Hospital sues law firm for legal malpractice, Pembroke Pines Homecare Agency Notes The Florida Current Report

By Christine Jordan Sexton, August 29, 2011

A merger negotiated behind closed doors between a private hospital and public facility spawned a controversy in the Florida Legislature last year and helped lead to the creation of a gubernatorial committee on taxpayer-funded hospital districts.

Now the failed merger has spawned a malpractice lawsuit.

The Southeast Volusia Hospital District board of directors voted unanimously last week to move ahead with a $22.5 million lawsuit against Lowndes, Drosdick, Doster Kantor & Reed and one of its attorneys, Jim Heekin . The hospital is arguing that Heekin advised the public facility to merge with Adventist Health System in closed meetings. Heekin is a former chairman of the Board of Regents, the now-defunct panel that once oversaw the state university system. The law firm did not return calls seeking comment.

The merger was invalidated by a circuit judge who ruled that 21 closed-door meetings that the Bert Fish Medical Center held with Adventist Health Systems regarding an $80 million lease violated the state’s open government requirements.

A number of bills that would have required judicial review of the sale or lease of a county or municipal hospital were filed during the 2011 session and two of them, SB 1448 and HB 619 were moving but died after aggressive lobbying efforts from high-powered lobbyists Ron Book, Mark Delegal and the Safety Net Hospital Alliance of Florida. For profit hospital lobbyists supported the legislation.

While no bills passed, Gov. Rick Scott appointed a Commission on Review of Taxpayer Funded Hospital Districts, which has held a spate of meetings in Tallahassee this summer. Its next meeting is Tuesday, Sept. 6.

What is Social Security Number Randomization? Starting June 25, 2011, Social Security Administration Will Begin Limiting Numbers Avaialble for Issuance to Individuals By State

Effective June 25, 2011, the U.S. Social Security Administration is changing the way Social Security Numbers (SSNs) are issued. This change is referred to as "randomization." The SSA is developing this new method to help protect the integrity of the SSN. SSN Randomization will also extend the longevity of the nine-digit SSN nationwide.

The SSA began assigning the nine-digit SSN in 1936 for the purpose of tracking workers' earnings over the course of their lifetimes to pay benefits. Since its inception, the SSN has always been comprised of the three-digit area number, followed by the two-digit group number, and ending with the four-digit serial number. Since 1972, the SSA has issued Social Security cards centrally and the area number reflects the state, as determined by the ZIP code in the mailing address of the application.

There are approximately 420 million numbers available for assignment. However, the current SSN assignment process limits the number of SSNs that are available for issuance to individuals by each state. Changing the assignment methodology will extend the longevity of the nine digit SSN in all states. On July 3, 2007, the SSA published its intent to randomize the nine-digit SSN in the Federal Register Notice, Protecting the Integrity of Social Security Numbers [Docket No. SSA 2007-0046].

SSN randomization will affect the SSN assignment process in the following ways:

It will eliminate the geographical significance of the first three digits of the SSN, currently referred to as the area number, by no longer allocating the area numbers for assignment to individuals in specific states.

It will eliminate the significance of the highest group number and, as a result, the High Group List will be frozen in time and can be used for validation of SSNs issued prior to the randomization implementation date.
Previously unassigned area numbers will be introduced for assignment excluding area numbers 000, 666 and 900-999.

These changes to the SSN may require systems and/or business process updates to accommodate SSN randomization.

If you have any questions regarding SSN randomization or its possible effects to your organization, please see the related
Frequently Asked Questions or email your question(s) to

For more information about a Miami-Dade, Broward and Palm Beach County homecare and home health care agency for seniors, disabled, Alzheimer's patients, sufferers of dementia and other family members needing home health care services or in-home health aides, contact Brian Gauthier at A Family Member HomeCare (954) 986-5090 or visit

Health News Florida Reports: Layoffs hit some Florida county health units harder than others, Broward home health care agency notes

Layoffs hit some county health units harder than others

By Carol Gentry
8/24/11 © Health News Florida

Department of Health lists of employee layoffs by county show a big difference in the effect on local health units of the Legislature's funding cuts.

Some counties are laying off a dozen or more employees, while others are not eliminating personnel at all, instead ending certain services, such as flu clinics. The lists -- one for state employees, the other for those on temporary contracts -- don't include some counties, since they reflect layoffs of personnel accomplished or identified as of Aug. 10.

The biggest change, at least on paper, appears to be at Hillsborough County Health Department, which is losing more than 100 employees on Sept. 1. But the patients and employees really aren't taking a hit at all, the department says.

That's because six primary-care clinics the health unit offers to children and pregnant women are being transferred over to two non-profit organizations that already operate similar facilities around the county, according to a press release.

"Patients are still going to be seen in the same place, by the same people," said Ryan Pedigo, director for public health preparedness for the Hillsborough department. "All our staff were offered positions."

It wasn't clear this morning whether staff titles and pay will be the same. Pedigo said he didn't know, and other officials from the department were out of the office today, supervising vaccination clinics.

The non-profit organizations that are taking over clinical and administrative duties, Tampa Family and Suncoast Community Health Centers, already run a total of eight local clinics around Hillsborough County, with similar services.

