(213) 240-8101
December 29, 1998
Honorable Board of Supervisors
County of Los Angeles
383 Kenneth Hahn Hall of Administration
500 West Temple Street
Los Angeles, California 90012
Dear Supervisors:
(3 Votes)
IT IS RECOMMENDED THAT YOUR BOARD:
Approve and authorize the Director of Health Services, or his designee, to sign an agreement substantially similar to Exhibit I, with Stephen Wolfson, Attorney at Law and Medical Management Consultants, Inc. under which a hard to place County-responsible patient will receive living, home health care, and financial management assistance, effective upon Board approval through December 31, 1999, with provisions for four automatic one-year renewals through December 31, 2003, at an estimated cost of $151,142 per year, with provisions for increases of up to a maximum of 10% per year for anticipated increases for employers paid workers compensation, health insurance, employers taxes and payroll processing.
PURPOSE OF RECOMMENDED ACTION:
In approving this action, the Board is:
- authorizing the Director of Health Services, or his designee, to sign an agreement which allows a hard to place, seriously disabled patient to manage his own affairs, including hiring independent care givers to attend to his daily living needs in lieu of the County assuming the costs of long-term institutional care; and
- authorizing financial support in the estimated amount of $151,142 per contract year, effective upon Board approval through December 31, 1999, with provisions for four automatic one-year renewals through December 31, 2003, with provisions for
Honorable Board of Supervisors
December 29, 1998
Page 2
annual increases of up to a maximum of 10% per year for anticipated increases in the contractcost, such as employers paid workers compensation, health insurance, employers taxes, and payroll processing, to maintain a home living arrangement for a hard to place County- responsible patient.
JUSTIFICATION:
The patient's history of disputes with some of his providers has made it difficult for contract home health care agencies to identify and retain staff to care for him. Consequently, the current contract agency is not willing or able to complete the term of their agreement. The Department of Health Services (DHS) overwhelming concern is that at any moment the patient may be abandoned because of the unavailability of staff, thereby placing his health and safety at risk. The patient gets along well with some of his provider members and the Department believes the problems he has experienced in the past will be eliminated if he has the ability to select and manage his care givers.
FISCAL IMPACT:
Budgeted expenditures for attendant care services from date of Board approval through December 31, 1999 are estimated to be $151,142, with provisions for annual increases of up to 10% per contract year for anticipated increases in employer paid workers compensation, health insurance, employers taxes and payroll processing.
FINANCING:
Funding is available in the approved DHS FY 1998-99 Budget, and will be requested as a continuing appropriation in FY 1999-2000, FY 2000-2001, FY 2001-2002, and FY 2002-2003.
This patient's only source of income derives from monthly social security disability payments which are insufficient to pay for his attendant care needs. His medical care is covered by Medi-Cal, but it does not cover 24-hour, 7 days a week attendant care.
FACTS AND PROVISIONS/LEGAL REQUIREMENTS:
While the services provided under the standard home health agreements meet the needs of most County patients, there are patients who require services beyond the intended scope of the standard agreements. These patients require ongoing treatment and are difficult to place because of their debilitating illnesses. When placed in County hospitals, such patients tie up acute medical beds, add to hospital patient loads, and result in higher County costs.
The patient covered under this agreement is totally disabled with fusion on almost all of his joints, including his vertebral column. He is also blind and hearing impaired. For these reasons, he requires care and supervision 24 hours a day, seven days a week. Through the years, the Honorable Board of Supervisors
December 29, 1998
Page 3
Department has attempted to place this patient in a series of skilled nursing facilities only to have him returned to the Countys hospital system because of his temperament and outspoken dislike for some of his providers.
Because of the strain he places on County hospital staff, a plan was devised to rotate this patient among the six County hospitals. However, his discontent with residing in County hospitals increased and he expressed an interest in establishing a home living arrangement. Until recently, this arrangement brought stability to this patient's life. However, the patient's recent abusive attitude toward some of his attendants have made it difficult for County contracted agencies to hire and maintain staff willing to care for his needs.
Within the past 12 months, two home health care agencies have terminated their County agreements and two nurse registries have refused to have any further contact with this patient. After less than one month, the current nurse registry has indicated that any further incidents by the patient will result in their refusal to provide services.
CONTRACTING PROCESS:
In 1984, the Board approved the first contract with a nursing care agency to provide 24-hour attendant care. On December 11, 1990, the Board approved a sole source agreement after numerous attempts failed to identify other providers willing to accept this patient. On
November 4, 1997, the Board approved the assignment of this agreement to Pediatric Services of America (PSA). PSA terminated their agreement on September 1, 1998 and no other home health agency has been identified that is willing to care for this patient. County contracted nurse registries have been called upon to maintain services on a temporary basis.
Because of the difficulty in finding health care agencies to meet this patient's needs, DHS recommends a new approach whereby the patient serves as his own service coordinator, with the assistance of his attorney, with the responsibility for hiring his own attendants. This approach is inspired by the supported living services provided by the California Regional Centers for the developmentally disabled.
Since this agreement establishes a unique contractual relationship among three parties: the County, the County-responsible patients attorney, and a management agency to handle payment of salaries to the attendants hired by the patient, who will be the employer of the attendants, and payment of the patients monthly living expenses, DHS did not advertise this arrangement on the Office of Small Business' Countywide Web Site.
IMPACT ON CURRENT SERVICES (OR PROJECTS)
This agreement will ensure that attendant care services will continue uninterrupted.
Honorable Board of Supervisors
December 29, 1998
Page 4
When approved, this Department requires three signed copies of the Board's action.
