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.