The health department will still operate its WIC program (Women, Infants, Children) nutrition program out of the clinics, according to the release. And the department will continue programs in immunization, tuberculosis, HIV and sexually transmitted diseases.

Not all counties are making cuts without layoffs, as the lists show. After Hillsborough, the counties with the highest number of employee reductions reported as of Aug. 10 were Osceola, Marion and Broward.

As the Sun-Sentinel reported Tuesday, at least 60 people in the Broward and Palm Beach health departments face layoffs, most of them in Broward. Collier County is laying off 25 employees as of next Monday, the Naples News reported today. An additional 26 positions were eliminated.

But the Herald reports today that Miami-Dade plans to lose only its seven-member Rodent Control Team.

The lists of layoffs were released to Health News Florida late Tuesday by DOH Press Secretary Jessica Hammonds, along with a statement that said DOH took a total budget reduction of $55.6 million during the legislative session.

Counting the central office, DOH is eliminating 229 full-time job positions, of which 172 are from county health departments, she wrote. The Legislature specified that certain programs were to be reduced, she wrote.

"We need to right-size our organization and to operate within our budget," Hammonds wrote. "We will continue to seek ways, through streamlining and process efficiencies, to protect and promote the health of Florida’s residents and visitors."

Hammonds provided a breakdown of DOH’s state budget reductions:

Central Office:
Administration in the central office in Tallahassee: $775,143
Information Technology: $2,123,585

Family Health Services:
Administration: $432,353
Contribution to County Health Departments: $1,389,307
Family Planning: $906,984
Healthy Start: $5,400,000
Vision Quest *10/11 restored as Non-Recurring :$250,000

Infectious Disease Control:
Contribution to County Health Departments: $2,449,847
(includes Immunization, HIV/AIDS, STD, Epi, TB, AGH)

Environmental Health Services:
Administration: $243,347
Contribution to County Health Departments: $884,654
Birth Defects Registry: $56,283

Statewide Support Services:
Administration: $1,947,898
(includes Labs, Pharmacy, DEMO, PHN, Vitals)

Community Health Resources:
Administration: $181,104
Contribution to County Health Departments: $21,255
Area Health Education Centers (AHEC): $4,801,743

Children’s Medical Services:
Administration: $2,018,059
CMS Network: $396,002
Fetal Alcohol Spectrum Disorder (FASD): $100,000

County Health Departments:
County Health Departments: $29,737,488
Community Health Initiatives: $107,140
Manatee Rural Health: $7,717

Disability Determinations:
Administration: $74,714

For more information about a Miami-Dade, Broward and Palm Beach County home health care agency for seniors, Alzheimer's patients, sufferers of dementia and other family members needing home health care services or in-home health aides, contact Brian Gauthier at A Family Member HomeCare (954) 986-5090 or visit

Miami Herald reports Miami mother and son Medicare fraud duo of Angie's Home Health Care Inc. sentenced to jail, $1,566,288 in restitution

NBC Miami

Mom and Son Sentenced in Medicare Fraud

Pair will have to pay back $1.5 million taken in scheme

By Brian Hamacher
Tuesday, Aug 23, 2011 | Updated 12:25 PM EDT

A Miami mother and son Medicare fraud duo were sentenced Monday in a scheme that bilked the program out of over $1.5 million, federal prosecutors said.

Angela Bustillo, 57, was sentenced to 71 months in prison and son Alfredo Morrera, 30, was sentenced to 57 months in prison for their roles in the scheme, according to the U.S. Attorney for the Southern District of Florida.

Both will have to pay back $1,566,288 in restitution and will serve three years of supervised release at the end of their prison sentences.

According to prosecutors, Bustillo and Morrera owned and operated Angie's Home Health Care Inc., a Miami-Dade based home health agency that provided nursing services to homebound Medicare beneficiaries.

But prosecutors say the company gave care to patients who didn't need it and billed Medicare for the unnecessary services. Morrera told patients to give false info so they would qualify for home health services, even though they didn't, prosecutors said.

Angie's also paid kickbacks to nurses and recruiters who paid Medicare beneficiaries who agreed to be treated at Angie's, prosecutors said.

Mother and son submitted $2,295,139 in false claims to Medicare, with Medicare paying out $1,566,288.
Find this article at:  

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Miami Herald's Jay Weaver reports jury convicts Miami woman of Medicare fraud involving mental-health clinics; Two Home Health Care Agencies in Conspiracy: ABC Home Health Care and Florida Home Health Care Providers

Posted on Tuesday, Aug. 23, 2011

Jury convicts Miami woman of Medicare fraud involving mental-health clinics


A business woman accused of conspiring with the owners of a Miami-based company in the nation’s biggest mental-health billing racket was convicted of defrauding Medicare Tuesday by a federal jury.

Judith Negron, 40, of Hialeah, served as vice president of a subsidiary of American Therapeutic Corp., a seven-clinic chain that billed Medicare $200 million for group mental health sessions that were either unnecessary or not provided to patients.

Some people, suffering from dementia and Alzheimer’s disease, could not have benefitted from the treatments.

