Home care executives and attorneys are readying themselves for a wave of mergers and acquisitions in New York’s licensed home care services industry, after four years waiting for the state Department of Health to green-light a process to make such deals official.
The Health Department released the new licensure application process this month. It enables licensed home care services agencies, which provide nonmedical personal care to Medicaid and private-pay patients, to apply for a new license reflecting any change in ownership due to a merger or acquisition. The application also outlines a pathway for new home care agencies to obtain licensure.
The sector had gone without a licensure application since 2018, when the state responded to the rapid proliferation of licensed home care services agencies by enacting a two-year moratorium on the processing and approval of applications. The moratorium expired March 31, 2020, and the Health Department did not release a new application.
Kathy Febraio, president and CEO of the New York State Association of Health Care Providers, said the Health Department blamed the wait on pandemic-related staffing issues. As a result, natural market forces that have long been stymied are about to explode into view.
“There’s a lot of pent-up need for that application and pent-up desire for LHCSAs [licensed home care services agencies] to make changes,” Febraio said.
Monica Pomeroy, a Health Department spokeswoman, said the moratorium enabled it to develop a new methodology for the public-need criteria. She said the department continued to process asset acquisitions and licensure approvals for agencies associated with assisted living programs. She attributed the delay in releasing the application to the pandemic.
“The pandemic disrupted patterns of service delivery as well as LHCSA operations, causing the department to defer release of the new application until such time as unregistered and nonoperational LHCSAs could be identified and new patient service by county data could be collected and analyzed,” she said in a statement.
The new application for change in ownership requires agency operators to pass financial feasibility and character and competence reviews. New agencies must prove a public need for services in their county, meaning either that the area has fewer than five or that the new agency would serve a population not being served by existing agencies.
The nonexistence of the application did not halt M&A activity, said health care lawyer Emina Poricanin, who runs Albany-based firm Poricanin Law. Home care executives instead drew up agreements to manage the target agency, which kept its own separate license, and submitted those to the Health Department.
The department said it has 68 management agreements under review, the majority of which involve an asset purchase agreement for change in ownership.
Julian Hagmann, vice president at Caring Professionals in Forest Hills, Queens, said the home care agency inked a management agreement for an additional two licenses during the moratorium. It now can file for a change in ownership to formalize the acquisition.
“It’s basically a mad scramble right now if you’re an attorney in the home care space, because you have all these M&A agreements on the back burner,” Hagmann said. “The department’s going to get flooded.”
Poricanin said it might take the Health Department up to two years to go through all the license applications, which then go before the state Public Health and Health Planning Council for approval. The wave of new applicants includes home care operators who shied away from deals during the moratorium and those who applied for licensure before the moratorium went into effect but did not win approval in time.
Given that many licensed home care agencies rely on the Medicaid program for revenue, Poricanin said operators have a huge incentive to engage in mergers and acquisitions.
“Really the only way that these providers are making money is by volume, so they have to grow,” she said. “Consolidation is the means of survival.”
Other major changes to the state’s home care sector are afoot. Stakeholders are bracing for the release of a request for proposals under the Medicaid long-term-care program—which would further whittle down the number of licensed home care agencies in New York by requiring them to go through an application process to be able to continue billing Medicaid.
Febraio said the Health Department should wait to release the RFP until the full effects of the new licensure application are clear because current state data on the number of licensed agencies might not be accurate. —Maya Kaufman
White Plains Hospital opens $11M expanded Intensive Care Unit
White Plains Hospital has opened an $11 million, 9,500-square-foot intensive-care unit, which aims to treat its most vulnerable patients with more advanced technology, the hospital announced Friday.
The redesigned ICU includes 12 beds that have negative pressure, which pumps air out of the treatment area in order to reduce infections; in-room lifts that can help patients out of bed to go to physical therapy; and private bathrooms, according to the hospital. The unit also has four large, universal care rooms for patients who are recovering from cardiac surgery. Historically, such patients have had to recover elsewhere in the hospital.
