00;00;01;15 – 00;00;14;16

Jeff Howell

Welcome to Home Health 360, a podcast presented by AlayaCare. I’m your host, Jeff Howell, and this is the show about learning from the best in home health care from around the globe.

00;00;19;05 – 00;00;38;11

Jeff Howell

Hey, listeners, today’s pod is all about self-directed care. If you’re interested in expanding your service lines to include family and friends to help deliver better and more care, then you’d be interested in listening to today’s guest. The VP of CDPAP Services at Community Care Home Health in New York, Megan Shergill. Thanks for being here today.

00;00;38;25 – 00;00;46;27

Megan Shergill

Thank you so much for having me, Jeff. It’s a true pleasure. And happy Friday. I don’t know if your listeners know it’s a Friday. Fridays are always happy. Thanks for having me.

00;00;47;01 – 00;00;57;01

Jeff Howell

And it’s sunny and warm out and it’s a long weekend where I live, so it’ll be a nice good, long weekend. Well, tell us a little bit more about your career path, Megan.

00;00;57;18 – 00;01;19;15

Megan Shergill

Oh, sure. Well, first, I just have to compliment you. You pronounce my last name correctly. Shera Gill. As in sharing information, but I’m sure. Right. So that’s typically what I was born to do. So when people ask about my career path, my next question is typically how far back do you want to go? But I’ll condense it for the purpose of this conversation that we’re having today.

00;01;19;29 – 00;01;49;07

Megan Shergill

So as I mentioned right now, the title is vice president of CDPAP Services, which is an alternative homecare program to traditional home care services at an organization called Community Care Home Health Services. We are located or corporate office, where I’m speaking from today is in Smithtown on Long Island. However, we service all of Long Island, Westchester, the five boroughs of New York City, Monroe County, and Erie County.

00;01;49;15 – 00;02;22;14

Megan Shergill

And come April, we anticipate to service an additional 20 counties throughout New York State. So I think that your listeners will be very encouraged to know that our the breadth of our territory is about to be quite enormous. So we can help a lot of people. And now to go back to how my career path started was if we’re being honest, when I was ten years old, graduating from fifth grade elementary school, my art teacher at the time identified me as a good candidate to volunteer at a special needs summer camp for children with special needs.

00;02;23;02 – 00;02;50;14

Megan Shergill

Teaching them art and music. So then, for the next five years during that summer camp, I obviously developed relationships with families and those children with special needs. And then for the next five years, and then one of those families really, really connected with, as I turned 15, 16, they actually asked me to start babysitting their child with low functioning autism, which we both knew was going to be a challenge.

00;02;50;14 – 00;03;10;14

Megan Shergill

But because I suppose I did a good job in that classroom setting. They wanted me to be in their home assisting them. So then from 15 to about 18 years old, I then at 18 got certified to be to be titled as something called a community habilitation specialist. Have you ever heard of that before, Jeff?

00;03;10;20 – 00;03;12;13

Jeff Howell

No, especially at that age now.

00;03;12;25 – 00;03;41;17

Megan Shergill

So, Community Habilitation specialist, their role is to go through different activities of daily living with that individual, the child, and to try to get them to get towards as much independence as possible, completing their activities of daily living, using things like gesturing, verbal prompting, and then like physically, physically completing if they’re not able to actually do it. So that was my role as a community habilitation specialist.

00;03;41;27 – 00;04;19;26

Megan Shergill

Once I got certified at 18, I then started working for an organization called the Center for Family Support and actually ended up doing it, having a roster of different families that I would work for throughout the week. Beyond that, just one family. And then from there, I transitioned to an organization called the Developmental Disability Peace Institute in Suffolk County, Long Island, which is a residential facility for children from 13 to 21, meaning that my role was to get them ready for school from 6 a.m. till 9 a.m., doing all of their activities of daily living like grooming, dress, dressing, showering, bathing, toileting, things like that.

00;04;20;22 – 00;04;54;10

Megan Shergill

And I worked there for a couple of years, but to be candid, there was burnout. The burnout was real because it’s very physically hands on. And these children, although identified as children, I’m not joking. One was six foot four and little five foot six me petite. You know, it was taking a toll on me, you know. So then I segued into looking into the home care space so that I could better help a better volume of families in an administrative role rather than physically helping them, just knowing that I couldn’t keep it going.

00;04;54;20 – 00;05;19;01

Megan Shergill

So then I segue into home care and I was blessed to start entry level as a scheduling coordinator, meaning that I was the person scheduling the home health needs to go into people’s homes. And then I was blessed to be mentored by the CEO at the time to then kind of raise me through the ranks, to then be a manager, an administrator, a director, an assistant vice president.