Negron ran MedLink Professional Management Group, which Justice Department prosecutor Jennifer Saulino said was set up solely to launder $83 million in Medicare payments to American Therapeutic’s owners, employees and others who participated in the scheme over the past decade.

Negron was found guilty of 24 counts of conspiracy, fraud, paying kickbacks and money laundering. She faces up to 20 years in prison when she is sentenced by U.S. District Judge James Lawrence King. No date has been set for that hearing.

Negron’s conviction at trial sets her apart from three other major defendants charged last October in the American Therapeutic prosecution.

In April, the top executives of American Therapeutic, Lawrence S. Duran and Marianella Valera, pleaded guilty. Duran, 49, and Valera, 40, both of Miami and now in custody, owned the chain of clinics.

Also that month, the company’s marketing director, Margarita Acevedo, 41, became the first defendant to plead guilty, admitting that she paid millions of dollars in kickbacks to South Florida recruiters associated with assisted-living facilities and halfway houses.

In addition, 20 other American Therapeutic employees, psychiatrists and others have been charged in the sprawling investigation by the FBI and Internal Revenue Service.

In another Medicare criminal case, a Miami-Dade doctor pleaded guilty Tuesday to fraud conspiracy in connection with two agencies, ABC Home Health Care, 8360 W. Flagler St., and Florida Home Health Care Providers, 4150 NW Seventh St. They submitted a combined $25 million in bogus bills to Medicare for unnecessary diabetic services, physical therapy and other treatments.

Dr. Jose Nunez admitted he wrote prescriptions for homebound diabetic patients and received kickbacks as payments for his services, according to prosecutor Joseph Beemsterboer.

Nunez is among dozens of defendants, including other physicians, charged in the ABC and Florida Home investigation.
© 2011 Miami Herald Media Company. All Rights Reserved.

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For more information about a Miami-Dade, Broward and Palm Beach County home health care agency for seniors, Alzheimer's patients, sufferers of dementia and other family members needing home health care services or in-home health aides, contact Brian Gauthier at A Family Member HomeCare (954) 986-5090 or visit

Attitude adjustment: With recent law on their side, Michigan chiropractors work with newfound respect; A 2010 state law lets Michigan chiropractors perform more services, Detroit Free Press Reports

State Rep. Mike Callton, who is also a chiropractor, is pleased that the state has eased regulations that will allow him more latitude in treating patients. The next step, he says, is to get more reimbursement from insurers and government health plans.
State Rep. Mike Callton, who is also a chiropractor, is pleased that the state has eased regulations that will allow him more latitude in treating patients. The next step, he says, is to get more reimbursement from insurers and government health plans. / Photos by JESSICA J. TREVINO/Detroit Free Press


Mike Callton demonstrates a neck adjustment on his summer intern, Jessica Fountain. Callton, a chiropractor, has treated fellow lawmakers in his Lansing office.

Chiropractors can do more

A 2010 state law lets Michigan chiropractors perform more services.

FORMERLY: Could treat joint dysfunction only in the spine and adjacent joints.

NOW: Can treat joint dysfunction anywhere in the body.

FORMERLY: Could not perform physical therapy (PT).

NOW: Can perform PT, including using ice, heat, electric muscle stimulation, water therapy, ultrasound, traction, taping, rehabilitative exercise and more.

FORMERLY: Could not perform blood tests or measure blood pressure.

NOW: Can perform and order many tests.


He's quite the rare bird in Lansing.

State Rep. Michael Callton is the first chiropractor elected to the state Legislature. He performs spinal adjustments and other chiropractic care for lobbyists and lawmakers in his Lansing office.

"A lot of them don't even know what we do," he says.

Callton's election in November came just months after Michigan chiropractors won a fight for wider acceptance, getting the state law that regulates what chiropractors and other health professionals can do for their patients broadened.

Since the late 1970s, chiropractors had been hamstrung by a state health code with tight limits, among them: They could treat only a patient's spinal area and joints near it, such as the elbow and hip. Last year, after decades of lobbying and despite opposition by physician groups, lawmakers eased the rules. Now, chiropractors can treat virtually all of the body's muscles and bones, and they can branch out to do physical therapy.

Callton, 53, a Republican who represents rural Barry and Ionia counties west of Lansing, is vice-chair of the House Health Policy Committee.

"Finally, we have a seat at the table. And it's a great time for chiropractors to be at the table because of all the decisions coming up in national health care," he says.

Untying the hands of chiropractors, no longer banning them from such tasks as taking a patient's blood pressure, makes sense to Peggy Schodowski, 45, of Rochester Hills.

Twelve years ago, before she moved to Michigan, Schodowski says she was helped by a Wisconsin chiropractor for a jaw problem -- care that Michigan chiropractors could not have given then. When her chiropractor pressed on her jaw, "I could actually feel it open up my hearing," she says.

"I started to go to him for my back. And one time, my jaw was clicking when I was there, and he said, 'Oh, I can treat that too.' "

Liz Dehn, 61, of Lake Orion is a retired nurse who -- contrary to the advice in hospitals where she worked -- has seen chiropractors for years, she says. Dehn, who injured her back lifting patients, was happy with the no-drug pain relief she got from a chiropractor.

