COUNTY OF SAN MATEO

Inter-Departmental Correspondence

Health Services Agency

DATE:

August 20, 2004

BOARD MEETING DATE:

September 14,2004

TO:

Honorable Board of Supervisors

FROM:

Charlene A. Silva, Director of Health Services

Lisa L. Mancini, Director of Aging and Adult Services

SUBJECT:

Agreements with various Home Health and Attendant Care Providers for Fiscal Years 2004-2007

Recommendation

Adopt a resolution authorizing the President of the Board to execute agreements with Addus HealthCare, Inc., American CareQuest, Inc., Medical Care Professionals, Nurse Providers Plus, Inc., Nursing Resources, Professional HealthCare At Home, and Rainbow Home Care Services for home health and attendant care services for FYs 2004-2007

Background

Aging and Adult Services (AAS) provides protective and supportive services, case management, and conservatorship services to functionally impaired adults and seniors. Funding for these services is a combination of federal, state, and county funds as well as fees for services. Protective and supportive services provided by AAS include attendant care to individuals living independently. Attendants provide a variety of personal and health-related services that enable clients to remain in their own homes and avoid institutionalization. AAS programs that provide attendant care include Multipurpose Senior Services Program (MSSP), AIDS Case Management and Waiver (AIDS), Linkages/Respite, Centralized Intake/Adult Protective Services (APS), and Public Guardian.

MSSP serves persons age 65 or over who are eligible for or are receiving Medi-Cal and who are eligible for placement in a skilled nursing facility. For the past fourteen (14) years AAS has received funds from the California Department of Aging (CDA) to provide MSSP. The AIDS Case Management Program, including AIDS Waiver, provides services to clients who are at risk due to deterioration in health related to HIV. The program is funded primarily through an intrafund transfer from the AIDS Program and through Medi-Cal. Linkages provides assessment and case management services for seniors and disabled adults. Through the purchase of services such as in-home chore care, attendant care, and transportation, persons having difficulty caring for themselves can continue to live independently in the community. Linkages is funded through the Community-Based Services Program provided by the California Department of Aging. The APS staff assess and develop care plans in situations where the elderly or dependent adults have been subjected to or are at-risk of neglect, abandonment, isolation, abduction, or physical, mental, or financial abuse. When needed, the social worker can provide emergency protection such as shelter, food, or attendant care until a longer-term care plan is implemented. Primary funding for APS is a combination of state and federal revenues paid through the Department of Social Services. The Public Guardian manages the personal care and financial resources of individuals who are unable to provide for their own personal or financial needs. The cost of attendant care services for conservatees is paid out of their own funds. The purchase of these services, which enables conservatees to remain safely in their own homes, is overseen and authorized under the supervision of the Superior Court.

Discussion

A Request for Proposals (RFP) for a four-year cycle starting July 1, 2004 to June 30, 2007, for home health and attendant care services for clients in five programs (AIDS, MSSP, Linkages/Respite, APS, and Public Guardian) was issued in January 2004. Eight organizations submitted proposals in response to the RFP: A Warm Embrace, Addus HealthCare, Inc., American CareQuest, Inc., Medical Care Professionals, Nurse Providers Plus, Inc., Nursing Resources, Professional HealthCare At Home, and Rainbow Home Care Services. A review committee including representatives from various Aging and Adult Services programs evaluated all the proposals to assess the applicants’ experience and competence in the provision of the services required. Based on the criteria and the committee’s evaluations, all eight applicants were selected to provide home health and attendant care services. A Warm Embrace was unable to comply with the contracting requirements. We are recommending contracting with seven of the eight selected providers and contracting with A Warm Embrace when it is compliant.

Use of attendant care in programs throughout AAS helps the division achieve one of its primary performance measures: maintaining severely impaired clients in an independent setting. The Division’s minimum acceptable goal is to achieve at least 78%. Case management is the most important factor affecting achievement of this percentage; however, other factors such as the availability of attendant care resources or the funding to purchase those services, can influence this measure as well.

Performance Measure

Actual

FY 2001-02

Actual
FY 2002-03

Estimate
FY 2003-04

Target
FY 2004-05

Percent of severely impaired client population maintained in an independent setting through case management

81%

82%

80%

80%

The agreements have been reviewed and approved by County Counsel, and they meet CDA and the State Department of AIDS requirements for subcontractor agreements.

Vision Alignment

Home Health and Attendant Care Services keep the commitment of ensuring basic health and safety for all and goal number 8: People- Help vulnerable people— the aged, disabled, mentally ill, at-risk youth and others—achieve a better quality of life. The agreements contribute to this commitment and goal by providing services throughout the county designed to assist individuals with the greatest needs to maintain their independence and dignity within the least restrictive setting possible.

Fiscal Impact

The term of the agreements is July 1, 2004 through June 30, 2007. The maximum the County shall be obligated to pay collectively for these agreements under a single resolution for fiscal year 2004-2005 is $950,000. Funding is a combination of state, federal, and county funds as well as payments from conservatees’ personal accounts, which pays for their attendant care. Funds for these services are included in AAS’s approved budget for 2004-2005.

The amounts to be paid for subsequent fiscal years will be determined at a later date, and amendments will be brought before the Board of Supervisors for approval to include the additional amounts when that information is available. Any ongoing expenditures will be reduced if funds are unavailable in future years. There is no impact on the County General Fund as a result of this action.

1.

General Description of RFP

Home Health and Attendant Care Services

2.

List key evaluation criteria

• Prior Experience

• Demonstrated competence in performing the services required

• Staff training and experience, skills expertise, ratio of staff to client

• Cost

• Ability to document services, provide reports and maintain records

3.

Where advertised

Through the Independent Newspaper to seven San Mateo County newspapers

4.

In addition to any advertisement, list others to whom RFP was sent

36 letters were mailed to potential Home Health and Attendant Care providers informing them of the RFP.

5.

Total number sent to prospective proposers

13

6.

Number of proposals received

8

7.

Who evaluated the proposals

The committee consisted of people from:

Aging and Adult Services Administration

Aging and Adult Services Public Authority

Aging and Adult Services MSSP

8.

In alphabetical order, names of proposers (or finalists, if applicable) and location

A Warm Embrace, San Mateo, CA

Addus HealthCare, Inc., Palatine, Il

American CareQuest, Inc., San Francisco, CA

Medical Care Professionals, So. San Francisco, CA

Nurse Providers Plus, Inc., Daly City, CA

Nursing Resources, Fremont, CA

Professional HealthCare At Home, San Pablo, CA

Rainbow Home Care Services, San Francisco, CA