00;05;19;10 – 00;05;27;04

Megan Shergill

And then today here I stand as the vice president of the program that I have the most passion for CDPAP here, community care.

00;05;27;19 – 00;05;33;26

Jeff Howell

And CDPAP is really a New York specific term. Can you bring us through what the acronym stands for?

00;05;34;08 – 00;05;56;00

Megan Shergill

Of course. And I like that you said that because I had some fun dinner table dinner party facts for you. I’ll bet we can dive in, too for a second. But yes. So c d pap stands for the consumer directed personal Assistance Program. And that usually goes over people’s heads because first they think, is it the same as a C pap machine, which which it is not.

00;05;56;16 – 00;06;19;17

Megan Shergill

And then they hear terms like consumer and personal assistant, and it still does not quite register with what that means. So generally speaking, I like to paint a picture. Picture? Mrs. Smith She’s considered to be alert and oriented, and she wants to have more control over her home care services, meaning she wants to be the boss of her home care services.

00;06;19;27 – 00;06;46;08

Megan Shergill

In this program, she, Mrs. Smith, would be known as the consumer. She’s then allowed to find her own caregivers. Personal assistants known in this program train her caregivers, monitor the work of the her caregivers, and coordinate the shifts of her caregivers. And she could hire just about anyone as long as they’re at least an adult and eligible for employment in the United States.

00;06;47;07 – 00;07;17;29

Megan Shergill

There’s only just a few exceptions. She can’t hire her legal spouse to be her caregiver for obvious reasons. Conflicts Beyond that, there’s very limited limitations on who can be her caregiver because New York State Department of Health Policy and Regulations states that the CDPAP there are no drug screens required and no background checks required. Now different agencies have their own internal policies that sometimes implement those things.

00;07;18;07 – 00;07;42;18

Megan Shergill

But community care is a firm believer that the consumer, they have their choice. Meaning if Mrs. Smith wants to hire her adult grandson, who perhaps does have some type of criminal history record for doing something stupid when she was young, she can still hire him. And people tend to be a little bit polarized in regards to, you know, different types of drugs, you know, like one way or the other.

00;07;42;26 – 00;08;25;18

Megan Shergill

But at least in this program, the consumer takes on the responsibility of choosing whether or not to trust someone to be her caregiver. And the beauty of it is that it allows the consumer, like Mrs. Smith, to be the boss of her home care services. And then the next question people often ask is, So what is a home care agency known as the fiscal intermediary and CDPAP actually do if Mrs. Smith is doing everything else, fiscal intermediary, we are solely responsible for enrolling families into CDPAP, make sure that they know the rules, regulations and responsibilities, and we monitor them on a certain frequency to make sure that they know and are still abiding by those

00;08;25;18 – 00;08;51;08

Megan Shergill

rules and regs and responsibilities. And then we process the people for the caregivers so that Mrs. Smith can wipe her hands clean when she’s being the front of the head boss. And we’re just simply the back out the back round, back end payroll processors. So to go back to my little fun dinner party facts, you mentioned that New York State’s term for this consumer directed home care model is C, D, pap.

00;08;51;16 – 00;09;07;15

Megan Shergill

But do you, Jeff, know which state in the United States? Because all states now have have a consumer directed type of home care program putting you here on the hot seat? What do you think is the state with the highest volume of consumer directed home care services?

00;09;08;07 – 00;09;15;15

Jeff Howell

Well, listen, Megan, I’m the one that’s supposed to be asking the questions around here. But let me guess. I’m going to say it’s got to be a good.

00;09;15;17 – 00;09;16;19

Megan Shergill

Yes, take a good guess.

00;09;16;21 – 00;09;43;11

Jeff Howell

Okay. It’s not going to be an obvious state based on population. It’s going to be a state that has really jumped in to self-directed care. If if I didn’t think that this was a trick question, I would guess I would guess New York, just because I’ve seen CDPAP everywhere versus other states, I think no one is actually branded a term of their own and they’re just using the generic self-directed care term.

00;09;43;17 – 00;09;44;16

Jeff Howell

So I’m going to go with New York.

00;09;45;11 – 00;10;09;14

Megan Shergill

Good guess. So CDPAP or the consumer directed home care model started in New York State in the 1970s by a group of individuals who were physically disabled and who the day sat around a round table. So they had diagnoses like M.S. or they were paraplegics. So they were alert, just physically disabled. And they said, We want your own boss, get the home care agency less involved.