The beds in each room feature pressure equilibration, allowing them to better distribute the patient’s body pressure and reduce the risk of bedsores. Staff workstations are located near the beds.
The ICU will support the hospital’s expanded complex care services in areas including cardiology and neurosurgery, White Plains said. The hospital’s critical care team sees more than 2,000 patients annually, and the hospital expects the new ICU to treat about 800 patients per year.
The expansion comes after the hospital opened a 9-story, 252,000-square-foot outpatient facility last year that connected the main hospital with its Center for Cancer Care. It also launched a cardiac surgery program and built a cardiac operating room.
The hospital has 292 beds and is part of Montefiore Health System, which is based in the Bronx and operates 10 hospitals and more than 200 outpatient sites in the borough, Westchester County and the Hudson Valley. —Jacqueline Neber
Northwell hits 2% margin in Q2 amid growth of outpatient network
Northwell Health pulled in a $79 million operating surplus during the second quarter of the year, ending up with a 2% margin, according to financial results released last week.
The health system reported $3.8 billion in operating revenue for the three-month period that ended June 30, an increase of about 6.8% year over year.
Total patient revenue was almost $3.5 billion, up 6% since the same period last year.
That included about $706 million from its physician practices, thanks to continued growth in Northwell’s physician and ambulatory network resulting from ongoing recruitment efforts and practice acquisitions. Increases in specialty and retail pharmacy sales caused other revenue to climb 14% year over year to $342 million.
Total operating expenses rose 6.6% year over year to reach $3.8 billion in the quarter. Wages were up 6.8% to almost $2 billion, and benefit expenses increased 7.5% to more than $436 million—which management attributed to premium costs to cover employees on leave and staff vacancies as well as investments to support expanding the system’s physician and ambulatory network. Supply costs added up to $1.2 billion, up 5.7% from the second quarter of last year, thanks to continuing volume recovery and inflation.
The system recorded $5.8 billion in total net assets, a decrease of $547 million since the end of the first quarter, as the volatility in the investment markets continued to spark fluctuations in nonoperating results.
Northwell’s performance reflected a slight improvement from the second quarter of last year, when it reported a $69 million surplus and a 1.9% operating margin.
“Continued volume recovery and demand for lab services along with unanticipated government rate trends and other government relief funds have helped mitigate the impact of inflationary pressures on operating expenses and costs associated with continued community vaccination and testing efforts,” Barbara Osborn, a spokeswoman for the health system, said in a statement.
Osborn said Northwell expects operating results to approach historical pre-Covid levels by the end of the fiscal year, due to advancements in operational efficiency and strategic growth.
Northwell Health includes 19 owned hospitals, three long-term care facilities, certified home health care agencies, a hospice network, about 850 ambulatory and physician practice locations, the Feinstein Institutes for Medical Research, a centralized lab and joint ventures. —M.K.
Meet more Crain's Notable Health Care Leaders
TheCrain’sNotable Health Care Leaders listrecognizes 86 individuals who have helped people lead healthier lives. The honorees are notable for their consummate leadership, pioneering accomplishments and ability to adjust to crises. Moreover, all of them have demonstrated a commitment to mentoring.
To be eligible, nominees were required to live in New York City or its environs, work for a health care or health insurance organization, have at least 10 years of experience in the field and hold a leadership role. They also had to have a willingness to share their expertise with others in the field. These leaders bring their expertise to health tech firms, hospitals, insurance providers and other health care companies.
Dr. Mark Leondires-Medical director and partner in reproductive endocrinology,Illume Fertility
Leondires oversees Illume, aninfertility treatment and reproductive endocrinology practice. Under his leadership, Illume has helped families welcome more than 8,000 babies. His forging of a partnership with Fertility Partners, a network of leading clinics, has given Illume access to technological advancements to enhance patient experience. Leondires founded Gay Parents to Be, an educational resource for LGBTQ couples and individuals on afamily-building journey. He sits on the board of the Nest EggFoundation, which partners with Illume to offer invitro fertilization grants. He previously chaired the American Society for Reproductive Medicine’s LGBTQ+ special interest group.
