Lisa Stockdale: Listeners, thank you for joining aging in full bloom with
Lisa Stockdale. I'm your host, Lisa, and today my guest is
Joe Russell. Joe is the executive director of Ohio Council
for Home Care and Hospice.
Joe and his organization are near and dear to my heart
because my day job, my real job is closely connected to
home health care, and Joe's organization is sort of on the
front lines protecting and advocating for our industry.
Good morning. Good afternoon, Joe.
Joe Russell: How are you, Lisa?
Excellent. Thanks for having me today.
Lisa Stockdale: Of course, of course.
Tell us about how counsel for home care and hospice, I
think I sort of described it, but you might want listeners
to know a little something more a little something
different.
Joe Russell: Absolutely. So the Council for Home Care and Hospice has
been around since 1965.
We started out as a very small, volunteer driven
organization that really just existed to share resources
amongst home care companies.
And then over the years, it's really grown as the industry
has grown. We we specialize in providing more than 600 home
care hospice and palliative care organizations across the
state with education providers support and technical
assistance, as well as government advocacy and lobbying.
And we've we've really come into our own and we're really
just trying to get ready for the new world.
Covid is really accelerated what post-acute health care
looks like, and we're trying to lead the way for our member
agencies to to create a world in which more people can stay
home as they get older.
Lisa Stockdale: Yeah. And I just want I want to read an excerpt from an
article I wrote recently, which will be published soon.
It's called Receiving care at home has its advantages, and
the first paragraph goes like this.
An emotional attachment to home has now been validated by
science. But seriously, we don't need science to tell us
what we already know.
Our relationship to home is real.
The concept of home rises above the constructs of brick and
mortar or dwelling home provides an unrivaled sense of
security, belonging, privacy and comfort.
It's the place we make memories, retreat from the public
and care for ourselves and our families.
And what we know Joe is home health care providers or
advocates is that people want to age at home.
They want to get well at home, they want to die at home
homes where it's at.
It is our comfort zone and we're in a unique position as
providers to help them realize that desire.
And I think that's why we're in love with this industry.
You referenced post-acute.
We always talk in terms that the average Joe or the
consumer doesn't understand.
We're talking about after the hospital, after the nursing
home, you can go home and continue to receive medical
services there, whether you're on the road to recovery or
whether you're at end of life.
That's where we have you covered on the home care and
hospice side, and we're passionate about this industry.
I think you have an idea of why I am.
Why are you so passionate about it, Joe?
And I know you are.
Joe Russell: I am very passionate about home care, and we actually refer
to it as health care at home because it encompasses so many
different things.
Home care and how it works is different than hospice, but
both of those are primarily provided in the home.
And then you get into, you know, other services like
transportation and durable medical equipment.
And all of a sudden there is a lot of complexity to trying
to deliver services in the home.
I'm actually passionate about health care at home because
of my personal experience.
I've watched my grandparents utilize hospice and I they
were lucky enough to be able to receive those services in
their home and a little bit of my background.
I spent a number of years as a lobbyist for the
Developmental Disabilities Association here in the state of
Ohio, and that's near and dear to my heart because I have
relatives who are developmentally disabled and.
I have watched the difference between the life they can
lead in the community versus the life they can lead if
they're quote unquote institutionalized.
Yeah. So when I when I was approached to take this
position, I actually was not a home care expert by any
means, but I already knew and I already had a sense that
this is where things were moving because of consumer
demand, because of costs that are rising.
It's less expensive and higher.
Have better customer satisfaction, so to speak, when when
that health care is provided in the home versus having to
get in the car or go somewhere or even stay somewhere.
So it is it is near and dear to my heart.
This is not just a job to me, and actually, if you talk to
our staff or board, they'll tell you, Joe is very
passionate. I'm very passionate about about this work, and
I'm very dedicated to continuing to push for changes that
are going to make living in the community and receiving
health care in the community better.
Lisa Stockdale: Yeah, and full disclosure.
So one of the owners of the company that I work for and the
company that sponsors this podcast, Capital Health Care
Network, one of the owners, Care Bernsen, is a board member
at Ohio Council, and she has told me how crazy passionate
you are. And that's a good thing because we can talk about
protecting an industry and people might start to take a
nap. But really, we're protecting people, people who are
vulnerable. What makes them vulnerable is the fact that
they have a health care challenge.
Any time we have a health care challenge, we become
vulnerable so that it is all about people, people who
deserve services and they are readily available.
And we just have to figure out a way to help the powers
that be help us keep doing what we're doing.
And I understand we have some challenges when it comes to
that. Talk to me about that.
Joe Russell: Well, I love the fact that you just talked about health
care, especially in this space being all about people and
all about. It's not just the patient, right?
