Providers Push Back on Senate Committee Move to Slash Home Care Funding in VA Bill

McKnight’s Home Care
 
Home care providers are lobbying a Senate committee to reverse its recent decision to remove a central provision from the Elizabeth Dole Home Care Act. The provision would allow the Department of Veterans Affairs to fund nursing home-level home care at 100% of the cost of nursing home care. Currently, the VA can only fund home care at 65% of the cost of institutional care.
 
“We urge you to keep section 3 in the Elizabeth Dole HCBS Act, which will provide veterans a choice as to where they receive care by raising the 65% cap on non-institutional care,” Vicki Hoak, CEO of the Home Care Association of America, wrote in a Feb. 14 letter to the chair and ranking member of the U.S. Senate Committee on Veterans Affairs.
 
HCAOA, many of whose members provide VA-funded home care, learned earlier this month that the Senate committee intended to eliminate Section 3 of the bill. In the letter to the committee, Hoak referred to a General Accounting Office (GAO) report that found the average cost of institutional care per veteran in nursing homes was $268 per day, or nearly $98,000 per year. That compares to VA data showing the average cost per veteran receiving non-institutional care was only $5,500 a year.
 
She also mentioned that allowing the VA to offer home care alleviates the strain on nursing homes. Most nursing homes have limited capacity to serve veterans with special needs, especially those needing dementia, ventilator or behavioral care, she wrote. 
 
“Removing the 65% cap on nursing level care in the home setting would provide relief to the capacity issues of institutional care while providing access and choice for veterans,” Hoak wrote. 
 
She told McKnight’s Home Care Daily Pulse that if a veteran hits the 65% cap and still needs services, they need to go to a nursing home. It doesn’t negate the obligation of the VA. And it’s not just home care that contributes to the cap; respite and adult day care services also add to the cost, she said. 
 
Removing the provision in the bill hurts those veterans who want to stay in their homes as long as possible, she said. 
 
“Everyone wants to age in place, but when they need the care we put a cap on the care,” she said.

Our members and home care providers are encouraged to continue to use HCAOA’s Legislative Action Network to send updated messages to members of Congress to urge them to keep the Dole Act intact and oppose efforts to eliminate or reduce HCBS funding.

Click to send a message to your legislators.

Senate Panel Launches Effort to Shore up Health Workforce and Ease Crippling Shortages

Fierce Healthcare | By Robert King

A key Senate panel is launching a major effort to shore up the healthcare workforce after lingering shortages have roiled the industry. 
 
The Senate Health, Education, Labor and Pensions (HELP) Committee held a hearing Thursday on addressing the crisis. Some of the policy solutions include expanding the Graduate Medical Education program and growing teaching health centers. 
 
“A shortage of healthcare personnel was a problem before the pandemic and now it has gotten worse,” said HELP Committee Chairman Bernie Sanders, I-Vermont. “Health care jobs have gotten more challenging and, in some cases, more dangerous.”
 
Sanders said Thursday that in the next decade there will be a shortage of more than 120,000 doctors as well as a massive need for 450,000 nurses within the next two years. The staffing shortage has been particularly acute among nurses, as hospitals have turned to pricey contract labor to shore up capacity.
 
Lawmakers detailed where the panel could go to combat the problem. 
 
Ranking Member Bill Cassidy, R-Louisiana, said that one of the biggest potential barriers could be the education requirements for nursing educators, which his home state is looking into. 
 
“States have to ask—what does that student need to know to effectively care for patients and whom can they learn it from?” he said during the hearing. “That will be a way to remove a real choke point in terms of educating these nurses.”
 
Sanders added that the panel could look into expanding residency slots for the GME program and “increase student loan debt forgiveness and scholarships provided” under the National Health Services Corps.
 
There are some potential must-pass vehicles for the panel to include reforms, chief among them extending mandatory funding for the National Health Service Corps and the Teaching Health Centers GME program. 
 
Another program set to expire in 2023 is the Children’s Hospital GME program that helps to train pediatricians and other pediatric specialties.
 
“It is important that funding for these programs is extended on time, in a bipartisan fashion, with the appropriate spending offsets,” Cassidy said.