Michelle Lewis-CEO,NYC Health + Hospitals/Gotham Health
At Gotham Health, Lewis offers direction for and coordination ofa range of initiatives aimed atimproving the patient experience andincreasing timely access tocare. She hasformed partnerships and generated new projects,. Lewis promotes inclusive practices in her workplaces, regularly meeting with the diversity, equity and inclusion office of NYC Health +Hospitals to brainstorm relevant workshops. Leading Gotham Health—the largest federally qualified health systemin the country—through the pandemic, Lewis was responsible for providing support to sites in thenetwork asthey strove to get Covid-19 testing andvaccinations into the community.
Rebecca Linn-Walton-Senior assistant vice president,New York City Health + Hospitals
Linn-Walton leads H+H initiatives related to substance-use funding, policy advocacy, program design, performance management and behavioral health public strategy and response. Shedirects operations and management for outreach tothe homeless, and she coordinates with government agencies. She leads a working group focused on equity and access to care and serves as central office lead on abortion access and pregnancy care forbehavioral health patients. Inresponse to the pandemic, Linn-Walton aided in the shift from in-person to telemedicine sessions and mentored clinicians during the transition. In addition, she was an advocate for marginalized mental health patients.
Rita Mabli -President, CEO,United Hebrew of New Rochelle
Mabli has dedicated her four-decade career to growing and transforming the United Hebrew facility in New Rochelle, one of the metropolitan area’s major comprehensive senior services and care organizations. Most recently, she helped United Hebrew adjust to changing markets and community needs and expanded dementia care and affordable housing programs. Under her leadership, United Hebrew was named one ofU.S. News & World Report’s best nursing homes, among other accolades. She engineered partnerships that helped United Hebrew respond to the pandemic. Mabli is a Fellow of the American College of Health Care Administrators and sits on the board of theWestchester County Association’s Healthcare Consortium.
Dr. Sharmila Makhija-Professor and department chair,Montefiore Health System/Albert Einstein College of Medicine
Makhija manages and mentors a team of physicians, trainees and staff at more than 10 Einstein sites. In addition to being chair of the OB/GYN and women’s health department, sheheads thesteering committee of the faculty practice group, which is responsible forintegrating 23 clinical departments in order to foster patient access. In response tothe pandemic, she and her team created and implemented early-stage Covid-19 plans for maternal care that were shared with hospitals locally and nationally. She formed an equity task force to lead efforts toward equitable recruitment, diverse hiring and compensation policies. She sits on the board ofmaternal care nonprofit Every Mother Counts.—Crain's staff
AT A GLANCE
SUPPORTIVE HOUSING: The city Department of Social Services awarded Jamaica-based AIDS Center of Queens County, Inc. nearly $2 million for 50 units of transitional supportive housing and supportive services for New Yorkers living with AIDS. The center is the largest provider of HIV and AIDS health care services in Queens and serves more than 10,000 HIV-positive people across five sites.
NEW PARTNERSHIP: Venture capital firm General Catalyst, which has an office in Soho, is partnering with Pennsylvania-based health care system WellSpan Health to work on digital health projects, Modern Healthcare reported Monday. WellSpan Health will have access to the companies that are part of General Catalyst’s recently-closed $670 million Health Assurance Fund II, which aims to address the industry’s workforce shortage, develop new technologies and address mental health concerns. WellSpan is the venture capital firm’s fourth digital health partnership this year.
UKRAINE AID: Midtown-based medical device company V6CO is donating nearly $3 million in medical supplies to help people in Ukraine in partnership with nonprofit United Help Ukraine, the company announced Monday. The supplies will include more than 11.5 million syringe sets. During the pandemic, V6CO shifted its manufacturing to include medical supplies such as masks, syringes, needles and gloves.
WHO'S NEWS:The "Who's News" portion of "At a Glance" is available online atthis linkand in the Health Pulse newsletter. "Who's News" is a daily update of career transitions in the local health care industry. For more information on submitting a listing, reach out to Debora Stein:[emailprotected].