It's not just the person receiving services, it's also
their family because we're interacting with families and
we're going into people's very personal space to provide
them, in some cases, very personal health care related
services. So we have to be about people.
And in fact, if you talk to many of the members of the
association, they'll tell you, you know, we make.
We don't make decisions based solely on business.
We make decisions based upon how we're serving our
community and how we can positively impact our community.
The problem is, is that we spend a lot of our time at the
administrative level focused on the business of health
care. And that's not because that's not because of our own
doing. It is sort of the nature of the beast.
And so when I'm having conversations with the Department of
Medicaid or the Department of Health or the General
Assembly, a lot of those, a lot of those patients, a lot of
those problems are the business of.
Of health care and in it it bogs you down, and it's
disappointing because, you know, there's a lot of things
that are barriers to individuals being able to receive more
care in the home, and it's directly related directly.
It's directly related to the business of health care, and
we're working on that.
We're going to continue to chip away.
But that the point about being all about people is exactly
what we want for health care at home.
Lisa Stockdale: Yeah. And fortunately, the work that we have to do to
protect the people who benefit from this industry is knee
deep in bureaucratic weeds, if you will.
And it isn't always fun, but you your you folks are getting
it done. Is there anything on the horizon right now that is
particularly challenging or that you would want the general
public to understand?
Joe Russell: Definitely. I think there's there's two big areas.
One is in regards to how folks insurance works with
providers, and this may not be something that that
patients. Often think about, but, you know, when you start
to think about, okay, if I want home care, who can I have,
who can provide those services, the people that might be
available in your insurance network might not be the best
providers. They might be, but they might not be either.
And a lot of times.
And this is becoming more and more of an issue is where,
you know, the health plans are are in between the provider
and the patient in a way that makes it very difficult for
the provider to to do it, to do their job.
And so we're continually building relationships, we're
continually having conversations and trying to drive
positive changes that will lead to better relationships
between the health plans and home health and hospice
agencies. But the really big thing going on right now that
all your listeners really need to know about is the Choose
Home Care Act.
This legislation is has received bi partisan, bicameral
support in Congress.
And what it would essentially do is create a new benefit in
the Social Security that when and if you get to a point
where you need skilled nursing care, that you automatically
get a choice.
You get that care at home or if you want to go into a
nursing facility now, it doesn't mean that you're that you
can't. It's just we want to make sure people have a choice
because there's too many people that are kind of forced to
go into an institutionalized environment and they don't
really want to, but there's no other choice for them.
I think the fact of the matter is is that the home health
benefit for Medicare and and for Medicaid both are
outdated. They really need to kind of be updated so that it
reflects the current health care system because a lot of
these benefits were drawn many, many years ago when health
care at home looked very different.
And so we're really trying to effect positive change in
twos home.
Would really allow that to take place.
We were hoping that it could get passed in this Congress.
We're going to continue to work towards that.
But regardless of what happens, we are going to continue to
work on this even if it doesn't pass this Congress.
It's a really, really important development.
Lisa Stockdale: Ok, let me ask you some questions because you have inspired
a couple of burning questions for this Congress.
When does this Congress end?
Joe Russell: This Congress will end on December 31st of 2022.
Okay.
Lisa Stockdale: If we have bipartisan support, what's holding us up?
Joe Russell: Well, Lisa, how much time you got?
Yeah, it's it's politics, and it's not necessarily politics
that are attached to this issue of Washington.
And I'm probably not sharing anything that's that's mind
blowing here. But Washington, in the state of our current
country, is a divided place.
And getting anything done has proven to be very
challenging. And so although this is a particular issue
that, you know, has a lot of support, which, by the way, is
a very good sign.
Even though it does it, there's a lot of sort of different
pieces and parts that have to fall together right at the
right time in order to make it happen.
Okay. And so and I think if it was just this issue alone, I
don't I don't see that there.
Would be much of an issue, but, you know, let's be honest
that there are some stakeholders that are taking a look at
this and they don't love it. And it's undoubtedly because
they're starting to see, OK, you know, for example, if you
if you're an operator of a skilled nursing facility and
your census is struggling, you know the idea that now
you're going to struggle even more is a tough pill to
swallow in, you know, in a free country with a with a
Republican form of government.
Everybody has a voice, and I think Congress is doing its
due diligence to make sure that this is the right policy
for for the country.
We obviously think it is and we will continue to push for
it. But but that's just sort of the high, high level
explanation of what can kind of hold things up.
Lisa Stockdale: But it's important for our listeners to understand that even
though we say it sounds good on all fronts, there's always
somebody opposing everything.