Staff Recommendation Hours Worked Under the Fair Labor Standards Act (FLSA)

SESCO Management Consultants

This fact sheet provides general information concerning what constitutes compensable time under the FLSA. The Act requires that employees must receive at least the minimum wage and may not be employed for more than 40 hours in a week without receiving at least one and one-half times their regular rates of pay for the overtime hours. The amount employees should receive cannot be determined without knowing the number of hours worked.

Definition of "Employ"

By statutory definition the term "employ" includes "to suffer or permit to work." The workweek ordinarily includes all time during which an employee is necessarily required to be on the employer's premises, on duty or at a prescribed workplace. "Workday", in general, means the period between the time on any particular day when such employee commences his/her "principal activity" and the time on that day at which he/she ceases such principal activity or activities. The workday may therefore be longer than the employee's scheduled shift, hours, tour of duty, or production line time.

Application of Principles

Employees "Suffered or Permitted" to work: Work not requested but suffered or permitted to be performed is work time that must be paid for by the employer. For example, an employee may voluntarily continue to work at the end of the shift to finish an assigned task or to correct errors. The reason is immaterial. The hours are work time and are compensable.

Waiting Time: Whether waiting time is hours worked under the Act depends upon the particular circumstances. Generally, the facts may show that the employee was engaged to wait (which is work time) or the facts may show that the employee was waiting to be engaged (which is not work time). For example, a secretary who reads a book while waiting for dictation or a fireman who plays checkers while waiting for an alarm is working during such periods of inactivity. These employees have been "engaged to wait."

On-Call Time: An employee who is required to remain on call on the employer's premises is working while "on call." An employee who is required to remain on call at home, or who is allowed to leave a message where he/she can be reached, is not working (in most cases) while on call. Additional constraints on the employee's freedom could require this time to be compensated.

Rest and Meal Periods: Rest periods of short duration, usually 20 minutes or less, are common in industry (and promote the efficiency of the employee) and are customarily paid for as working time. These short periods must be counted as hours worked. Unauthorized extensions of authorized work breaks need not be counted as hours worked when the employer has expressly and unambiguously communicated to the employee that the authorized break may only last for a specific length of time, that any extension of the break is contrary to the employer's rules, and any extension of the break will be punished. Bona fide meal periods (typically 30 minutes or more) generally need not be compensated as work time. The employee must be completely relieved from duty for the purpose of eating regular meals. The employee is not relieved if he/she is required to perform any duties, whether active or inactive, while eating.

Sleeping Time and Certain Other Activities: An employee who is required to be on duty for less than 24 hours is working even though he/she is permitted to sleep or engage in other personal activities when not busy. An employee required to be on duty for 24 hours or more may agree with the employer to exclude from hours worked bona fide regularly scheduled sleeping periods of not more than 8 hours, provided adequate sleeping facilities are furnished by the employer and the employee can usually enjoy an uninterrupted night's sleep. No reduction is permitted unless at least 5 hours of sleep is taken.

Lectures, Meetings and Training Programs: Attendance at lectures, meetings, training programs and similar activities need not be counted as working time only if four criteria are met, namely: it is outside normal hours, it is voluntary, not job related, and no other work is concurrently performed.

Travel Time: The principles which apply in determining whether time spent in travel is compensable time depends upon the kind of travel involved.

Home to Work Travel: An employee who travels from home before the regular workday and returns to his/her home at the end of the workday is engaged in ordinary home to work travel, which is not work time.

Home to Work on a Special One Day Assignment in Another City: An employee who regularly works at a fixed location in one city is given a special one-day assignment in another city and returns home the same day. The time spent in traveling to and returning from the other city is work time, except that the employer may deduct/not count that time the employee would normally spend commuting to the regular work site.

Travel That is All in a Day's Work: Time spent by an employee in travel as part of their principal activity, such as travel from job site to job site during the workday, is work time and must be counted as hours worked.

Travel Away from Home Community: Travel that keeps an employee away from home overnight is travel away from home. Travel away from home is clearly work time when it cuts across the employee's workday. The time is not only hours worked on regular working days during normal working hours but also during corresponding hours on nonworking days. As an enforcement policy the Division will not consider as work time that time spent in travel away from home outside of regular working hours as a passenger on an airplane, train, boat, bus, or automobile.