"When I first went in, I couldn't even stand up straight" because of back pain, she says. Now, encouraged by her chiropractor, she does a lot of walking. Recently, under the broader scope of practice, her chiropractor treated her wrist pain, caused by overuse of a laptop computer.

According to state physician groups, Michigan has long had the narrowest scope of practice in the nation for its 2,400 licensed chiropractors. Now, the state falls roughly in the middle, helping the chiropractors compete with Michigan's primary-care medical doctors, a group nearly 10 times larger.

Before, "we were the Rodney Dangerfield of doctors -- we didn't get no respect," quips Kristine Dowell, executive director of the Michigan Association of Chiropractors in Lansing. Dowell says the wider scope was overdue because chiropractors were the first physicians to promote today's health-care grail of preventive, holistic, low-cost care, coupled with a philosophy that emphasizes diet and exercise over surgery and drugs.

Chiropractors believe that many of the body's ills stem from misaligned joints, mainly in the spine. They treat pain mainly by manipulating spinal joints, aiming to release pressure points -- called subluxations -- where, according to chiropractic theory, the spinal nerves are squeezed to cause pain or disease.

Chiropractors must complete four years of graduate training, generally after receiving an undergraduate degree, making their educations comparable to those of medical doctors, Dowell says. Admission to chiropractic colleges, however, is widely known to be less rigorous than that for medical schools.

In Michigan, as in other states, chiropractors can't perform surgery or prescribe drugs. Some critics contend that chiropractors provide only short-term pain relief. And the September issue of Consumer Reports magazine warns that their treatments may be risky for neck pain.

There are wide variations in the types of treatments that chiropractors offer. Some stick closely to spinal manipulation while others sell nutrition supplements and weight-loss formulas. Still others offer an array of alternative therapies, including unsubstantiated approaches such as homeopathy.

"There are some out there that I think are quacks," says Schodowski, a single mother of two school-age children. She advises choosing a chiropractor based on the recommendation of a trusted friend.

Dr. Donald Reno of Sterling Heights, chairman of the Michigan Association of Chiropractors, says the broader legislation is revolutionizing his practice. He plans to add 50% more space, two associate chiropractors and a massage therapist in a new office he's building next to his current one.

"Before, it was just neck, back and low back. Now we can look at the whole picture," Reno says. He has a growing weight-loss practice and he advises cancer and diabetes patients on diet and exercise, he says.

Dr. Leigh Elceser, a chiropractor in Pontiac, sees many patients from a General Motors plant across the street. She says that much of her care is not covered by insurance so she often discounts her rates. An office visit costs $35 to $55, she says.

"I have a lot of people come in from the factory with carpal tunnel (a syndrome of wrist pain) or rotator cuff injuries (to the shoulder)," she says.

Before the scope of practice eased, "I couldn't help them. Now, even though I can treat them, some can't pay for it and their insurance doesn't cover it. But I can't just ignore them," she says.

That's a familiar complaint among chiropractors, including the new state lawmaker who is introducing chiropractic care to decision makers.

Chiropractors -- with their emphasis on prevention and low fees -- deserve more reimbursement for their services from insurers and government health plans, Callton says.

Achieving that is "my next big priority" in Lansing, he says.

Contact Bill Laitner: 586-826-7264 or

To view this article online, go to:

Detroit Free Press

Broward County Chiropractor Dr. Troy Lomasky heads Coast Chiropractic of Wilton Manors, Florida. A graduate of the famed New York Chiropractic College, he specializes in quickly treating pain from a variety of conditions. Services include: Consultation, X-ray, spinal adjustments & massage therapy, physiotherapy, spinal decompression for disc problems; spinal and muscular rehabilitation. New patients, weekends & same-day appointments available. (954) 463-3036 or On-call for emergencies 24 hours. Serving Broward, Miami-Dade and Palm Beach Counties.

South Florida Sun Sentinel's Bob LaMendola: Florida fines Humana $3.3 million for slow reports of suspected Medicaid fraud

Florida fines Humana $3.3 million for slow reports of suspected Medicaid fraud
By Bob LaMendola, Sun Sentinel

Friday, August 19, 2011

The state has fined health insurance giant Humana Inc. $3.3 million for failing to promptly report Medicaid fraud or abuse to state investigators, as the law requires.

The company did not disclose what it knew about suspected fraud and abuse by Medicaid providers — such as doctors and hospitals — or recipients back as far as Sept. 1, 2009, health regulators said in two letters sent last week to Humana's Miramar office.

Humana and its CarePlus subsidiary together make up Florida's largest and most profitable HMO with 568,000 members — most of them in Medicare — and 2010 profits of $330 million. Nationwide, the company is the second-largest Medicare insurer, with 4.3 million members.

It's unclear if the fine is related to an internal investigation the company is making in South Florida, which the company says it has disclosed to federal prosecutors, Medicare and state Medicaid officials.

The investigation is looking into potentially improper loans or financial assistance the company made to Florida providers, including physician groups, and improper relationships between company employees and providers, the company said in public documents filed in May.

