Honoring Oregon Seniors? The Client Employed Provider Program Report


 Secretary of State


The State of Oregon

900 Court Street NE, Salem, Oregon 97310  -  oregon.sos@oregon.gov

Secretary Richardson

Honoring Oregon Seniors?

The Client Employed Provider Program Report

A month before deciding to run for state office back in September 2001, my wife Cathy, myself, and our family had the honor and the burden of assisting my sister, Donna Sue Richardson, during her final battle with breast cancer. She had survived two previous battles in the prior decade. Donna died at home in Central Point in August 2001 at the age of 53 after months of a heroic yet progressively more futile battle. I was sitting at her bedside, late at night, during her final hours. She expressed her love, tightly squeezed my hand, and closed her eyes for the last time.

A year earlier a family friend spent countless hours along with our family, attending Cathy’s 98 year-old grandfather during his final phase of earthly life. Rulon Sirls Winsor passed away at home in Central Point in August 2000. He had a goal of attending church service on his 100th birthday. We were all rooting for Grandpa Winsor, but he wasn’t quite able to make it.

Only one month before Grandpa passed, in July 2000 my sister Donna and I, with family and friends, had the bitter-sweet honor of sharing the final months, weeks, days and hours with my mother, Eva McGuire Richardson, as she passed away in her mobile home in Gold Hill. She had lived for 91 years. Without going into further detail, our family and friends also attended the passing of my father, Ralph Lee Richardson, in April 1991. I was with him during his final phase of life and at the end. My dad also passed away in my parent’s nearby Gold Hill mobile home that he and Mother had shared for nearly a decade.

These were good, humble people who have helped form my life, and I will never forget them. Each of them was born, lived, and died. Like it or not, we all will follow the same path.

I have shared these personal stories with you to make a point. When family or friends are there to care for senior family members—as is the case about 80% of the time—the final years can truly be golden. I remember my mother saying at age 88 that these were the happiest years she could remember. My two sisters and I were always there for her. She once laughed and said that all she had to do was snap her fingers and we would come “a-runnin.” But, when a senior citizen does not have a support system of family and friends, society—which means community and not just government programs—has the opportunity to provide more than a roof, a bed, Medicaid, and Medicare. We can help give many of our senior citizens the dignity, the honor, and the opportunity to live out their final phase of life in the comfort and familiar surroundings of their own homes.

Oregon has several programs that focus on giving limited assistance to elderly folks who want to remain in their own homes for as long as they can. For many, staying in the familiar surroundings of one’s own home and neighborhood fills a bleak present and future with rich, warm memories of the past. Many elderly citizens want nothing more than just enough help so they can retain the life they have known for decades in the home where their sweet memories live and their walls, covered with photographs, are constant reminders of brighter days.

Today, I am reporting on the audit of one such program. It is administered by the Department of Human Services (DHS), Aging and People with Disabilities (APD) Department, and is called Consumer-Employed Providers (CEP). The audit has a descriptive title: “DHS-Aging and People with Disabilities: Consumer-Employed Provider Program Needs Immediate Action to Ensure In-Home Care Consumers Receive Required Care and Services.”

Oregon leads the nation in maximizing clients' independence and choice in long-term care services. The CEP program offers aging adults and people with physical disabilities, who otherwise would be eligible to receive care in nursing facilities, the opportunity to safely remain in their homes. This choice comes with additional requirements. Clients in the CEP program are responsible for hiring, training, supervising, and dismissing their home care workers.

Our audit found shortcomings in vital components of the CEP program are putting elderly or disabled clients' health and well-being at risk. 

These shortcomings include the following:

• Some clients are not able or willing to successfully manage their homecare workers. As an example, a client experiencing memory issues from Alzheimer's may be unable to confirm that a homecare worker is completing necessary tasks.

• APD does not ensure that homecare workers are prepared to provide the care and assistance clients need. For example, homecare workers are not required to be trained to meet a client's specific needs.

• Excessive workloads prohibit case managers from contacting clients as frequently as required and from monitoring the critical services clients should be receiving. According to the auditors' file reviews, roughly one third of CEP clients in 2016 did not receive all of their monthly required case manager monitoring contacts. In addition, some of those contacts included 1 minute to 30 minute face-to-face and 30 second to 10 minute telephone calls. Whether the contacts were closer to the 1 minute face-to-face or 30 second call end of the spectrum, APD could not tell.

• Data collection and utilization practices make it difficult to adequately evaluate CEP program performance and the safety of clients. For instance, APD does not track the percentage of CEP clients who are abused, neglected, or victims of fraud. 

Without addressing these issues, the integrity of the CEP program, as well as the clients it serves, will continue to suffer. 

Drawing on current program policies and examples from other states and similar programs, the audit recommends APD actually and consistently follow its existing monitoring policies, address and reduce case managers' excessive workloads, and provide more support to clients and homecare workers. 

Of primary importance, APD caseworkers have too many assignments. They cannot be expected to spend the necessary time with their clients when they are also expected to (1.) assist elderly and disabled individuals with multiple responsibilities they have as “employers;” (2.) make determinations on physical and mental capacities that have a direct effect of the level and amount of services these elderly and disabled individuals are to receive; (3.) train inexperienced care providers, who are often family members or friends, etc.

In other states, caseworkers are allowed to be caseworkers, and extraneous duties are contracted out or otherwise fulfilled by those who are qualified and have time to do them.

Finally, I inquired as to the reason that there are 33 caseworker vacancies in a program where it is obvious there are too few caseworkers, and the present caseworkers are too busy and too burdened with unrelated duties to ensure the wellbeing of their senior or disabled clients. The answer was the legislature required that 5% of the CEP caseworker positions remain vacant to help balance the 2015-17 state budget and that restriction was continued for the current 2017-19 budget.

Balancing the state budget on the backs of state workers entrusted with the care and oversight of Oregon’s most vulnerable seniors and disabled is shameful. 

In the Consumer Employed Provider program, Oregon’s seniors and disabled citizens are at great risk of fraud, neglect, and abuse. 

So, what does the CEP program cost? We need to know this number to do the cost/benefit analysis that every government program should undergo periodically. Unfortunately, the auditors and I are unable to give you an accurate figure.  We were, however, able to determine that the average cost for health care providers is about $28,000 per year. They are S.E.I.U. members and get paid $15 per hour for up to 50 hours of service per week. While preparing this newsletter, I asked what the administration costs are for caseworkers, field operations, facilities and fixed expenses. I believe you deserve to know the “unit cost” for every program supported with public funding. The auditors were told that such information is not tracked and is not available.  In short, the leaders of the Aging and People with Disabilities Department of DHS say they don’t know what the administrative costs are for the CEP program. We’ll circle back with the true cost of the Client Employed Provider program once we have it.  Only then will you, the people, be able to determine the cost/benefits of this program.

In conclusion, caring for the fragile members of our society is a cause that is near and dear to my heart.  We can and must do better to ensure the safety and well-being of our vulnerable family members and neighbors. Where each of us can help—in our families, neighborhoods and communities—let’s recommit to doing so.  Where our social programs are needed, they should be empowered to accomplish the missions we give them.

To be better informed, read this audit report and learn what needs to be done to enable the Department of Human Services Aging and People with Disabilities Department and the Consumer-Employed Provider Program to operate effectively, efficiently, and economically. Our legislators should be informed and reminded of the high funding priority of adequately caring for our most vulnerable senior and disabled citizens. In our society, they are one of our highest priorities. 

—Dennis Richardson