CONTACT US: Have a tip about news happening in the local health care industry? Want to provide feedback about our coverage? Contact the Health Pulse team at [emailprotected]
- Deliver care that is appropriate to the cultural needs of the client. ...
- Ensure caregivers are spending as much time as possible with the client. ...
- Match the best-suited staff members to each individual client.
A minimum of 28 days notice is required for Live In Care and 7 days notice for hourly care, for either notice of cancellation or change of hours, unless a different agreement is negotiated and agreed between both parties.
To offer consistent, unconditional care, enabling each service user to live in an environment that encourages positive relationships, mutual respect, trust, and consideration for others. To accept and understand each individual service user, at all times maintaining their dignity and self-respect.
Home care agencies employ care workers and arrange for them to visit you to provide care services. You could get help with: eating and drinking. bathing and personal hygiene.
- Get Planning. You're no doubt passionate about caring for the elderly in their own homes, and have followed your dream to open your own home care agency. ...
- Organise Finances. ...
- Ramp Up Networking. ...
- Build Your Digital Presence. ...
- Diversify Marketing. ...
- Utilise Existing Clients.
- Train frontline home health agency staff. ...
- Train follow up staff. ...
- Know individualized patient needs. ...
- Take time with clients. ...
- Listen and connect. ...
- Empathize and take concerns seriously. ...
- Empower and educate. ...
- Partner and advocate.
Ending assignments and dismissal
Usually you need to tell them in writing. An agency can usually end their relationship with you – or 'dismiss' you – without notice or reason unless: your contract says otherwise. you're an employee of the agency and have been employed for at least 1 month.
- Are they safe? Safe: you are protected from abuse and avoidable harm.
- Are they effective? ...
- Are they caring? ...
- Are they responsive to people's needs? ...
- Are they well-led?
The fees which recruitment agencies charge can be significant, especially with higher-paid staff. As a general rule, a recruitment agency will charge between 10-30% of the base annual salary.
- Assess medical needs. Checking on your senior loved one's health is an important caregiver responsibility. ...
- Prepare a care plan. ...
- Assist with basic needs. ...
- Provide companionship. ...
- Help with housekeeping. ...
- Monitor medications. ...
- Assess your care plan regularly. ...
- Prepare meals.
Ensuring that you maintain clients dignity, rights and freedom at all times and treat them with respect. Having the ability to differentiate between good and poor practice. Being honest, trustworthy, compassionate and reliable. Accepting and celebrating difference.
Care Assistants frequently check up on patients to monitor their vital signs, help them move from place to place, deliver meals, feed patients, help them use the toilet and bathe. They communicate with patients about their symptoms and needs, reporting changes or concerns to other members of the patient's care team.
- Privacy and confidentiality of information.
- Individuality and identity.
- Carers should not smoke in service users' homes.
- Workers must not be intoxicated or consume alcohol while on duty.
- Carers can't take another person into a service user's home.
A new report lists home health care as one of the top five most profitable franchises in the U.S., even as the industry fights new Department of Labor rules calling for mandatory overtime and minimum wage requirements for home health employees.
- Introductory Services.
- The local newspaper.
- Online Classified Ads.
- Care Specific Job Boards.
Keep your online presence professional, or private
This is especially crucial when marketing yourself as a nanny or caregiver. Your online job profile, social media accounts and website should be polished and complete with your experience and skills that show you are a well-rounded and qualified candidate for any job.
- Make it easy for caregivers to get information online. ...
- Offer support with resources outside of your healthcare organization. ...
- Help caregivers prevent or manage caregiver burnout. ...
- Amp up the empathy. ...
- Be inclusive. ...
- Be upfront about finances.
- Stay Current on Regulations. ...
- Setting Up Payment Best Practices. ...
- Qualify Your Staff. ...
- Embrace The Tech Race. ...
- Get Cases Quickly.