Last week's letters from Mike Blackburn, chief Medicaid inspector general at Florida's Agency for Health Care Administration, did not specify what instances of fraud or abuse the company failed to promptly disclose. Agency officials were not available for comment.

Humana's Florida spokesman Mitchell Lubitz said the company is reviewing the letters and "after completing the review, Humana will determine its next steps, including whether to appeal the fine."

The company declined to comment on the internal investigation.

The letters said the state fined the company $2.7 million — at $1,000 a day per violation — for not disclosing fraud or abuse as the law requires Medicaid HMOs to do within 15 days of discovering it.

A second fine of $660,000 — at $200 a day — says the company's failure to disclose the fraud violates the terms of its contract as a Medicaid HMO.

For more information about a Miami-Dade, Broward and Palm Beach County home health care agency for seniors, Alzheimer's patients, sufferers of dementia and other family members needing home health care services or in-home health aides, contact (954) 986-5090 or visit

The Florida Current Infographic: According to figures released by the U.S. Census, Florida’s population will steadily get older over the next 20 years. By 2030, projected figures show that 27% of Florida’s population could be over 65 years old.

Infographic: Aging in Florida

From The Florida Current

According to figures released by the U.S. Census, Florida’s population will steadily get older over the next 20 years. By 2030, projected figures show that 27% of Florida’s population could be over 65 years old.
Population 65 years and older (as %  of the total population)
United StatesFlorida

Florida, especially South Florida, has long been a haven for retirees. An increase in aging populations can impact health care services like Medicare. In 2008-2009, nearly 3.4 million people were enrolled in Medicare in Florida, 2.9 million of which were over the age of 65.

For more information about a Miami-Dade, Broward and Palm Beach County home health care agency for seniors, Alzheimer's patients, sufferers of dementia and other family members needing home health care services or in-home health aides, contact (954) 986-5090 or visit

Kaiser Health News and Washington Post: Senior Boom Creates A Demand for Home Health Workers


KHN logo blue

Senior Boom Creates A Demand For Home Health Workers

Reprinted from Kaiser Health News:

August 15, 2011

This story was produced in collaboration with wapo

WASHINGTON, D.C. - At her home health care agency here, Venus Ray quizzes 65 job applicants assembled before her: Can they cook? Do they know the right way to wash their hands? Can they safely transfer patients into wheelchairs? If they give wrong answers, speak English poorly or — God forbid — forget to turn off their cell phones, she asks them to leave.

Francess Sillah helps to transfer Tanya Pittman out of an imaginary wheel chair while role playing during a group interview at Health Management Inc. Venus Ray, the agency's executive director, looks on and assesses their skills to be a home health aide. (Photo by Jessica Marcy)

By the end of the session, Ray has dismissed 42 of the applicants, almost two-thirds, even though she's in dire need of employees.

Ray is executive director of Health Management Inc., which employs about 410 people, including 395 home health aides. With business booming, she is constantly looking to hire more, and she holds group interviews once or twice a month.

"There's a huge demand, and it's only going to get larger as the years go by," Ray said. With the nation's aging population, she added, many people "will tell you that they are more comfortable in their home."

The demand for workers by Ray's company mirrors national trends and is fueled in part by stepped-up efforts to keep seniors and the disabled out of nursing homes. The growth is likely to pick up in coming years as the 2010 federal health law tries to reduce hospital readmissions and expands programs such as Money Follows the Person, which encourages Medicaid recipients to receive care at home.

Washington D.C. Area Requirements Vary

The area is a good example of how regulation of direct-care workers can really depend on geography.
  • In Maryland, the Board of Nursing licenses all certified nursing assistants and home health aides. The state requires them to complete 100 hours of training. Those working in homes must also undergo an additional 12 hours of training annually, and pass a competency evaluation. They must also undergo a criminal background check. Although Maryland does not standards for personal care aires, some people hire companions to help with household chores, but they are not supposed to provide any care.
  • Virginia requires that certified nurse assistants have 120 hours of training and that home health aides have the 75 hours specified by federal law. Personal care aides must have 40 hours of training if they work for a Medicaid agency. The state requires all employees of home health agencies to have a Virginia State Police check, which does not include fingerprinting.
  • The District mandates that certified nursing assistants have 120 hours of training and that home health aides and personal care aides have 75 hours. People in all three professions also must receive 12 hours of annual training.
-Jessica Marcy
But experts warn that a shortage of qualified labor is looming. Workers often lack the training and support needed to properly care for patients, and poor working conditions lead to high turnover, experts say. In addition, salaries are low: In 2009, the median national hourly wage for direct-care workers — a term that includes home health aides — was $10.58, substantially below the $15.95 median for all U.S. workers.

Nearly half lived in households that received food stamps, Medicaid or other government aid, according to PHI, an advocacy group for direct-care workers.

In addition, experts say, regulations about training and background checks for direct-care workers vary across states, and often leave consumers without adequate protection.

"I see tremendous challenges on the care side and the consumer side," said Peggy Powell, national director of curriculum and workforce development at PHI, which is based in New York. "My fear, my deep concern, is that in this quick switch [to provide care at home], there is the potential for care to get worse and for the direct-care workers' job to get harder, with less support and training."