Typical Problems

Problems arise when employers fail to recognize and count certain hours worked as compensable hours. For example, an employee who remains at his/her desk while eating lunch and regularly answers the telephone and refers callers is working. This time must be counted and paid as compensable hours worked because the employee has not been completely relieved from duty.

WHAT IS NEW AND WHAT HAS CHANGED IN HR

FMLA leave. The U.S. Department of Labor (DOL) has issued a new opinion letter pertaining to the Family and Medical Leave Act (FMLA). According to the guidance, an eligible employee with a serious health condition that necessitates limited hours may use FMLA leave to work a reduced number of hours per day (or week) for an indefinite period of time as long as the employee does not exhaust his or her FMLA leave entitlement.

Sexual harassment. Under the federal Speak Out Act, which was enacted in December, pre-dispute nondisclosure clauses and non-disparagement clauses relating to sexual assault or sexual harassment are no longer judicially enforceable where the conduct is alleged to have violated federal, tribal, or state law. States and localities may continue to enforce state-law provisions if they are at least as protective of an individual's right to speak freely.

Workplace romances. While Valentine’s Day is over, love is still in the air at many workplaces. More than one-fourth (27 percent) of U.S. workers are currently involved in a workplace romance or have been in one before, according to a new survey from the Society for Human Resource Management (SHRM). Most (79 percent) have dated their peers; 10 percent have dated their subordinates; and 18 percent have dated their superiors. Notably, nearly three-fourths of workers said their employer does not require them to disclose their involvement in a workplace romance.

Telework. The DOL has issued Field Assistance Bulletin 2023-1, which covers telework under the Fair Labor Standards Act (FLSA) and the FMLA. According to the bulletin, employees who work from home, telework, or work away from premises managed or controlled by the employer remain equally covered by the protections of these two laws. For example, they are equally entitled to compensation for all hours worked and short rest periods of 20 minutes or less, as well as break time to express breast milk under the FLSA. Additionally, employees who telework from home consistently or in combination with working at another or various worksites are equally entitled to have all hours worked counted for purposes of determining their eligibility for leave under the FMLA.

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Do I Stay in Contact After the Death?

By Barbara Karnes

Dear Barbara, Working in hospice, I always had a terrible time with --  do I stay in contact with the family after the death?

I think staying in contact with a family after the death is a personal practice and option. Most of the time there is another patient and family admitted to our full schedule and we get caught up in "there aren't enough hours in the day" living. 

I do think it is healthy for us to attend the visitation of our patient. It brings us closure and is appreciated by the family. The visit is our way of paying respect to the patient and family. It is also our final goodbye.

I personally discovered years ago that I needed some sort of closure ritual for myself when a patient I worked with died. For me, attending the visitation gave me contact with the family and offered me that final goodbye—that was my closure ritual.

As a hospice team most of us sign a sympathy card that is sent to the grieving family. For the primary care nurse or social worker or any staff member that has had direct contact on numerous occasions with the patient and/or family, I recommend sending a personal card or note to the family in addition to the team card. We in health care enter a family's life at a challenging, sad and fearful time. It is our acts of thoughtfulness that will be remembered and provide comfort.

All that said, I want to give you something to think about: We do not get emotionally involved with most of the patients and families we provide care for. We do not develop relationships that we want to continue after our work is done. Every so often a person and family will enter our personal space, fill some void we have within ourselves. For that person we will grieve. For that person we may want further contact.  

If all the patients and families got that deep inside our hearts we would not be able to continue our work. Our heart, our mind, and our life would carry too much grief. We would not be able to be objective. It would not be healthy for us to stay in end of life work.

Something More about...  Do I Stay In Contact After the Death?

Agencies (and end of life doulas) use my booklet, My Friend, I Care; The Grief Experience as their sympathy "card". The team signs the front page of the booklet and provides the family with a support tool and comfort for the bereaved.

Here is another article that give suggestions on further support for families- The Reluctance to Attend Bereavement Support Groups.