Feds crack down on Alaska home care programs

Moratorium bars new participants until problems solved

Posted: Wednesday, July 15, 2009

The federal government is barring Alaska from accepting more of its frail and elderly residents into its home and personal care services programs until the state shows it can fix a series of problems that may be endangering seniors.

Alaska Senior and Disability Services Director Rebecca Hilgendorf acknowledged problems at a press conference Tuesday, but said the state was already on its way to addressing those issues.

"Some of them are absolutely correct," she said. "We want to make improvements."

A lack of staffing, especially in the number of nurses who assess prospective clients for home health services and monitor care, has been hampering Alaska. The home care program has a 40 percent vacancy rate, said Marcy Rein, chief of SDS programs.

Money is available in the state budget, Hilgendorf said, but a nationwide shortage of registered and licensed nurses has made hiring in Alaska particularly difficult, she said.

What Hilgendorf did dispute was whether anybody had been hurt by the lack of care or supervision.

"We believe there is a very good quality of care being given to Alaskans," Hilgendorf said.

It is unclear what impact the understaffing has had. The CMS review noted that from October, 2006 to May 2009 there had been 27 deaths among people waiting for initial assessments, and 227 deaths among those waiting to be reassessed.

Alaska officials said they don't know if any of those deaths were caused by inadequate care, but had not done the mortality studies that would help answer that question.

Federal regulations require Alaska to have necessary safeguards in place to protect the health and welfare of the recipients of services, said Barbara Richards, associate regional administrator for the federal Centers for Medicare & Medicaid Services (CMS), in a letter to Commissioner Bill Hogan of the Department of Health and Social Services.

"The Alaska State Medicaid Agency has not provided CMS sufficient assurance that those necessary safeguards are currently in place and/or being followed," Richards wrote.

A hiring freeze instituted earlier this year by Gov. Sarah Palin as a cost savings measure delayed some hiring, Hilgendorf said, though some hires were granted waivers.

Hilgendorf said that while some nurses were hired elsewhere while awaiting waivers, that happens sometimes in the highly competitive world of nurse recruiting anyway and can't be directly linked to the freeze. Palin lifted the freeze June 1.

The state has taken new steps to boost hiring, Rein said, including advertising on Yahoo.

State officials say they expect the backlog of assessments for service eligibility to be resolved in four to five months.

While the federal moratorium will bar new people from the programs, it will not affect the several thousand people already in it, Hilgendorf said.

Alaska has waivers from federal authorities to provide frail and elderly residents with community and home-based care, and keep them out of expensive nursing homes and hospitals.

The home and community services can also help move people out of spendy specialized facilities, freeing up space for those with greater need.

Half the cost of those programs is picked up by Medicare and Medicaid, which must approve how Alaska manages its programs.

Alaska began using nurses in 2007 to do assessments, replacing a system in which assessments were sometimes done by those who would be doing care, setting up a conflict of interest.

Using nurses in its employ to do the assessments provided significant cost savings, Hilgendorf said.

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