LeadingAge NY Participates in Third DOH ACF Respite Workgroup Meeting
(July 2, 2024) On June 27th, LeadingAge NY participated in the third of five workgroup meetings to inform the development of a respite program established in the 2023-24 final budget. $7.2 million was appropriated for services and expenses related to providing relief to high-need family caregivers in respite care at adult care facilities (ACFs). LeadingAge NY’s Diane Darbyshire, as well as LeadingAge NY member John Schuster, Senior Administrator, Wartburg, serve on the workgroup convened by the Department of Health (DOH). Click here for background on this effort and the scope and charge of the workgroup.
During the workgroup meeting, draft documents were reviewed, including the application that individuals would use to apply for the voucher and a cost of care survey that would go out to providers that would be used to establish voucher program rates. LeadingAge NY worked with other stakeholders to recommend refinements to these documents.
Respite Reimbursement
The Department developed a draft cost of care survey, which we have provided suggested changes to. Currently, the Department plans to collect average rate information from current respite providers to establish a rate for different licensure types. We also recommended that there be a regional rate, since costs vary in different parts of the state. We again cautioned that the rate must be sufficient to ensure that providers will participate.
There was a debate about whether the individual receiving respite should be asked to contribute to their payment for the respite stay. LeadingAge NY cautioned that the provider must be made whole; the ACF provider should not be expected to absorb any portion of the cost of the services.
There was also discussion regarding how respite might work in the Enhanced Assisted Living Residence (EALR). This raises questions about how best to establish a voucher rate for EALR respite. It also further begs the question of how best to identify for the prospective respite applicant which type of ACF/assisted living (AL) setting is most appropriate for their needs. Member input on this is welcomed.
Respite Timeframe
The potential approved timeframe for respite was debated. Existing law permits an individual to receive respite in an ACF for up to 120 days in a 12-month period. It was felt that, given the limited funds, this long duration may not be appropriate for any one individual, and we may not want to include language in the materials that suggests that is an option at the outset. There was also debate about the potential for intermittent respite (i.e., one night a week or every weekend for four weeks). LeadingAge NY cautioned that this would be complicated for the facility in terms of staffing and ensuring medications, etc., but also a bit disruptive to the resident and the broader community. Other stakeholders felt that the option should be preserved and ACFs can decide at any given time what they are able to accommodate.
Process
There remains debate about how the process will best work – if an individual will identify an appropriate respite setting first or submit a voucher application to the State first. LeadingAge NY cautioned that timing will be critical, particularly as some individuals may have an immediate, urgent need for respite. Further, an ACF may have a bed available at one time, but not be able to hold it for weeks while a voucher application is under review. This issue merits further consideration.
Educating the Public
One stakeholder suggested there be a public information campaign to educate the public about the program; however, DOH noted that funds were not appropriated for that purpose. LeadingAge NY urged that the Department develop a website that provides information to the public regarding the program, similar to how the Department approached the Special Needs Assisted Living Residence (SNALR) Voucher Program. On that site, it would be important to convey who might be appropriate for a respite stay in an ACF/AL setting. We noted that it is important that we provide information to avoid individuals applying whose needs cannot be met in our settings. In addition, we recommended that it be stressed that this program is for a short-term stay, with the goal of supporting a caregiver so the individual can return home.
What Factors Should State Consider in Review of Applications?
The group continued to discuss how the State should prioritize applicants if they have multiple applications at any given time. Related to that issue, we have discussed what information the State should collect in the application to make that determination. While the legislative language is vague, the purpose is to support caregivers in caring for their loved ones in the community, and that should be a guiding principle in the development of the program. It was felt that financial need should also be a criterion, and yet the parameters for that have not been established. We invite member input on this issue.
Termination of Residency Agreement
DOH is researching, legally, whether an individual who is in an ACF short term for respite has the same rights as a resident in terms of termination of residency agreement. The Model Respite Addendum allows the termination of the agreement by either party with three days' notice. We are exploring what other language we can add to clarify that this program is intended for temporary stays. There is concern, however, about what will occur if the resident or caregiver does not want the resident to leave when the respite stay concludes.
Key Questions
We continue to invite member input on key questions:
- On a high level, what information is needed to determine what type of ACF/AL provider is appropriate for providing respite? Memory impairment and wandering behaviors? Other issues or needs?
- What is the best way to establish an EALR respite rate, given that services and costs may vary?
- Are there ways in which we could make it easier for an ACF to admit individuals seeking respite? Can the process be streamlined, while ensuring that the ACF gets the critical information needed to make a determination regarding appropriateness and develop a plan to meet that individual’s needs?
- How do you prioritize who receives respite services? What factors should be considered, and what information must be gathered for the State to make that determination?
- It was felt that there should there be a financial consideration in determining eligibility for this State-funded respite program, meaning the individual should have financial need for support. What should those parameters be? How should that be established?
Next Steps
This was the third of five workgroup meetings, and there are some complicated issues to resolve before the program can be implemented. We encourage member input and questions on these issues, as this will help inform our discussions in the subsequent meetings. The group will be finishing its work in mid-July.
Contact: Diane Darbyshire, ddarbyshire@leadingageny.org, 518-867-8828