A Family Member HomeCare, a Hallandale Beach and Miramar Home Health Care Agency Notes Bill Pending in Florida Legislature (SB 1370) That Would Force Clients to Accept All Qualified Assistants Regardless of Race, Creed or Sexual Orientation

Florida law would ban bias by at-home patients

The patients would be protected by a bill of rights under the Senate measure, but they would also be required to accept assistants regardless of race, creed or sexual orientation.

By Diane C. Lade, Sun Sentinel
Published January 18, 2012

Floridians receiving professional home healthcare could become among the few in the nation with their own bill of rights. Among the guarantees: Appointment times that are honored, disclosure of out-of-pocket costs and high-quality care.

But under the proposal being considered by Florida legislators this session, home health agencies would have rights, too, including one likely to spark much debate: Clients would have to accept all qualified assistants in their home “regardless of race, creed or sexual orientation,” according to SB 1370. Patients or their families also would need to tell agencies in advance which primary language is spoken in the home.

Five states have similar home-care bills of rights, although only one, Iowa, addresses discrimination against nursing assistants and aides. These guidelines echo bills of rights for nursing home patients, which have been in place for years.

“If someone is certified, licensed and able to provide the service at a good price, they should not be turned away because of the color of their skin,” said Sean Schwinghammer, executive director for the Florida Alliance of Home Care Services. The alliance, a trade group for medical-equipment providers, is pushing the bill of rights and recruited Sen. Mike Fasano, R-New Port Richey, as a sponsor.

Schwinghammer said ethical guidelines would put bad providers on notice in a rapidly growing industry that has been plagued by Medicaid and Medicare fraud. Demand for home nursing care has been exploding, as seniors and government programs look for less expensive alternatives to nursing homes.
The Paraprofessional Healthcare Institute, a nonprofit organization promoting better job conditions for long-term care workers, projects the number of home care aides needed in Florida will increase 41 percent over 10 years, to 46,353 required by 2018.

The bill tackles one of the touchiest, yet usually unaddressed, issues in long-term care: cultural rifts between the aides and assistants, who often are minorities, and their patients, who often are white Anglos. It can be even more complicated in South Florida, where many care professionals come from Caribbean countries where they spoke Creole or Spanish.

Only 17 percent of the 7,642 employees belonging to 1199 SEIU United Healthcare Workers East, a union representing Florida’s nursing assistants and other long-term care staff, are listed as white, according to the organization’s statistics. The majority are black and Hispanic, although a quarter is unknown.
Broward County seniors receiving government-subsidized home health care through Medicaid “sometimes call us, frustrated, because they can’t understand the way [an aide] speaks,” said Edith Lederberg, executive director of the Aging & Disability Resource Center of Broward County, which manages services for the elderly. “But if the person is able to do the job and do it well, the client should be willing to accept them.”

State officials received 338 complaints against home health agencies in 2011, up from 296 complaints five years ago. Quality of care and treatment issues accounted for 42 percent of last year’s complaints, compared with 22 percent of those filed in 2007.

The standards are a “two-way street,” Schwinghammer said, drawn from common complaints the association has heard from both patients and the home care industry. Some agencies said clients were refusing to take caregivers from certain ethnic groups, he said, leaving providers “having to pay a premium to get someone with the right skin color and accent.”

When the clients are on Medicaid or Medicare, that premium is picked up by the taxpayers, Schwinghammer said.

Nationally, almost half of those working on health care’s front lines are black, Hispanic or mixed race, according to the paraprofessional institute. But those ratios can vary greatly from state to state, experts say.

The U.S. Equal Employment Opportunity Commission has been involved in several cases involving home health discrimination, including one in Maryland where a home-care agency coded charts indicating which seniors would accept only white caregivers. The agency settled the case in 2010, agreeing to stop race-based assignments unless the pairing would cause the client to become violent.

Yet some are questioning how the state could refuse to let families who have private duty caregivers (vs. public-funded aides) choose the race and language proficiency of the people they hire.

“I think if someone is paying out of their own pockets for a service in their own homes, in principle, they are going to have some say in who is their caregiver,” said Bobby Lolley, executive director of the Home Care Association of Florida.

Lolley said the association is talking with Fasano, but has not yet decided whether it will support the measure. A bill of rights is a “worthy endeavor,” Lolley said, but the anti-discrimination clause might be a sticking point.