00;10;09;21 – 00;10;29;21

Megan Shergill

So it started in New York State. That’s where then I’m disheartened because it’s actually not the highest volume state to have the consumer directed program. A lot of people guessed California because it’s very it’s a very progressive state. A lot of people. Yes. Florida, because of the high geriatric population, but it’s actually Washington state.

00;10;30;08 – 00;10;35;02

Jeff Howell

Oh, interesting. In Washington is pretty far down the list in terms of population.

00;10;35;03 – 00;10;50;16

Megan Shergill

Yeah, exactly. And another fun dinner party. Fact is, there is well, I’ll just tell you, Australia is the the only home care offering that they have for individuals is the consumer directed home care program.

00;10;50;28 – 00;11;12;02

Jeff Howell

I am well familiar with that. They’re probably the leaders in the world in that regard where, you know, you get a check and then you decide how to spend that money through. It’s a popular program and in fact, there can be things, for example, installing an air conditioner could qualify as a way to direct those funds know as an example.

00;11;12;03 – 00;11;20;25

Megan Shergill

So and in California their program is not called CDPAP. It’s actually called Bring your own Caregiver biopsy, which I think is cute.

00;11;20;27 – 00;11;26;11

Jeff Howell

Oh, okay. Okay. I’m learning some new things. I got to write that down by AOC. I didn’t know that.

00;11;26;19 – 00;11;30;02

Megan Shergill

This is why Jeff, people call me the CDPAP girl.

00;11;30;07 – 00;11;30;21

Jeff Howell

Yeah.

00;11;30;29 – 00;11;46;29

Megan Shergill

Is because I and this is why I’m so passionate about this program. Is it disheartens me knowing it started in New York State, but not enough people seem to know that it’s an option available to them. And you and I know not everyone’s right for this program, you know, so it’s good for them. Just at least know it’s an option.

00;11;47;03 – 00;11;51;21

Jeff Howell

You’ve you’ve kind of gone through that experience yourself with you being the fifth grade caregiver to. Right.

00;11;52;03 – 00;11;52;18

Megan Shergill

That’s right.

00;11;54;12 – 00;12;16;25

Jeff Howell

If I am a family at home and I’m just discovering home care and then my mind is blown about how we can have Cousin Tommy provide care. What steps do do the families take to affiliate themselves with the homecare agency? I’m assuming they pick one homecare agency to be the fiscal or the financial intermediary. Like how? How does it all work?

00;12;17;16 – 00;12;39;29

Megan Shergill

It’s a hard question to answer because every family or individual, as I’m sure you know, kind of starts at a different starting point being some people are not yet approved for Medicaid and this is a medic funded homecare program. So they first have to have Medicaid and then they have to go through an assessment process because just because you’re approved for Medicaid, I’m going to use Mrs. Smith again as an example.

00;12;40;09 – 00;13;08;24

Megan Shergill

Mrs. Smith is approved for Medicaid, but that does not mean that she’s automatic going to get approved for home care services, which can be considered to be like a community based homecare program. Right. So there’s an independent organization in New York State called NYA, NY, a the New York Independent assessor. So what my team and myself, our goal is to help walk people through that process of, okay, you’ve been approved for Medicaid.

00;13;09;02 – 00;13;39;25

Megan Shergill

Now you have to wear your family, have to call near to schedule an assessment to see if, one, you’re eligible for home care services because you and I, number one, can safely receive care at home and to how many hours will get approved on a weekly basis, because it varies, because what the nurse assessors are doing during the during these assessments is calculating how much physical assistance Mrs. Smith needs for each activity of daily living.

00;13;40;03 – 00;14;06;18

Megan Shergill

And then each task, like toileting, for instance, is accrued to a certain amount of time. So let’s say that the family has proven that Mrs. Smith needs physical assistance with toileting. I don’t know the exact numbers. Let’s just say that that has been a come and it coincides to 15 minutes. If Mrs. Smith toilet’s eight times a day time, seven days a week, that’s then how they start grouping, how many hours they’re going to approve for her.

00;14;07;04 – 00;14;56;08

Megan Shergill

So once then they get approved for homecare services. There’s a couple different parts. Geriatric individual typically gets enrolled into their local department of social services for the first three months or so, and then they’re prompt to enroll into a managed long term care plan, an insurance plan which then takes over paying for the home care services. Now, on the flip side, if it’s an individual with special needs that’s typically enrolled into what’s known as an Opw D waiver program or a TBI waiver program, then that individual is always enrolled and will stay enrolled into their local department of Social Services as the homecare payor source.