A Growing Force

There are several types of direct-care workers, and their titles often vary:
  • Certified nursing assistants provide basic clinical care such as taking blood pressure and caring for wounds. They also help with the activities of daily living such as eating, dressing and bathing. They usually work in nursing homes or assisted living facilities and have at least the 75 hours of training required by the federal government for positions at a Medicare- or Medicaid-certified facility.
  • Home health aides provide similar care but in private homes and under the supervision of a nurse or therapist. If they're employees of a home care agency, these aides also may need at least 75 hours of training because the federal requirement extends to agencies that serve Medicare and Medicaid patients.
  • Personal care aides work in the home and help with everyday activities such as bathing and also perform light housekeeping and cooking chores. There are no federal requirements for their training, which is generally minimal. About a quarter of these workers are not employed by agencies, according to PHI.
In some states, certified nursing assistants and home health aides can administer medication, although some states require that they get extra training to do that. Personal care aides cannot.

Hannah Asmare struggles to explain in English why she wants to be a home health aide to Venus Ray, executive director of Health Management Inc. Asmare was one of 65 applicants at the home health agency's group interview process (Photo by Jessica Marcy).

More than 3.2 million people work in direct care, according to 2008 data from the Bureau of Labor Statistics. That is 52 percent more than in 1998. Jobs in direct care are projected to account for four of every 10 new health-care jobs between 2008 and 2018, according to PHI.

'What's Your Passion?'

Venus Ray begins her group interview by asking: "Why do you want to be a home health care worker? What's your passion?"

Many describe caring for a loved one, while others say they have been drawn to the field by their deep religious faith. Latreaviette Stewart, 21, says she decided to become an aide after caring for her grandmother, great-aunts and her mother's best friend, who recently died of breast cancer. She just completed a home health aide program at the Community College of the District of Columbia.

Pamela Nfor, a 34-year old aide from Cameroon who has a child with disabilities, describes why she wants to be a home health aides with Health Management Inc. during a group interview process (Photo by Jessica Marcy).
​ Pamela Nfor, a 34-year-old aide from Cameroon who has a child with disabilities, says she enjoys seeing how clients, even those who are depressed and can't go out, improve under her care. "I love the job and I hate the money," she tells other applicants, who erupt in laughter.
Emotions run deep during the morning's activities. One West African woman passionately describes how God revealed her vocation to be in home health care after she prayed intensely, while another woman nearly breaks into tears when she's asked to leave after her cell phone goes off. Both women fail to pass the interview process.

Later, Ray said that she once had to dismiss an entire group of 12 applicants after all of their cell phones rang.

The applicants provide a visual snapshot of national trends. Direct-care workers are disproportionately minorities, and 23 percent are foreign-born. Almost 90 percent are female. The average age is 42, but the number of workers older than 55 is increasing rapidly, according to PHI.

To ensure a qualified workforce, experts say, it's important to increase wages, improve training and beef up licensing requirements.

"It's really important to figure out how to build career ladders for these workers so that they can advance and see this as a real career," said Bob Konrad, a researcher at the University of North Carolina at Chapel Hill. "We have to turn these folks into really active and engaged people in the health policy world."

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The New York Times Explores How Elderly Manhattanites are Staying Longer in Their Homes in "A Rocking Chair Called Manhattan"

To view this article online, go to at:

Fred R. Conrad/The New York Times
Above:  Harold and Phyllis VanderMalle, both in their 80s, plan to stay put in Penn South, a middle-income co-op in Chelsea.

The New York Times

August 12, 2011

A Rocking Chair Called Manhattan

BACK in the 1940s and ’50s, Isabel Morton used to stride onto the stages of hotels in the Catskills, wearing shimmering beaded gowns and belting out Gershwin classics like “The Man I Love.” The gowns were made by her husband, Irving, who worked in the garment industry.

“And I had a great figure,” Mrs. Morton said proudly. “I still do.”

Fred R. Conrad/The New York Times
Above:  Isabel Morton, 92, is cheered by the visits of young volunteers to her apartment on East End Avenue.

Mrs. Morton is now 92. She has lived for 35 years in a rent-stabilized one-bedroom apartment on East End Avenue for which she pays $1,200 a month. Her husband of 53 years and her only child have died. She has had four heart attacks and has neuropathy, a neurological disease, although as she said cheerfully, “Nobody ever died from numb feet.” She is largely homebound; only when an aide pushes her in a wheelchair can she go to Carl Schurz Park.

And so she is cheered by visits from the teenage girls dispatched weekly by Dorot, an organization that provides services designed to help the city’s elderly stay in their own homes for as long as possible.

“I teach the girls points of interest, like how to conduct themselves, and in turn they keep me company,” Mrs. Morton said. “I always like an audience.”

According to the most recent census figures, Mrs. Morton is one of 460,000 New York City residents age 75 and over, a group that makes up 5.6 percent of the city’s population. Nearly 100,000 of them live in Manhattan, where they account for 6.2 percent of the population. Moreover, their numbers are poised to explode. Starting in January, when the first of the baby boom generation began turning 65, a boomer has reached that milestone every eight seconds.