And even though we say we have bipartisan support, it
doesn't mean that this is of high importance to everybody.
You didn't say that. So I'll say that and I'll own it.
It's important to us because we do this and we see the
people who directly benefit, and we know that we can
enhance people's quality of life by providing an
experience, as you referenced the customer service piece.
It's just a happier place to be.
It's your comfort zone.
And there's a bunch of evidence to suggest that people
recover quicker at home, but it doesn't mean it's at the
top of every politician's to do list to help the home care
industry and the elderly who need services at home.
It's it's at the top of our list and we're working to make
it more of a priority for them.
Absolutely. And it's called choose the Choose Home Care
Act.
Joe Russell: Yes, in the home.
And you know, there's two.
We've got some really great partners in Washington that are
leading the charge on this.
The National Association for Home Care and Hospice, led by
Bill Darby, has done an incredible job sort of leading the
charge on trying to get this done.
The Partnership for Quality Health Care Working, being led
by Joanne Cunningham, has done another spectacular job in
helping organize advocates to push.
But we're really, really what what people can do, who are
listening. If you're interested in this and you want to get
involved is reach out to your legislator, both your U.S.
representative and your U.S.
senator and ask them to co-sponsor the bill, ask him
they'll know what shoes home is.
We've been doing a lot of advocacy, but ask them to
co-sponsor, choose home.
The more co-sponsors we have, the more likely it is for.
People to or for legislators to for it to get passed,
essentially. And the other thing you can do is we actually
have an advocacy center on our website where people can
sign up for it and can get updates, not just on this issue.
The Choose Home issue, but also all the issues that we've
been working on. People can go to WW W o CHC H.
Org slash advocacy slash take action.
And there's a button to click to sign up, you just put your
name and contact information and then you're in the system
and periodically you'll get you'll get updates on things
we're working on, including shoes home.
So.
Lisa Stockdale: And is there a mechanism on the website for us to actually
contact our representatives?
Joe Russell: That is a great question.
I am trying to.
Yeah, so you'll you'll be able to to get connected with
your legislators through through this and if not.
There are other resources on the advocacy portion of our
website to make connections,
Lisa Stockdale: And we'll make sure when the podcast publishes that we give
accurate information about what the easiest way to do this
is because everybody wants ease of use, right?
Everybody wants it to be easy and there.
I don't know if there's a number, if there's a phone number
that you can call or not, but we'll find all that out and
make sure that we share that with our audience.
You know, when it does publish because we think that's
important. Now I want to ask a few more questions.
Sure. So is home health care as an industry ready to rise
to the challenge in terms of providing the kind of care at
home that a nursing home perhaps provides?
You know, in a nursing home, I mean, aren't those two
different things?
Joe Russell: Yeah, that's a really great question, and it's a complex
answer. But the the simple answer is yes.
So it's important to understand how health care at home
looks compared to other health care delivery systems.
You know, when you go into a hospital, you sort of have an
expectation of what a hospital is and what it looks like,
right? And no matter where you go in this country in a
hospital, they're fairly, fairly similar.
I mean, obviously, some of them have better specialties
than others or, you know, whatever, but they're kind of
similar health care homes, a little bit different, and it's
because it's so consumer driven.
We've got programs at our hospital based programs, our
nursing facility based programs.
They're independent.
They're large, they're small.
There's we have members that literally only serve their
local community. That's it.
They don't have any big goals of going national or anything
like that. So obviously the capabilities between those
different entities are different.
Mm hmm. And then also to the way that the programs shake
out at the state of Ohio, with there being so much
fragmentation between these different payer sources in
different programs means that different programs have
developed different areas of specialties.
So, for example, some people might focus their attention on
what we call nonmedical care or just your simple home care,
because that's what they thrive in, where other agencies
might focus entirely on the skilled portion of of home
care, which we refer to as home health.
Mm-hmm. But at the end of the day, all the work that we're
doing and working with our members is to to to get them
prepared for this new era of health care.
If they're not already the the thought of.
When you ask most people what what home care is and what
you know, it's a lot of people will either not know or
they'll say, Oh, that's when someone goes in their house
and has a cup of coffee with them to keep them company.
And I assure you, nothing could be further from the truth.
Our members are treating very complex patients with
multiple comorbidities.
We everywhere from kids that have traits and, you know,
breathing tubes all the way up to advanced diseased
individuals who you know are, we're just trying to manage,
manage them at this point.
So who you know, who lived a long life?
Great lives? And everything in between.
So we definitely have the capability to meet the future of
the health care needs, but it's going to it's going to take
it's going to take some more work and there are other
extenuating circumstances that are outside our industry's
control that also also play into that.
Lisa Stockdale: And that's where you say, like when I think of counsel, I
always think advocacy.
