Report of EVV ‘Firestorm’ Draws Home Care Industry Pushback

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The rollout of electronic visit verification (EVV) for home care has created a “firestorm” of complaints in Ohio, according to a recent article in the Columbus Dispatch. However, that news story painted an incomplete picture, some home care providers and EVV vendors have told Home Health Care News.

Under the federal 21st Century Cures Act, all states must implement an EVV platform for Medicaid-certified home care providers by Jan. 1, 2019, or they face reductions in federal funding. The idea is that by verifying when and where home care services are provided, EVV will cut down on fraud and abuse.

Ohio awarded a seven-year, $66.5 million contract to a New York-based vendor, Sandata Technologies, to administer the state’s EVV system—and that system, as well as the state’s rollout of it, have drawn the ire of home care consumers, according to the Feb. 19 Dispatch article.

The platform relies on “repurposed, military-grade cellphones with GPS monitoring,” the article states. The state began distributing the devices to home care recipients last month, causing backlash and disgruntlement, according to the Dispatch. Reporter Rita Price spoke with 39-year-old Melissa Day, who immediately stashed her device in her garage and feels it is a violation of her privacy to be tracked. She has opted for an alternative, call-in EVV method, but said this is also a burden.

“Basically, every time you log in or log out, it records the location,” another home care client, Rajai Saleh, told Price, speaking of the Sandata device. “Now, if you’re in your home or within 1,000 feet (of your home), you don’t have to do anything extra. But if it’s an unknown location that’s not associated with the consumer, it’ll show up as an exception.”

Another individual who uses home care, Adam Hebling, said that he worries the system will deter people from becoming home care aides.

The Ohio Department of Medicaid is working to address consumer concerns, assistant director Jim Tassie told the Dispatch, and he emphasized that the devices do not passively transmit GPS data to the state at all times. They only do so when activated during a home care visit, he said.

The Ohio Department of Medicaid had not responded to requests for comment from Home Health Care News as of press time.


Home Care Beats Assisted Living, Nursing Facilities in Hospice Satisfaction

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Hospice care administered in the home is seen as higher quality than hospice care administered in an assisted living community or a nursing home, according to a new study from the Indiana University Center for Aging Research and the Regenstrief Institute.

The study, published in the Journal of the American Geriatrics Society, compared the quality of hospice services provided for patients living at home, in assisted living communities and in nursing homes, as perceived by their family members. In writing the study, researchers combed through the results of a federally mandated quality survey for 7,510 hospice patients over the age of 18.

The results showed that 67.8% of respondents reported that the home hospice care provider for their loved ones was “excellent,” beating out hospice care in assisted living communities (64.3%) and nursing homes (55.1%).


“They Want Docile”

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How Nursing Homes in the United States Overmedicate People with Dementia.
Too many times I’m given too many pills…. [Until they wear off], I can’t even talk. I have a thick tongue when they do that. I ask them not to [give me the antipsychotic drugs]. When I say that, they threaten to remove me from the [nursing] home. They get me so I can’t think. I don’t want anything to make me change the person I am.
—Walter L., an 81-year-old man given antipsychotic drugs in a Texas nursing facility, December 2016.
It used to be like a death prison here. We cut our antipsychotics in half in six months. Half our residents were on antipsychotics. Only 10 percent of our residents have a mental illness.
—A director of nursing at a facility in Kansas that succeeded in reducing its rate of antipsychotic drug use, January 2017.

In an average week, nursing facilities in the United States administer antipsychotic drugs to over 179,000 people who do not have diagnoses for which the drugs are approved. The drugs are often given without free and informed consent, which requires a decision based on a discussion of the purpose, risks, benefits, and alternatives to the medical intervention as well as the absence of pressure or coercion in making the decision. Most of these individuals—like most people in nursing homes—have Alzheimer’s disease or another form of dementia. According to US Government Accountability Office (GAO) analysis, facilities often use the drugs to control common symptoms of the disease.

While these symptoms can be distressing for the people who experience them, their families, and nursing facility staff, evidence from clinical trials of the benefits of treating these symptoms with antipsychotic drugs is weak. The US Food and Drug Administration (FDA) never approved them for this use and has warned against its use for these symptoms. Studies find that on average, antipsychotic drugs almost double the risk of death in older people with dementia. When the drugs are administered without informed consent, people are not making the choice to take such a risk.

The drugs’ sedative effect, rather than any anticipated medical benefit, too often drives the high prevalence of use in people with dementia. Antipsychotic drugs alter consciousness and can adversely affect an individual’s ability to interact with others. They can also make it easier for understaffed facilities, with direct care workers inadequately trained in dementia care, to manage the people who live there. In many facilities, inadequate staff numbers and training make it nearly impossible to take an individualized, comprehensive approach to care. Many nursing facilities have staffing levels well below what experts consider the minimum needed to provide appropriate care.


Nassar Scandal Prompts Focus on Prevention, Protection, Accountability

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The case of disgraced former Michigan State University doctor Larry Nassar has prompted state lawmakers on both sides of the aisle to look at funding, policy and structural changes to address the issue of sexual assault on college campuses. 

The Progressive Women's Caucus this week laid out three principles they hope will guide the state's approach to sexual assault: prevention, protection and accountability. 

State Rep. Erika Geiss, D-12th Dist. and the group's vice-chair, wants the state to create a Title Nine ombudsman who would protect the victims of sexual assault from retaliation.

"Our society has systematically failed to listen to and believe victims without also assigning shame, blame or invalidation," she says. "It's past time that the state stood with survivors."

The group also is calling for comprehensive K-12 education on the importance of consent, an increase in spending for services for victims of sexual assault, as well as legislation to remove the statute of limitations in assault cases. 

Last week, a group of Republican lawmakers introduced a package that would expand mandatory reporters of sexual assault to include coaches and athletic trainers, and to let students confidentially report tips about sexual assaults to law enforcement.

Nationally, one in four women reports having been sexually assaulted or abused by the time they graduate from college, and Geiss, an adjunct professor, says the impact of the trauma can undo a student's future.

"I understand all too well how derailing it can be for a student who is sexually assaulted to then continue with her or his studies uninterrupted," she adds. "I've had students who were otherwise dedicated to their studies suddenly stop attending class, or have their grades affected negatively."

Many of the legislative items laid out have been slowly making their way through the Capitol since the Nassar scandal began to emerge, with lawmakers saying there is bipartisan support for the majority of the proposed changes.