THE BEST EVIDENCE
In an unfair dismissal claim, the best way to prove that you have been unfairly dismissed is to source previous messages or emails with your employer, manager or colleagues.
You only have the right to claim unfair dismissal if you're an employee - this includes part-time and fixed-term employees. Unfortunately, you don't have any rights to challenge your dismissal if your employment status is: self-employed. an agency worker or classed as a 'worker'
“Wrongful dismissal” is the general term used to describe any situation where an employer has explicitly terminated the employment of one or more of its workers without providing that worker with her or his entitlements under the law.
The Standards are built upon five principles; dignity and respect, compassion, be included, responsive care and support and wellbeing.
- Person-centred care. You must have care or treatment that is tailored to you and meets your needs and preferences.
- Dignity and respect. ...
- Consent. ...
- Safety. ...
- Safeguarding from abuse. ...
- Food and drink. ...
- Premises and equipment. ...
Under the new approach, CQC inspectors will make their judgement on providers by assessing services against five key questions: Are they safe? Are they effective? Are they caring? Are they responsive to people's needs?
Do recruiters take a cut of your salary? Recruiters do not take a cut of your salary. The company the staffing agency places you at however does compensate the recruiter based on a percentage of your first year's salary if the employer and recruiting agency have a contingency agreement in place.
But the short answer is, yes, it is certainly okay to work with multiple agencies to meet your travel goals. If you are working with a recruiter and company you love and trust, who is able to keep you employed consistently, you are in an ideal situation.
Casual employees receive a higher rate of pay to compensate for the fact that they do not receive all the same paid entitlements as permanent employees, such as annual leave or personal leave.
Assisting with personal care: bathing and grooming, dressing, toileting, and exercise. Basic food preparation: preparing meals, shopping, housekeeping, laundry, and other errands. General health care: overseeing medication and prescriptions usage, appointment reminders and administering medicine.
Checking on your senior loved one's health is an important caregiver responsibility. You may need to help assess pain levels, schedule medical appointments, or manage medications and chronic conditions. It's a good idea to discuss your loved one's health with their doctor and other health professionals regularly.
- Home management and care planning. ...
- Medical advocacy. ...
- Prescription medication management. ...
- Help with personal hygiene and care. ...
- Assisting with meals and nutrition. ...
- Help with mobility. ...
- Home maintenance and basic housekeeping. ...
What are the rights roles and responsibilities of a support worker involved in the care relationship? ›
participate in treatment decisions and decisions about ongoing care. seek and receive additional information about the mental health consumer's support, care, treatment, rehabilitation and recovery. be consulted by service providers about treatment approaches being considered for the mental health consumer.
Examples in Duty of Care
Dignified and courteous treatment. Your culture, diversity and identity are valued as well as supported. Living a life free of abuse and neglect. Your independence.
Example: "I truly believe that care assistants have one of the most important jobs out there. We help people live their lives in a way that they wouldn't be able to do without our help. Helping them retain as much independence as possible with as much dignity as possible is always my primary goal.
- Being Passionate about their Job. A good carer is passionate about the care they provide and the needs of the people they care for. ...
- Empathy and Patience. ...
- Being Positive and Encouraging. ...
- Reliable and Respectful of Choices. ...
- Being Observant with Excellent Communication Skills.
- Patience. Those who provide home care to others need to be patient. ...
- Compassion. When someone has compassion for another they have an understanding of what the person is going through.
- Attentiveness. ...
- Dependability. ...
Given the nature of their job, truly great caregivers are naturally dependable, compassionate, and trustworthy. They should be able to empathize with the needs of their patients and identify them even before their families do.
- Helping a care home resident get dressed, wash and eat.
- Providing company: chatting and sharing news.
- Involvement with writing residents' care plans.
- Providing information to family members regarding the care plan.
- Ensuring that the resident's needs and wishes are met.
For instance, can a Healthcare Assistant become a nurse? The answer is yes! However, you must have the necessary academic qualifications, certificates and experience.