Respectfully submitted,
Mark Finucane
Director of Health Services
MF:re
Attachment
c: Chief Administrative Officer
County Counsel
Executive Officer, Board of Supervisors
BLETRAEH8.RE
ATTACHMENT A
1. TYPE OF SERVICE:
Home health care and patient financial management services will be provided to a hard to place patient with debilitating illnesses and an abusive temperament and attitude.
2. AGENT AND AGENCYS ADDRESS AND CONTACT PERSONS:
a. Stephen Wolfson, Attorney at Law b. Medical Management Consultants, Inc.
11949 Jefferson Blvd., Suite 107 8797 Beverly Blvd., Second Floor
Culver City, California 90230 Los Angeles, California 90048
Telephone: (310) 822-4117 Attn: Eric Galtress, Representative
Telephone: (310) 659-3835
3. TERM:
The agreement will commence upon Board approval and will remain in effect through 12/31/2003.
4. FINANCIAL INFORMATION:
Budgeted expenditures for home health services and financial management services are estimated to be $151,142 for the contract year, commencing upon Board approval through 12/31/99, with provisions for four automatic one-year renewals through December 31, 2003. Funding is available in the approved Department of Health Services Fiscal Year 1998-99 Budget, and funding will be requested as a continuing appropriation for FYs 1999-2000, 2000-01, 2001-02, 2002-03.
5. PERFORMANCE INFORMATION:
Through the years, DHS has attempted to place this patient in a series of nursing facilities only to have him returned to County facilities because of his abusive language and behavior toward some of his care givers. Until recently, a County funded supported living arrangement whereby the patient resides in his own home with care provided by a County contracted home health agency worked well. However, the patient's temperament and attitude have made it difficult to identify and maintain an agency willing to complete the term of their agreement.
6. REASON FOR THIS AGREEMENT:
The patient is blind, hearing impaired, totally disabled and bed-bound and requires care 24 hour, 7 days a week. The current provider of care has indicated that they may terminate their services any day now leaving the patient without a care giver.
7. GEOGRAPHIC AREA SERVED:
The patient resides in the West Los Angeles area.
8. ACCOUNTABLE FOR MONITORING:
Rancho Los Amigos Medical Center has assigned a social worker case manager to monitor the patient on an ongoing basis.
9. APPROVALS:
Operations: Douglas D. Bagley, Acting Assistant Director
Contracts and Grants Division: John H. Ricks, Chief
County Counsel (approval as to form): Daniel D. Mikesell, Jr., Principal Deputy County Counsel
BLETRAEH8.RE
COUNTY OF LOS ANGELES - DEPARTMENT OF HEALTH SERVICES
FACT SHEET
SUBJECT: PILOT AGREEMENT FOR THE PROVISION OF HOME HEALTH CARE AND PATIENT FINANCIAL MANAGEMENT SERVICE
REQUESTED ACTION:
Approval of an agreement to financially assist a hard to place, seriously disabled patient attend to his daily living needs in lieu of the County assuming the costs of long-term institutional care.
BACKGROUND:
a. This patient is totally disabled with fusions on almost all of his joints, including his vertebral column. He is also blind and hearing impaired, with serious behavioral disorders. He requires care and supervision 24 hours a day, seven days a week.
b. Through the years, the Department of Health Services (DHS) has attempted to place this patient, who we will refer to as Richard J, in a series of skilled nursing facilities only to have him returned to County health facilities because of his unmanageable behavior.
c. Because of the strain he has placed on County hospital staff, a plan was devised approximately 15 years ago to rotate Richard J among the six County hospitals. However, his discontent with residing in County hospitals increased and he expressed an interest in establishing a home living arrangement.
d. In 1984, the Board approved the first contract with a home health care agency to provide around-the-clock care. Until recently, this arrangement worked well and brought stability to this patient's life.
e. Recently, Richard Js abusive behavior toward his attendants increased, making it difficult for County-contracted agencies to hire and maintain staff willing to care for his needs.
f. Within the last 12 months, two home health care agencies have terminated their County agreements and two nurse registries have refused to have any further contact with Richard J. The nurse registry, which is currently providing temporary home health care services to Richard J, has advised the Department that they are also no longer interested in providing services to this patient.
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FACT SHEET (contd)
g. DHS recommends a new approach whereby Richard J serves as his own service coordinator with the responsibility for hiring his own home health care attendants. This approach is inspired by one operated for the developmentally disabled by the California Regional Centers. Richard J and his attorney are receptive to the plan.
h. A qualified professional employer organization will serve as the direct recipient of County monies, pay the recipient's employees/attendants, and maintain and prepare employee records to meet all Federal and State tax requirements.
FISCAL IMPACT:
The estimated cost of the agreement is $151,142, for the 12-month period commencing upon Board approval through December 31, 1999, with provisions for four automatic one-year renewals through December 31, 2003. Provisions are also included in the agreement for a maximum increase of up to 10% per year for anticipated increases for employees workers compensation, health insurance, employers taxes and payroll processing.
Cost/day at RLAMC: $1,542/day = $10,794/week for 52 weeks = $561,288/year
Cost $561,288/year at RLAMC minus $151,142 contract cost/year
= $410,146 in annual savings to the County.
CONTRACTORS:
a. Stephen Wolfson, Attorney at Law b. Medical Management Consultants, Inc.
11949 Jefferson Blvd., Suite 107 8797 Beverly Blvd., Second Floor
Culver City, California 90230 Los Angeles, California 90048
Telephone: (310) 822-4117 Attn: Eric Galtress, Representative
Telephone: (310) 659-3835
Supervisorial District: 3
DHS Contact Person: John H. Ricks
Telephone: (213) 240-7723
Date: 12/18/98
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