00;14;56;18 – 00;15;26;21

Megan Shergill

So whether it’s the geriatric individual under an MLT, C, a long term care company or a special needs individual, getting the home care services paid through the local department of social services, at some point they’ll be prompted to choose a home care agency and a type of service that’s then when those professionals are supposed to be giving them the option of choosing traditional home care services or CDPAP services.

00;15;27;00 – 00;15;54;00

Megan Shergill

And in my experience, I’ve found that they’re not often educated about CDPAP being an option. So that’s why I do a lot of these speaking engagements, a lot of virtual presentations. You and I are LinkedIn, LinkedIn now and LinkedIn. You see, I promote, I do a lot of virtual events, a lot of in-person events, just so that people know it’s an option because it’s very disheartening when they don’t realize that they could have more autonomy, privacy and independence using CDPAP.

00;15;54;09 – 00;16;03;21

Jeff Howell

Sure. Yeah. And I would suspect, you know, these are situations where there are family caregivers that are providing care anyways, and it’s a good opportunity for them to be compensated for it.

00;16;04;02 – 00;16;21;14

Megan Shergill

So here’s an example, if you don’t mind me just peppering in, say, Jeff, you work here 9 to 5, but just like generally speaking, you check in on your own mom after business hours to make sure she’s got a warm meal to help feed her before bed and then put her in her PJs, took her in a night.

00;16;21;25 – 00;16;43;05

Megan Shergill

You could get clocked in and get paid for doing those services through CDPAP. It doesn’t mean you need to be mom’s primary caregiver. You can hire someone or you know someone else with her mom or someone taking on that responsibility of being the boss. If she’s not self directing, can choose to hire other primary caregivers. But if you’re already doing that, it’s a win win.

00;16;43;05 – 00;17;01;12

Megan Shergill

And then for the special needs population, a lot of people don’t realize that once a special needs individual is 21 years old, their parent can get paid to be their caregiver, which is, you know, they’ve been doing this labor of love for years. Let them get some type of compensation for doing so.

00;17;01;27 – 00;17;23;10

Jeff Howell

Yeah, for sure. The general public really is only the pandemic actually shone a little bit of a light on home care. But, you know, CDPAP or any other self-directed care where family caregivers would really just have no idea about these programs. How many agencies would you say? I think there’s I think there’s about 1400. Alex’s. So those are the Medicaid agencies in New York.

00;17;23;14 – 00;17;26;25

Jeff Howell

What’s your estimate of how many of those would have CDPAP programs?

00;17;26;27 – 00;17;28;20

Megan Shergill

You know, you’ve done your homework, Jeff.

00;17;30;00 – 00;17;33;26

Jeff Howell

I like I like to throw out a few facts every once in a while and make it seem like an hour segment.

00;17;35;00 – 00;17;37;22

Megan Shergill

You also have dinner party, fun facts. I love it.

00;17;37;27 – 00;17;40;22

Jeff Howell

That’s right. Yeah. We should we should go to the same dinner parties.

00;17;41;21 – 00;18;00;17

Megan Shergill

We should we’ll be like we’ll be like a live with Regis and Kelly and we’ll just be like, you know, roosting together. Okay. So to go to your point, last, actually, my total was about 1300. Alex’s but you’re probably right. It grows every day. As you know, not every like a licensed was a super again licensed.

00;18;00;18 – 00;18;01;12

Jeff Howell

Licensed home.

00;18;01;12 – 00;18;46;00

Megan Shergill

Care Service agency Alexa, I used to say that to my parents and they said something like what you’re saying now you have a license home to your service agency. Not every Alex’s has a CDPAP, f I, so you can’t directly correlated to them. But the last count in about 2017 that I saw that was that we foiled information that was published, said that there was about 800 CDPAP fires in New York State alone, which to me is mind blowing because you definitely you know, Jeff, as of a few years ago, around 20 2019 or 2020, before then, there was no application process or registering process or certification process to start up a CDPAP.

00;18;46;00 – 00;18;53;19

Megan Shergill

If I. So Jeff, I literally could have just said to you, Jeff, you want to open up a CDPAP fire in my basement? Sure, let’s do it. And let’s just.

00;18;53;19 – 00;18;54;03

Jeff Howell

Put it on the.

