Needless rule hampers home care

Once a week for the last couple of years, a home care worker named Lori has shown up at Steve Viera’s house to do laundry, carry in food, clean and generally help the disabled veteran live his life.

Viera is a former sheet metal worker who served in the Navy in the Middle East from 1979 to 1981, so the U.S. Veterans Administration pays for the visits. It’s just a short few hours, but for Viera, a divorced New Haven resident, it’s a lifeline.

“If it wasn’t for them I wouldn’t exist,” the 59yearold Viera said to me Friday.

Lori works for Companions & Homemakers Inc., a large, statewide agency that had more than 200 home care clients through the VA until recently. Starting Oct. 1, Companions lost that work for reasons that make little sense.

Lori is still coming to help Viera every week, but under murky circumstances, as Companions — probably not being paid for the visits — tries to sort out what’s happening.

The VA home care system changed under the sweeping MISSION Act in 2018. Home care for veterans such as Viera, which was arranged by local VA offices, is now organized by giant thirdparty administrators. In the Northeast, that’s Optum, a health services business owned by UnitedHealthcare.

And as we might expect when centralized bureaucracies grow because of grand, flawed visions of efficiency, this reform includes useless rules. To participate in the VA program, home care companies must now certify that they’re medical providers.

Trouble is, they’re not medical providers under a strict federal definition. Claiming they are could put their separate Medicaid business — a huge amount of their revenues — in jeopardy.

“We will not lie under oath,” said Linda Grigerek, the Companions & Homemakers president.

Her company has lost twothirds of its VA clients, about $1.2 million a year of work, as a result of the rule she can’t meet, even as the VA and Optum apparently struggle to find caregivers.

Although the VA did not confirm that it’s having problems filling the needed shifts, Companions & Homemakers is still working with more than 60 of the former clients because, Grigerek and other executives said, the VA has not found others to do the work under the new rules.

We all understand, of course, that business conditions and contract requirements change and that causes disruption with winners and losers. If this profitable company loses a few clients and other firms pick them up, that’s all part of the landscape, not my concern or the nation’s.

But this change is nettlesome because it represents a boneheaded government screwup for no clear benefit. The home assistance companies — about 600 registered in Connecticut, many of them momandpop firms — are not providing medical care such as blood pressure screenings and administering drugs.

That’s a different level of care, not covered by the lowcost contracts for caregivers who spend hours at a time with clients. The VA pays $16.48 an hour to home care providers in Connecticut for most con

tracts, meaning the workers typically make barely more than the minimum wage.

So all we have is a needless ruse creating chaos for vulnerable clients.

“There are other businesses that have signed a contract,” Grigerek said. “I don’t know if they know they’re lying under oath.”

Two of those smaller firms, which are on board in the new system, did not return calls Friday.

Late Friday, U.S. Rep. John B. Larson, DConn., sent a letter to Robert Wilkie, secretary of the Department of Veterans Affairs, offering help in straightening out the issue. “The local VA has assured us that there will be no disruption of care,” Larson said in the letter he sent after Companions & Homemakers reached out to him. “However, this change

has undoubtedly caused a disruption in the lives of the veterans impacted by it.”

Two spokeswomen for the VA were unable to provide an explanation of the situation late Thursday or Friday. A call and an email to Optum were not returned.

But as Larson said, it’s unclear how many caregivers have been replaced by new firms. Viera said the head of a home care agency has called him about 20 times, hoping to recruit Lori away from Companions & Homemakers. “He wants to talk to her and try to convince her to come to him. I can’t give him her number,” Viera said.

Among other issues, he said, Lori — whose last name I’m not using because I didn’t reach her — would lose seniority she has at Companions, and would make less money with the new agency, he said she told him.

“She wants to work, she wants to help me. She’s like emotionally involved with her clients. She

calls up to check on me to see if I’m OK,” Viera said, noting that’s not true of all caregivers. As for jumping to a new firm, “She’s not gonna unless they come up with money and pay her, which is the American way.”

That raises a related issue of controversy. With the state budget adopted in June and signed by Gov. Ned Lamont, home care agencies such as Companions & Homemakers lost the right to enforce socalled nonsolicitation agreements with their caregivers. That means as of this year, the agencies can’t stop employees from poaching the very clients they’re serving, as they’re serving them, to take the work away.

Most of us would agree it’s unseemly for employers to impose noncompete agreements on lowwage workers, preventing them from working for competitors. Advocates including Sen. Chris Murphy have fought for states and the federal government to outlaw noncompete clauses,

and the state of California has set an outright ban.

That’s good policy. But Connecticut barring the nonsolicitation agreements — with no debate in a hidden paragraph in the state budget — was bad policy, a measure too far.

Groups such as New Haven Legal Assistance, which have fought for an end to noncompete agreements for low and moderatewage workers, have not sought an end to nonsolicitation agreements — although James BhandaryAlexander, a staff attorney there, said the solicitation issue may not pose a significant threat.

Grigerek at Companions & Homemakers says it does threaten the company — and insists the VA issue is a perfect illustration, as competing firms try to hire her caregivers for the very clients she had. “There’s just nothing to protect the work that we do,” she said, matching caregivers with clients and providing backup support.

All of this represents gray areas of law and government practice, and Grigerek said she’d prefer to work with the state to clear up the nonsolicitation ban.

As for the VA transition, it will work out fine for disabled veteran clients in the end, as these things do. But the medical designation for nonmedical work is frustrating for affected families and firms because, at the rates they’re paying, the VA is not getting medical care, period, no matter what the documents show.

Linda Stewart, a Bristol resident and parttime caregiver for Companions, lost a client in the changeover and isn’t leaning toward signing up with the new firm, for just over $11 an hour and travel expenses not covered.

“I enjoyed working for him,” Stewart said, adding, “He has issues with trusting people because he has PTSD.”