lise Kennedy lives in Neversink, NY.