Home Health Care Bill of Rights Would Prohibit Discrimination

By Diane C. Lade, South Florida Sun-Sentinel

Floridians receiving professional home health care could become among the few in the nation with their own bill of rights. Among the guarantees: Appointment times that are honored, disclosure of out-of-pocket costs and quality care.

But under the proposal being considered by Florida legislators this session, home health agencies would have rights, too, including one likely to spark much debate: Clients would have to accept all qualified assistants in their home “regardless of race, creed or sexual orientation,” according to SB 1370. Patients or their families also would need to tell agencies in advance which primary language is spoken in the home.

Five states have similar home-care bills of rights, although only one, Iowa, addresses discrimination against nursing assistants and aides. These guidelines echo bills of rights for nursing home patients, which have been in place for years.

“If someone is certified, licensed and able to provide the service at a good price, they should not be turned away because of the color of their skin,” said Sean Schwinghammer, executive director for the Florida Alliance of Home Care Services. A trade group for medical equipment providers, the alliance is pushing the bill of rights and recruited Sen. Mike Fasano, R-New Port Richey, as a sponsor.

Schwinghammer said ethical guidelines would put bad providers on notice in a rapidly growing industry that’s been plagued by Medicaid and Medicare fraud. Demand for home nursing care has been exploding, as seniors and government programs look for less expensive alternatives to nursing homes.

The Paraprofessional Healthcare Institute, a nonprofit organization promoting better job conditions for long-term care workers, projects the number of home care aides needed in Florida will increase 41 percent over 10 years, to 46,353 required by 2018.

The bill tackles one of the touchiest, yet usually unaddressed, issues in long-term care: cultural rifts between the aides and assistants, who often are minorities, and their patients, who often are white Anglos. It can be even more complicated in South Florida, where many care professionals come from Caribbean countries where they spoke Creole or Spanish.

Broward County seniors receiving government-subsidized home health care through Medicaid “sometimes call us, frustrated, because they can’t understand the way [an aide] speaks,” said Edith Lederberg, executive director of the Aging & Disability Resource Center of Broward County, which manages services for the elderly. “But if the person is able to do the job and do it well, the client should be willing to accept them.”

State officials received 338 complaints against home health agencies in 2011, up from 296 complaints five years ago. Quality of care and treatment issues accounted for 42 percent of last year’s complaints, compared with 22 percent of those filed in 2007

The standards are a “two-way street,” Schwinghammer said, drawn from common complaints the association has heard from both patients and the home care industry. Some agencies said clients were refusing to take caregivers from certain ethnic groups, he said, leaving providers “having to pay a premium to get someone with the right skin color and accent.”

When the clients are on Medicaid or Medicare, that premium is picked up by the taxpayers, Schwinghammer said.

Nationally, almost half of those working on health care’s front lines are black, Hispanic or mixed race, according to the paraprofessional institute. But those ratios can vary greatly from state to state, experts say.

The U.S. Equal Employment Opportunity Commission has been involved in several cases involving home health discrimination, including one in Maryland where a home-care agency coded charts indicating which seniors would accept only white caregivers. The agency settled the case in 2010, agreeing to stop race-based assignments unless the pairing would cause the client to become violent.

Yet some are questioning how the state could refuse to let families who have private duty caregivers (vs. public-funded aides) choose the race and language proficiency of the people they hire.

“I think if someone is paying out of their own pockets for a service in their own homes, in principle, they are going to have some say in who is their caregiver,” said Bobby Lolley, executive director of the Home Care Association of Florida.

Lolley said the association is talking with Fasano, but has not yet decided whether it will support the measure. A bill of rights is a “worthy endeavor,” Lolley said, but the anti-discrimination clause might be a sticking point.

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