00;18;54;07 – 00;19;27;13

Megan Shergill

State Department of Health. The exactly. New York State Department of Health would be none the wiser, which is terrifying because I just got off the phone literally right before this meeting that we’re having today with a family member. That said, the other agency that I spoke to sounded so sketchy, so car salesman type, they didn’t know the rules, the regs, etc., because there was no application or certification process, which scares me because then they’re not on New York State Department of Health’s radar, meaning that they’re not getting audited.

00;19;28;03 – 00;20;10;00

Megan Shergill

What happened then, Perhaps if I can Segway is in your state, implemented something called an RFL. I forget what year I was, either 2019 or 2020. RF Oh, tons of fun acronyms. Am I right? The request for offers. So they implemented this New York State Department of Health basically saying that any CDPAP that wants to remain in business providing CDP services must complete a lengthy application process, include ing a thesis of best practices meaning like why New York State should choose them to be one of the remaining CDP hap five.

00;20;10;00 – 00;20;16;20

Megan Shergill

And when I’m talking thesis Jeff the one that I wrote was about with the help of the CEO at the time was about 400 pages.

00;20;16;24 – 00;20;17;20

Jeff Howell

Oh boy.

00;20;17;29 – 00;20;49;08

Megan Shergill

We put our blood sweat and tons of tears into that. Right, exactly. But then wait, Jeff, there’s more. As we know, New York State Department of Health tends to change things quite quickly. So we submitted it and then the pandemic happened. So under standardly they kicked the can in regards to who they were going to award to be the remaining 60 or so c f eyes, which is understandable.

00;20;49;08 – 00;21;15;12

Megan Shergill

Once the pandemic, the height of the pandemic died down a little bit, then they revisited. They then awarded about, I think it was between 62 to 68 CDPAP FI eyes. However, they did not make it public as to the criteria of how they chose them, which as you can imagine for the 700 plus other IFIs that weren’t chosen, there wasn’t an upheaval.

00;21;15;12 – 00;21;54;00

Megan Shergill

You know, let’s see what your criteria was. Why did you choose A, B and C agency over us? So then, oh, wait, there’s more. New York State Department of Health said you right. You’re right. We didn’t we didn’t make it clear what the criteria was going to be. And instead let’s renege on the whole RFA and instead said, if you can prove that you were a c pap f i that serviced 200 consumers in one county, I believe it was of the year of 2019 or 2020, Don’t quote me.

00;21;54;21 – 00;22;08;13

Megan Shergill

Then we’ll award you permission to move forward as one of the remaining five. There were two criteria. It was either servicing 200 consumers and one county or servicing, I believe, the borough or something like that. Does that sound familiar to you, Jeff?

00;22;09;02 – 00;22;26;08

Jeff Howell

I’m not familiar with that, but it makes sense that you have a criteria of existing volume that you’re servicing. I could see that as being so at the end or at the end of that. What was the shake out? If there were 62 to 68 before? And then when they rebooted this, where we at now.

00;22;26;19 – 00;23;09;03

Megan Shergill

They said around November that they would announce the awardees January 1st. Do we know what happened January 1st they kicked the can and now they said that they’re going to announce perhaps mid April. So we just wait. We do our best practice and what we do is I continue to do things like this is educate the community and I don’t know if you’ve gotten a chance, Jeff, to go onto Google and search community care, Home Health Services, Smithtown, which is our corporate office because we have so many offices.

00;23;09;03 – 00;23;30;11

Megan Shergill

But if you search Smithtown, you’ll see as of last night I believe we have 139 reviews with a 4.6 out of five star rating. And we’re very proud of that because as you and I know in the human services industry that people tend to only leave poor reviews. No one really goes out of their way to leave good reviews and you can’t pay for these reviews.

00;23;30;11 – 00;24;14;01

Megan Shergill

These are genuine reviews from from community members. So when I educate people about CDPAP, I always say I let them know the low down about the sketchy eyes out there who don’t right now always follow the rules and regulations and get audited. And the great thing about community care is we are also Alexa, so we know that at least on an annual basis, the New York State Department of Health, as well as different insurance payer sources, will come into our offices and audit our files, which is an open door policy because we’re doing things the right way, whereas an organization only providing CDPAP services may not be doing things above board, so to speak, or

00;24;14;02 – 00;24;14;28

Megan Shergill

above bathroom speak.

00;24;15;17 – 00;24;41;16

Jeff Howell

Got it. So circling back to a family, taking the very first step, no one would know to Google CDPAP New York. So if they arrive at home like they Google Homecare plus their local geography, maybe they’ll find out the land on the one of the companies that actually provides CDPAP. Most people wouldn’t know about the and why. A and I suspect that’s not the first step for families to take.