The lingering effects of the recession and the increasing appeal of the city have combined to persuade many older New Yorkers to stay put, avoiding the financial, psychological and logistical costs of uprooting themselves.

“We tend to think of Manhattan as a city largely of the young and middle-aged, but that’s not strictly accurate,” said Andrew A. Beveridge, a professor of sociology at Queens College. “When it comes to old folks, New York is full of them. Their presence undercuts the notion that everyone goes to Florida.”

Of the 10 census tracts in Manhattan with the greatest percentage of residents 75 and older (upward of 9 percent), 6 lie east or west of Central Park. From the white-brick buildings on the East Side to the stately prewars of the West Side, both areas are rich in apartment houses with elevators, doormen and a profusion of neighbors, all prized by this population. Single women, who make up the majority, appreciate the generally safe streets.

Like Mrs. Morton, some Manhattanites have been ensconced for decades in rent-stabilized apartments or in co-ops now worth many times the original purchase price. Their numbers are swollen by suburbanites eager to exchange driving and mowing the lawn for big-city attractions ranging from museums to unusual restaurants.

Audio & Photos
Choosing to Stay in the City

Growing numbers of older New Yorkers live in housing specifically tailored for their needs, or are helped by programs like Dorot that provide everything from home-delivered meals to volunteers who escort people to doctor visits. An increasingly age-friendly mass transit system, along with discounts for items ranging from subway rides to movies, can help older New Yorkers get around, manage on fixed incomes and fill their days pleasurably. The wealth of hospitals and social service agencies provide support in times of need. Even at a time of widespread budget cuts, Manhattan does relatively well in this respect.

And especially in Manhattan, with its rich cultural offerings, retirees can easily keep busy, active and stimulated. The concentration of apartment buildings can facilitate providing services like visiting nurses. All these things can help older people stay in their own homes, a goal that has broad public benefits.

Of course, the very sick or frail may be daunted even by the most sophisticated buses or the most welcoming museums. People from all income groups fall through the safety net, unserved by the programs intended to reach them. But for the relatively healthy and mobile, and those with some resources, Manhattan’s offerings are considerable.

Here are ways some of the borough’s older residents have made places for themselves.

Harold and Phyllis VanderMalle, both in their early 80s, and their friends Sally Praver, 79, and her husband, Paul, 86, live in Penn South, a middle-income co-op in the heart of Chelsea. They can often be found in the complex’s popular senior center, a space that suggests a well-equipped playroom for adults. Shelves containing thousands of donated books line the walls, and origami birds made by residents flutter from the ceiling above a huge flat-screen TV.

Penn South, which turns 50 next year, is what is known as a NORC — the initials stand for “naturally occurring retirement community.” Its 2,820 apartments are home to 5,000 people, of whom 22 percent are over 75. More than half the households include a resident over 60.

Thanks to large dollops of public and private money, the co-op offers a wide range of services intended to ease and enhance life for its aging population.

The VanderMalles, who have been married since 1956 and have one son, were among the original tenants. They live in a two-bedroom apartment, for which they paid $3,250. The Pravers, who have two sons, arrived in 2003 from Queens after 21 years on the waiting list. They have a one-bedroom apartment that cost $15,000.

“I didn’t think I’d be alive by the time my name came up,” Ms. Praver said.

They are among the many who partake enthusiastically of the services offered at Penn South, not just the library, which the VanderMalles run, but also the twice-monthly pizza and film evenings and the classes in activities ranging from yoga to indoor gardening.

And the center is just one of many offerings available at Penn South to address the needs of its older residents. On-site nurses measure blood pressure. On-site social workers help residents get access to Meals on Wheels and home health care.

When Mr. VanderMalle broke his pelvis, a walker appeared as if by magic. Nearby supermarkets have been encouraged to offer discounts to older customers. The landscaped grounds function like a college campus. “Outside, I greet I don’t know how many people,” Ms. VanderMalle said. “I never knew older people were so much fun.”

Penn South is one of more than 40 NORCs in New York — 16 of them in Manhattan — that receive combinations of city and state money. And in the opinion of many who deal with the elderly, NORCs are the wave of the future.

“This is clearly the way to go,” said Elaine Rosen, the social worker who runs the programs for the elderly at Penn South. “The real issue is the ability to stay in your home and not be isolated, not to be bored or lonely or scared.” Another benefit is that the population includes younger people who can provide an informal support system for their older neighbors.

It’s no surprise that the Penn South waiting list, now closed, contains 6,000 names.

Elaine Habib and Jo Marchese, widows who describe themselves as “over 75,” have lived for about a decade in the Hamilton House on West 73rd Street. A handsome building with a crystal chandelier in its double-height lobby, the Hamilton House is one of three nonprofit residences operated by Project FIND, one of the city’s most established organizations for the elderly. Rents are controlled and social services provided. To live in one of the 173 apartments, a person must be at least 62 and have an income that falls below a certain level (currently $45,850 for an individual and $52,400 for a couple). The waiting list is long.

Ms. Habib and Ms. Marchese each have one-bedroom apartments, pleasantly crowded with furnishings and memorabilia, for which they pay about $400 a month. The balance of the $940 rent is covered by a federally funded rental subsidy program called Section 8.