As mentioned before, formal qualifications are not essential in becoming a carer, however, they do help with job prospects and future progression. They also help you to carry out your role more efficiently and provide higher quality care.
The values of compassion, dignity and respect are essential when involving people in their own care.
- An interest in helping other people, regardless of their condition.
- The ability to communicate clearly and sensitively when talking to people and their families.
- Good listening skills.
- Great problem-solving skills and the ability to adapt and act accordingly to situations.
- Caring Skills and Techniques.
- Showing Approval.
- Creating trust.
- Gaining compliance.
- Social perception.
Carers are not allowed to accept any gifts.
You'll work 8 to 10-hour days on average as a live-in carer (not necessarily consecutive hours), but you'll also be on hand to help the client should they need you. You are not expected to work through the night unless that has been agreed through your employer.
Voluntary: you must make your decision to consent to or refuse treatment alone, and your decision must not be due to pressure by healthcare professionals, friends or family.
After you've worked for the same agency for 2 years, you'll also have the right to: not be unfairly dismissed - check if you've been unfairly dismissed. be given the reason for your dismissal in writing - check what to do if you haven't had a written explanation for your dismissal.
The law says that only care workers working as individuals can be exempted from the requirement to register. Partnerships providing the regulated activity 'personal care' must apply for registration with CQC.
Agency workers are usually considered to be 'workers' and not 'employees'. Further information on the employment rights for workers and agency workers is available on the following page: Employment status.
These fees tend to range from £15 to £30 per week, while the difference in monthly charges varies slightly more at between £80 and £130. These fees can vary depending on the umbrella company you choose.
The four year rule. If you're on fixed-term contracts for four or more years you'll automatically become a permanent employee, unless your employer can show there's a good business reason for that not to happen.
Many people don't realise that since 6 April 2012 new employees have to work continuously for two years before they acquire full employment rights. This is known as the “qualifying period” or “two year rule” and was only one year previously.
A dismissal will be classed as unfair if the reason the employer gives for the dismissal was not the real one, the reason was unfair or they acted unreasonably, for example, by failing to give the employee plenty of warning about their dismissal.
The CQC takes an average of 10 weeks to assess an application, but there is a lot to do first … make sure you are ready for them to view your service, talk to you and ensure you are able to explain your service and your responsibilities to the CQC including showing: How, as a provider, you meet the regulations.
Care and nursing homes
If you are planning to also provide personal care to people in the place they live as well as your care home, you need to register for both this regulated activity and 'accommodation for people who require nursing or personal care'.
- Strong leadership skills and the ability to motivate others.
- Good English, numeracy and digital skills.
- The ability to think strategically.
- Good project management and organisational skills.
- Experience working in a social care or health role.
There are four main types of contract businesses use, these are permanent, fixed-term, casual and zero hour. The contract you receive is based on your employment status and is to be agreed with the employer to ensure both parties are happy with its terms.
For example, the organisation might not pay the agency if they weren't happy with your work. If you haven't got a timesheet, your agency might delay paying you to check if you worked the hours claimed. They must pay you even if you can't produce a timesheet approved by the organisation you work for.
The biggest difference between agency work and zero hours contracts is your freedom – our work comes in the form of assignments, meaning that each stint is undertaken separately and you are not contracted for our sole employment in the spaces between.
Do recruiters take a cut of your salary? Recruiters do not take a cut of your salary. The company the staffing agency places you at however does compensate the recruiter based on a percentage of your first year's salary if the employer and recruiting agency have a contingency agreement in place.
- License Reimbursement Program.
- Opportunities at Prestigious Medical Facilities.
- 36, 40, 48, and 60-Hour Guarantees.
- Flexible-Length Assignments.
- Quick Start Dates.
- Unlimited Referral Bonuses.
- Medical, Dental, Vision and 401(k) Benefit Options Available.
NHS agency nurses are paid in accordance with the strict nurse pay rate guidelines set by the NHS, and whereas whilst private nursing jobs are often advertised as paying higher than market rate, private sector businesses can pay whatever they choose.