00;24;41;19 – 00;24;59;22

Jeff Howell

If you’re a family, like if if you’re advising a family on what they should do as their very first step, say they’re listening to this podcast like oh, I had no idea that there’s this consumer directed personal attendant program. Yeah, I provide care for mom. What’s the very next thing that I should do?

00;25;00;06 – 00;25;30;09

Megan Shergill

I would recommend selfishly, I would love for them to call myself or our team just to learn more, but honestly, for them to do their due diligence searching terms in Google like CDPAP, New York, look through the different agencies, make sure that they’re more mission driven rather than just trying to get your business, because our team is mission driven and fueled by just trying to be advocates and educating the community, because I can’t tell you how many people I turn.

00;25;30;09 – 00;25;49;04

Megan Shergill

I turn away just when I realize that perhaps this is not the right program for them, simply because it requires a lot of organization and oversight. And like a type-A personality, I don’t know if you picked up, I am a type-A, so I can say that. So but if you’re if you’re easily overwhelmed, this is not the program for you.

00;25;49;04 – 00;26;12;17

Megan Shergill

And that’s fine. That’s so great, because then we also have that traditional home care side that I can offer a warm handoff to, but the average person should be doing their due diligence looking on the social media platforms of the agency is to make sure that they are educating, that they’ve got great Google business reviews and talk to other professionals in health care.

00;26;12;17 – 00;26;26;18

Megan Shergill

Meaning if you’re working with an elder law attorney or a medicaid specialist or a special needs advocate, something like that, ask them, who do you trust? Because I would be very surprised if if you didn’t mention us, quite honestly.

00;26;26;29 – 00;26;33;07

Jeff Howell

Yeah, I can independently verify. I’m seeing 139 Google reviews at a 4.6 rating.

00;26;33;07 – 00;26;36;26

Megan Shergill

So listen, I’m prepared, Jeff, and I look at that every day.

00;26;37;16 – 00;26;42;19

Jeff Howell

Nice. What do you see as the trends that you think are going to emerge, Megan, over the next few years with the program?

00;26;43;03 – 00;27;08;09

Megan Shergill

I’m hopeful that New York City Department of Health will be true to their word and choose the remaining city path is like they’ve expressed. There’s already submitted our what’s known as an attestation proving that we serviced over 200 consumers in one and more counties at that time. So I’m hoping that they just don’t shift years and change their their minds for whatever reason.

00;27;09;01 – 00;27;25;08

Megan Shergill

But regardless, I really do hope that they reduce the amount of sea of ice. However, they don’t reduce it to only one because you can’t have a monopoly and you have to have consumer choice. Are you familiar with what CEOs are? Jeff?

00;27;25;21 – 00;27;26;11

Jeff Howell

I’m not.

00;27;26;27 – 00;27;56;24

Megan Shergill

So sea CEOs are are. It’s an acronym CARE Coordination organizations, and they are essentially case managers for typically the special needs population. And years ago, maybe like a decade ago, New York State Department of Health did the same type of awful process because there were too many CEOs and they were pushing to have only one remaining CEO service all of New York state, which is not right because consumers deserve choice.

00;27;57;05 – 00;28;21;27

Megan Shergill

So what instead they did was they approved seven remaining CEOs. And at least for every territory, there’s at least two to choose from, meaning that there’s some overlap in territory. But for every territory there’s at least two to choose from. So I’m hoping they do the same thing, maybe a little bit more volume. But for the city path of AIS, just to make it fair for the individuals and families we serve.

00;28;22;23 – 00;28;41;25

Jeff Howell

And I think it’s pretty rare. There might only be a couple of companies that can even try to think of that. Their main business is CDPAP, like I would tend to think it’s most people are in the Medicaid personal care space and then they’ve added being an f I for CDPAP on the side with RN, it’s a small priority for them.

00;28;41;26 – 00;28;45;21

Jeff Howell

Or is that what you would put as the general landscape?

00;28;46;05 – 00;29;07;03

Megan Shergill

I think it’s a healthy mix, to be honest with you. There are some of those like that. Just do CDPAP kind of like as a side gig for people who want that independence. But then I don’t want mention any names. There is a huge CDPAP fly that actually has very poor ratings on Google but has a lot of radio commercials and TV commercials, and their only business is C pap.