But there's this educational piece as well, like getting
the industry prepared to deal with the challenges coming
and the challenges at hand and the challenges that we
didn't expect that hit a smack in the face.
And, you know, say, March of 2020, if you were in Ohio,
might have been slightly different depending on where you
live in the country.
But there's these sort of dual purposes of your
organization, and that's one of the reasons that we value
and support what you do.
And the other piece that you alluded to was that.
And I want to say this because I want the the public to
understand as someone who works for a home health care
provider, if it were up to me and if it were up to the
owners of the company that I work for, if it were up to my
boss, if we're up to the nurses and the physical and
occupational and speech therapist and the back office
staff, we would take care of every sick elder that knocked
on our door. No one would ever be turned away.
We can't do that because there's this little thing called
reimbursement, and we have to make enough money to keep the
doors open, which means occasionally we have to make a
profit. And so if on the back end insurances aren't willing
to give us enough money to do that, we have a problem.
And then the other thing is, if they're not willing to
allow enough visits, you know, say they say, Oh, you can
only have six physical therapy visits, but maybe the
patient needs 10 or 12 in order to realize recovery.
That puts us in a pickle.
So we're doing the best we can, and home care is not unique
in this. I mean, we could.
The nursing homes face the same challenges, but a lot of
times it's the insurance companies, and I'm not trying to
paint them bad or color them bad.
But I'm just saying making a profit shouldn't be a bad
thing. It's it's a requirement in order to stay open in
order to continue to provide care.
And so in order to do that, we need fair reimbursement.
If that isn't happening or if it's only happening for
certain segments of the population, that puts us in a bad
spot. And so we're doing the best we can, and that's why we
need to fight the good fight.
Joe Russell: Well, Lisa, if I may, you know, just to kind of drill down a
little bit more so people understand what it is we're
talking about here. Yeah, the the state of Ohio in this
past biennium, budget increased home health services by six
point one percent, which in a one or even a two year period
isn't. Isn't that bad.
It's it's not spectacular, but it's not horrible.
But when you take into consideration the fact that there
had been that the reimbursement levels were at 1998 levels
prior to the sixty one point one percent increase.
Mm hmm. It just blows out the budget.
So what we're seeing is, you know, people are losing 30
cents on every dollar that it costs to provide a Medicare
recipient home care and people can't do it anymore.
And and so if you are.
Ohio in with less resources and you happen to be on the
Medicaid program, chances are that every day that goes by,
your ability to get access to home care is going to be more
and more diminished because those Medicaid recipients are
being crowded out by Medicare recipients.
When when the company has the same staff and there's
providing the same services, there are just two different
people paying the the bill.
It becomes very, very challenging.
So you're absolutely right that, you know, no, nobody's in
this business to make a ton of money.
If you were, this isn't the business you would choose.
But at the end of the day, the end of the day, health care,
even though it's a fully regulated market, it is a
commodity market because it relies on you giving me
something or me giving you something.
And so at a minimum, we need to have our costs covered.
And unless, you know, policymakers really put their heads
together to say, OK, all of health care is moving into
community direction, we need to invest in that.
And look, we're not against being held to certain quality
standards. You know, there's a big cost driver for the
state is hospitalizations.
We have a very unique ability to help these health plans
and the state of Ohio keep people out of the hospital.
But unfortunately, that there's just no mechanism for that
right now. And it's really problematic.
So we're going to continue to see problems like that unless
our elected leaders and policymakers kind of come to the
table and say, Hey, let's figure this out.
Lisa Stockdale: All right. We're almost out of time.
Bottom line is we need the public's help to continue to do
what we're doing, to do it for everybody to do it with the
highest quality in terms of delivery of care.
Ohio Council for Home Care and Hospice Joe Russell.
He's the executive director.
He's the fella talking to us right now.
They're behind us.
But we need you to push some buttons.
Contact your local representative, House of Representatives
or the Senate and tell them to co-sponsor this bill.
Choose home care.
Joe Russell: Absolutely. Thank you, Lisa.
Appreciate what you're doing.
Lisa Stockdale: Hey, we appreciate what you're doing and we'll stay in touch
and we'll circle back around and see whether or not this
Congress gets it done.
They've got time. It's only March right now.
Joe Russell: It's got time. Yeah, when when you've got it up and posted,
send it all over to me and we'll blast it out on our
circuits.
Lisa Stockdale: Sounds good, Joe.
Thank you for your work.
Joe Russell: Thanks, Lisa. I appreciate you.
Lisa Stockdale: Thank you. Listeners, we hope you enjoyed the program till
next time. May the road rise to meet you.
May the wind be forever at your back.