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A Family Member HomeCare, a Weston and Deerfield Beach Home Health Care Agency Applauds Sun-Sentinel Report: New Florida health secretary Dr. H. Frank Farmer Jr. targets pill mills, sex offenders

New health secretary targets pill mills, sex offenders

By Bob LaMendola and Alexia Campbell, Sun SentinelJanuary 22, 2012


Florida regulators are kicking out more medical practitioners who break the rules — from pill-mill doctors to health-care fraudsters to those having sex with patients.

This follows long-time criticism that Florida is too easy on doctors, nurses, pharmacists and other professionals.

The state's first-year health secretary, Dr. H. Frank Farmer Jr., said he has made it a top priority to yank the licenses of those who commit crimes and other serious violations.

Farmer said he has started suspending practitioners quickly after their alleged misdeeds come to light rather than letting them continue seeing patients during an investigation. He is asking disciplinary boards to be as tough as possible.

"There has been a concerted effort to crack down on … these cases that are clearly egregious," Farmer said.

Boca Raton pain doctor Thomas Weed, who had nine patients die of narcotic pill overdoses from 2004 to 2006 but kept seeing patients for years. Weed surrendered his license in 2010 when the state finally set a disciplinary hearing.

Some lawyers and activists question the depth of the crackdown, saying officials are focusing only on obvious problems such as shady pain clinics and massage parlors, but are not tougher on incompetent practitioners.

"They are not doing anything about those who harm patients by malpractice," said Ellen Rieback, a Plantation nurse who helps lawyers file health-care lawsuits.

The consumer group Public Citizen for years ranked Florida among five or six states with the fewest serious penalties against doctors. Still, Department of Health figures show disciplinary actions by the state are up sharply in the past two years.

In South Florida, 83 professionals had their licenses revoked by Florida disciplinary boards last year, almost double the number for 2009. Another 104 gave up their licenses to avoid a disciplinary case, up 40 percent.

Statewide, out of a million health professionals, 680 surrendered their licenses under fire or had them revoked last year, up 25 percent over 2009.

The state's get-tough effort started in 2010 before Farmer took over, when medical boards stiffened penalties for pill-mill doctors.

After becoming secretary in March, Farmer resurrected a unit to build cases against practitioners arrested or accused of serious offenses so he can suspend them quickly. His priorities: pain-pill abuse, sexual or physical assaults on patients, drug use and malpractice leading to death.

As a result, the number of South Florida professionals suspended last year while under investigation more than doubled to 103, and climbed 30 percent statewide to 326.

One was Palm Beach Gardens physician Scott Oster. In April, he was arrested in a police sting offering to trade sex for pain-pill prescriptions. Farmer suspended him within six weeks. Oster pleaded not guilty and is under house arrest.

Farmer also has asked law enforcement agencies to be more diligent about reporting arrests and convictions quickly.

Police and health officials rarely had shared information, and officers grew frustrated to see doctors they arrested soon back seeing patients, said David Gross, drug-crimes inspector for the Florida Department of Law Enforcement.

"There was a communication breakdown on both sides," Gross said.

Now, Gross said, the FDLE often alerts health officials before police make major arrests, so Farmer can act quickly.

"If local law enforcement doesn't tell [health officials], they might never find out," said lawyer Allen Grossman, a former general counsel for the medical board who now defends doctors. "There were a few people slipping through the cracks."

Cynthia Harris, a home-health nursing assistant, kept her license for 18 months after pleading guilty to exploiting the elderly by stealing $33,000 from a stroke patient west of
Boynton Beach.

Health professionals are required to alert state officials within 30 days after pleading guilty, but Harris waited eight months. The state finally revoked her license in April 2011, three years after her arrest.

Critics said the department still takes too long to weed out practitioners such as Lake City doctor Joseph Hernandez, who had 34 patients die from pain-pill overdoses in four months before Farmer suspended him in June.

"Why is it such a lengthy process? Why should they be allowed to continue killing people?" asked Janet Colbert, a nurse and co-founder of Stop the Organized Pill Pushers Now, a parents group that pickets at pain clinics and the medical board. "We have seen progress. But there are still plenty of parents writing to us saying they just buried their child."
blamendola@tribune.com or 954-356-4526apcampbell@tribune.com or 561-243-6609

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