00;29;07;22 – 00;29;35;08

Megan Shergill

But again, part of what our team, part of what our team does is we always jot down the feedback from families that transfer from different F to our airline and the trend that we’re seeing is either the other FAA is not responsive, not accessible, or they promised that a caregiver a high pay rate. But even though they offered them a very high rate, that caregiver is not getting paid timely or accurately.

00;29;35;17 – 00;29;54;19

Megan Shergill

So what’s the sense in getting an extra dollar or two an hour if you’re not getting paid timely or accurately? So we jot all this information down. And then on our weekly team meetings that myself and my manager just held with our team today on Friday is always how do we elevate? And actually that was our word of the month for last month was the word elevate.

00;29;54;25 – 00;30;16;19

Megan Shergill

How do we become better knowing this and I personally conduct weekly surveys with our caregivers and our consumers to get their feedback to improve our best practices. And because I know you’re wondering on my work, my whiteboard to my left right now, the word of the month for this month is love. Because of Valentine’s Day and because we love what we do.

00;30;17;07 – 00;30;22;05

Jeff Howell

That’s great. It’s also my mother’s birthday, so I never forget to call her on her birthday.

00;30;23;05 – 00;30;25;04

Megan Shergill

No way. Oh, my goodness.

00;30;25;05 – 00;30;51;18

Jeff Howell

Yeah. Yeah. It’s easy to remember. So a question for you on some of the challenges with the program, like I would imagine with electronic visit verification and you have these family caregivers know there’s the potential for Cousin Sally just not to show up. And then for the client not to say anything. I’m curious how the fi is really help to try to manage compliance and crack down on fraud.

00;30;52;23 – 00;31;13;26

Megan Shergill

So obviously I can’t speak on behalf of other efforts. And I do think that this program just as a whole is fraught with Medicaid fraud and kind of some shady business from both sides, from families and FIES who are trying to build Medicaid. And there’s been a lot of news as of late of people getting caught, which is why I’m proud to say that we are also a fact, you know, we’re going to get audited.

00;31;14;26 – 00;31;51;15

Megan Shergill

So I don’t know how much of your audience knows, but there’s actually a federal law called the 21st Century Cures Act that was implemented a year or two ago, I believe, which requires that any Medicaid program will make it mandatory for the caregivers to clock in and clock out using electronic visit verification. There’s two ways either clock in and clock out, using the to Smith’s home phone, using a toll free number, or they can use their personal cell to use an app that’s got geo locator to verify the GPS location.

00;31;51;25 – 00;32;17;21

Megan Shergill

So that’s required. And there’s no ifs, ands or buts. That’s a federal law. So all of our caregivers are required to do that. And do we get a little bit of pushback in the beginning? Of course. But but then we explain to them that if they use that, they will get paid timely and accurately. So once you explain that to them, rather than sent mailing in a timesheet that could get lost, the USPS, you know, now they’ve got buy in.

00;32;18;02 – 00;32;43;01

Megan Shergill

In addition to that, our team does two additional things that some other agencies may not do. We do what’s known as monitoring visits. So some of those monitoring visits are essentially spot checks done via telephone. And the beautiful thing about CDPAP is that the consumer has the right to change his or her schedule week to week as long as they don’t go over the weekly amount of approved hours.

00;32;43;09 – 00;33;09;17

Megan Shergill

So it’s hard for us to spot check telephonic we because I could call Mrs. Smith and she could say oh Cindy Lou was usually comes on Fridays but we actually changed to Saturday this week so it’s kind of hard to spot check in that way. But still we do these monitoring visit reports for a couple of reasons to make sure that they’re still aware that their caregivers must use electronic verification to make sure that the consumer is so alert and oriented.

00;33;09;17 – 00;33;40;27

Megan Shergill

And if not that they have someone designated as their designated representative to take on those responsibilities and that three, they still understand the rules and the regs and the responsibilities of the program. So we do that telephonically on a certain frequency as well as we have our field representatives go into consumer’s homes to also assess the environment, assess the alertness of the consumer, if to consider, to be alert and to check in the caregiver, to make sure that they understand how to use the event.

00;33;41;11 – 00;34;06;19

Jeff Howell

Right. Love it. And I’m sure all of that really helps contribute to your 139 Google reviews. For the consumers listening at home. The CARES Act was an Obama era piece of legislation that put a deadline on all Medicaid visits to be clocking in and clocking out. Right because no one’s late on a paper time sheet and they’ve always made it there.