They realize that without a place like the Hamilton House, they could not afford to live in such a pricey part of the city. They’re appreciative of the in-house social workers, the lively activities at the senior center next door and the rich cultural offerings in the area.

“There are so many pluses,” said Ms. Marchese, who used to work in customer service. “You’re independent. You’re in a beautiful neighborhood. You feel connected. What’s not to like?”

Ms. Habib, a former legal secretary, agreed. “Originally I was skeptical,” she said. “I didn’t want to live with all these old people. But now I’m one of them, and it doesn’t bother me at all.”

Eleanor Kremen, an 84-year-old former social worker who is divorced and has no children, lived for years in a one-bedroom apartment on West 96th Street. But her training made her conclude that as she aged, she might not be able to live alone. “I foresaw the future,” Mrs. Kremen said. “I realized I might need someone in another room.”

Twenty years ago she moved to a two-bedroom apartment in her building for which she pays $1,000 a month. The decision proved wise. Today she has Churg-Strauss syndrome, a rare autoimmune disease. Her arms and legs are thin as a child’s, and she can get around only in a wheelchair. Round-the-clock aides sleep in her bedroom, while she finds it more comfortable to sleep on the living room couch, near the old upright piano that she still plays.

And through the home-sharing program run by the New York Foundation for Senior Citizens, Ms. Kremen also has a roommate, Amy Ronek, a 37-year-old communications director from Iowa. Ms. Ronek, who has her own bedroom, shares the kitchen and bathroom and contributes to household expenses. She also provides companionship, or as she puts it, “I’m the entertainment.”

The home-sharing service, a sort of for the elderly, is free. Pairs are formed via a questionnaire that touches on everything from smoking to overnight guests. To date, the foundation has matched up more than 2,000 people.

For Ms. Ronek, the benefits are many. She had had roommates previously and enjoyed having another person around. Because she has her own room, she has privacy. And the arrangement allows her to live in a neighborhood like the Upper West Side, which she might not be able to afford otherwise.

For Ms. Kremen, also, the benefits are both financial and social.

“It’s very nice having someone in the house,” she said. “And Amy is a very special person. She’s more cheerful than me. She’s more cheerful than most people.”

Despite the number of services for the elderly, most Manhattan residents over 75 manage on their own, often in places they have lived for decades.

Brigitta Ortner, who is 83 and who emigrated from Germany with her family in January 1939, has lived since 1952 in a fourth-floor walk-up on West 95th Street, where her monthly rent is about $1,000. Years ago, when her stepmother first saw the apartment, she described it as a dollhouse. Despite the climb, Ms. Ortner, who used to work at Saks Fifth Avenue, has no intention of leaving. “I guess I’m too lazy to move,” she said.

Ms. Ortner walks a great deal, sometimes three to six miles a day. “The wonderful thing about New York,” she said, “is that you can walk everywhere — to the grocery store, the movies, Lincoln Center, in the parks.”

Her energy may be one reason she can manage all those stairs. And as an inveterate walker, she is especially enamored of the benches recently installed on her block where she can stop and chat with friends.

The benches were provided through the efforts of Gale A. Brewer, the local councilwoman. Her district, which covers a large swath of the Upper West Side, is home to nearly 50,000 older people. Partly for this reason, Ms. Brewer has been a prime mover behind the Age-Friendly New York Initiative, an effort sponsored by the New York Academy of Medicine, the City Council and the mayor’s office to institute modest changes that taken as a whole are meant to improve life for the city’s graying population.

Earlier this year Ms. Brewer’s office produced the Age-Friendly West Side Grocery Guide, analyzing 23 grocery stores in terms of amenities like handicapped-access restrooms, seating, senior discounts and meat in single-portion packages. Her wish list is long and includes goals like making parks more user-friendly (more restrooms, fewer stairs); making streets easier to navigate (fewer potholes, slower traffic signals); fine-tuning public transportation (adding bus shelters, repairing subway elevators); improving the Access-a-Ride program, which provides transportation for disabled people; and finding better ways to alert the elderly to the city’s many free or discounted cultural events.

For older New Yorkers who have no intention of forsaking the city they love, despite obstacles that can sometimes be formidable, such changes can’t come soon enough. “Someday I may have to retire to California, where my niece wants to take care of me,” Ms. Ortner said. “Till then, I’m staying in New York.”

Brian Gauthier's Ft. Lauderdale Home Health Care Agency, A Family Member HomeCare, Notes Florida Commission on Review of Taxpayer Funded Hospital Districts August 16, 2011 Meeting Materials Posted

The August 16, 2011 meeting materials for the Florida Commission on Review of Taxpayer Funded Hospital Districts have been posted.  To access each document, click on the hyperlinks below:

Agenda [269kb pdf]

Meeting Materials:

Commission Members
Governor's Executive Order Number 11-63
Hospital Tax District Survey Data

For more information about a Miami-Dade, Broward and Palm Beach County home health care agency for seniors, Alzheimer's patients, sufferers of dementia and other family members needing home health care services or in-home health aides, contact Brian Gauthier at A Family Member HomeCare (954) 986-5090 or visit