By Joe Russell, Executive Director
Over the past couple of weeks the State of Ohio has released more detail on its response to COVID-19, and boy is it detailed. The state aims to prevent the hospitals from being overwhelmed by creating more bed capacity, including creating new beds within skilled nursing facilities that are being called “health care isolation centers.”
The state has also divided Ohio geographically into three separate “zones” within which the major hospital systems are coordinating care with the isolation centers and health departments. The graph that shows how this will all work resembles more of Charlotte’s Web than a workable schematic to manage patients.
The detail doesn’t stop there. The pre-surge planning tool kit created by the state outlines how this will all work and includes a triage protocol, forms, processes, procedures, graphs, bells, whistles, and everything else but the kitchen sink. Unfortunately, in this case the kitchen sink is home health.
Despite all the detail in these plans, a simple message emerges that ironically confirms what the amazing people in home and community-based services have long thought: home health is NOT a priority in Ohio. If Medicaid funding is holding steady at 1998 levels didn’t convince you, take a look at the pre-surge planning toolkit. It’s right there clear as day. Home health and hospice is a patient source for hospitals and facility-based care, not the contrary, and certainly not the solution to congregate endangerment.
Please don’t misunderstand. This isn’t an indictment of the state’s work here. It’s clear that a lot of good people put a lot of time into this planning. We know that the talented people in the DeWine Administration have had their hands full dealing with a sickness that hasn’t been seen in over 100 years. This is simply an acknowledgement of reality.
To be fair, ODM Director Maureen Corcoran has done a great deal to support our industry’s requests. We’ve gotten flexibility on EVV, telehealth capabilities, priority status for PPE at local EMAs, and a myriad of other flexibilities given to Medicare providers. OCHCH is even being included in long-term care discussions alongside facility-based care despite not being part of the formal state plans. In fact, the only thing we haven’t gotten is COVID-19 testing capabilities and more funding.
Look, the state would not agree with my characterization of home health’s priority status. They would say that the focus on institutional care is simply because congregate settings are being the hardest hit. While that is true, it’s also true that this plan was constructed before they knew an issue with congregate settings existed. Whatever the case, it’s difficult to see any scenario where home and community-based services are a priority and facility-based care is not a priority, even one where home care and hospice providers and patients are the hardest hit.
We were never going to be a priority. We don’t need fancy modeling to tell us this. We were never going to be a priority because the general public and policy makers don’t know how our system works, don’t know the value we bring to the health care system. I can’t be the only person asking why we’re not using the health care delivery system that keeps people out of facilities if congregate settings is our biggest COVID-19 problem.
We have been relentless from day-one trying to get our members what they need to fight COVID-19, and to champion the ability to address the state’s issues when we have the right resources. Unfortunately, considerations to include home health as a solution for the state have only just begun. This upsets me and I hope it upsets you too.
While I’ve spent the better part of a month toiling over why, I’ve come to the conclusion that it doesn’t matter why. It is what it is. All that matters is what we’re going to do about it. Our industry must come together and educate people about home and community-based services so that we’re a priority for the State of Ohio policy makers moving forward.