00;34;07;14 – 00;34;27;16

Jeff Howell

And that’s rolling out into the Medicare space. But within three D pap, although the caregivers are typically neighbors and family members, they still have to abide by having a mobile app on their phone to clock in so that the fiscal intermediary can understand that someone was there for the visit. And when they clock out as well. So, Megan, we’re bumping up against our time here.

00;34;27;16 – 00;34;34;17

Jeff Howell

I’ll get you out of here on this question. Give us a reason to be optimistic about care delivered in the place where clients call home.

00;34;34;17 – 00;34;40;16

Megan Shergill

Well, I never want to rush your conversation with you, Jeff. You brushed me out of our places to beat up. I’m not kidding. I got work to do.

00;34;40;16 – 00;34;46;06

Jeff Howell

It’s my kids are home and Netflix so that I could know.

00;34;46;06 – 00;35;11;18

Megan Shergill

But Jeff, it’s been a real pleasure. Reasons for people to be optimistic about the future of care at home is I don’t know about you, but when I age, I want to age in place. I want to still have independence, privacy and autonomy, directing my own. So, you know, when that time comes, whether I’m in California with the IOC or New York State with the CDPAP, I want care at home.

00;35;11;26 – 00;35;37;18

Megan Shergill

And I think the pandemic really brought to light. There’s nothing wrong with a facility setting if it’s most appropriate for individuals. But if an individual has the ability to safely receive care at home, I think we can all default to saying that’s really where we would prefer to be. And the great thing about the consumer directed personal assistance program is that its purpose is to keep individuals within their communities, not just their homes.

00;35;37;25 – 00;36;00;21

Megan Shergill

We’re talking, running errands, escorting to medical appointments, going to festivals, going to the movies like it’s meant to keep them infiltrated. And I think that after the pandemic, we saw a huge rise in almost like PTSD and loneliness with especially the aging population that really required a lot of, you know, companionship. They didn’t see people for a long time.

00;36;01;00 – 00;36;40;02

Megan Shergill

So CDPAP part of the scope of practice is, of course companionship as well as the physical assistance of activities of daily living. So I think that everyone kind of saw the trend and the writing on the wall that home care is probably the way to go. And if you haven’t mentioned it enough times already, Jeff, I really just encourage your audience to consider reaching out to me for whatever questions they have about home care in general, because I’ve lived in the special needs community, I’ve lived on the lakeside and I’m currently living in the city realm, so I’m well-versed and I’m fluent and I’m always happy to help, even if they don’t choose our organization.

00;36;40;17 – 00;36;52;07

Jeff Howell

Yeah. So Megan’s a regular user of LinkedIn as well. So in the show notes, you can see how her name is spelled and find her on LinkedIn and what’s the website for your company as well?

00;36;52;17 – 00;37;01;18

Megan Shergill

Sure. So it’s community care. H as in Harry, ages in Harry S as in Samantha dot com.

00;37;01;18 – 00;37;22;20

Jeff Howell

Great. Well, Megan, I took three pages of notes. Here I am privileged to be able to mingle with some interesting people in the industry. I have say this is the most niche and revealing topic that I’ve had. We certainly got enough acronyms in, so I learned a few new ones today and I want to thank you for coming on.

00;37;22;20 – 00;37;24;16

Jeff Howell

This has been an outstanding episode.

00;37;25;08 – 00;37;31;17

Megan Shergill

Jeff, Can you write that down and put it put it on a plaque on my wall. I would love to get that feedback, so I’ll.

00;37;31;17 – 00;37;32;26

Jeff Howell

Put it on the Google reviews.

00;37;34;12 – 00;37;46;14

Megan Shergill

I was going to say, if you don’t mind, it helps. I always say it helps families and professional girls make better, well informed decisions in regards to home care services. So yes, if you don’t mind. Thank you so much, Jeff.

00;37;46;15 – 00;38;13;24

Jeff Howell

Okay. All right. Thanks for coming in today. Thanks, Megan. Take care. Home Health 360 is presented by AlayaCare. First off, we want to thank our amazing guests and listeners. To get more episodes. You can go to alayacare.com/homehealth360 that spell home health 360 or search home health 360 on any of your favorite podcasting platforms.

00;38;14;08 – 00;38;35;13

Jeff Howell

The easiest way to stay up to date on our new shows is to subscribe on Apple podcasts, Spotify or wherever you get your podcasts. We also have a newsletter you can sign up for on alayacare.com/homehealth360. Get alerts for new shows and more valuable content from a link here right into your inbox.

00;38;35;25 – 00;38;45;22

Jeff Howell

Thanks for listening and we’ll see you next time.