Monday, December 7, 2009

Couties Considering Phase-Out Of Home-Health Care

the Daily Mail

CATSKILL — With Greene County looking to get through one of its most difficult financial times in recent memory, one program that is facing eventual elimination is the CHHA — certified home health agency — which is provided by the Greene County Public Health Department.

While a final decision has not been made, the Greene County Legislature is currently considering phasing out the CHHA, which provides in-home nursing care to recently discharged patients.

“The majority of our patients are Medicare patients, so they are over 65 and homebound,” said Public Health Director Marie Ostoyich. “They are referred to the certified home health agency through the hospital or nursing home upon their discharge, and they need assistance with things like medication management, dressing change, or some kind of skilled nursing care at home.”

Eliminating the CHHA would save taxpayers approximately $800,000 a year, once it has been fully phased out. The first year of the phase-out program would save around $400,000.

However, county officials say care for current patients would not be impacted, and that the program would be phased out slowly over a period of two to three years.

“It would probably take several years to phase out the CHHA,” said Interim County Administrator Dan Frank. “A lot of people are under the impression that if they are currently getting care under CHHA they would be cut off, but that is not true. We would probably slow down the intake of new patients, and eventually stop it.”

Referrals for care generally cover a sixty-day period, and then need to be reissued should the patient continue to have a medical need for home health care. They would not be affected by the change, should it go through.

“For patients who are getting care right now, their care would continue for as long as it is needed,” Frank said.

Another group of residents who would not be affected by the phase-out of the CHHA are seniors who receive services through the Greene County Department for the Aging. Day-to-day care provided to those senior residents is not part of the phase-out proposal.

One option the county is considering to continue offering in-home care post-discharge is having private nursing agencies take over. Currently, some patients already receive care through The Eddy Nursing Service.

“Another option we could look at would be to have private industry take over the CHHA and let them operate it,” Frank said. “We are very concerned that people have alternatives. A segment of the population is already being served by private industry, so we could look at privatizing it.”

One problem with that option is that The Eddy currently does not provide service to communities on the mountaintop, and the needs of those clients have to be addressed as well.

Frank said the slumping economy has presented the county with serious financial challenges this year, and that it’s expected that things will only get worse over the next year or two. Implementing changes to the CHHA — or any other county program — is one way officials are looking to trim costs, but it’s a balancing act.

“Before we make a decision regarding the CHHA, we have to consider the best interests of our residents,” Frank said. “This will be a very difficult year for the legislature to decide the budget because they will have to balance the financial needs of the residents with the service needs of the residents. We are getting crunched in every direction.”

With the economic stakes high, officials say they want to minimize the tax burden on already stressed-out taxpayers. Frank said they are doing that by cutting expenses as much as possible. Much of that was done in the 2008 and 2009 budgets, and now that the easy changes have been made, the legislature is left with making some tough decisions on programming and services.

“We understand our residents are under a lot of financial pressure — unemployment is high, tax delinquency is up — so adding more tax to that would be difficult,” he said. “The county is already making substantial cuts to staffing — we eliminated positions, and we are proposing more cuts. There are no pay raises, and we are asking our employees to do more but we aren’t giving them more. Now, we need the agencies to share in the pain.”

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