LeadingAge New York Adviser Winter Vol. 1 | Page 28

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to convene a summit to look closer at this issue.
We have gathered demographic data and are
in the process of developing a medical group
home model through the NYS Office of People
with Developmental Disabilities (NYSOPDD) for
this population.
Beyond the overall mission that has evolved
to serve a larger continuum, we have a host of
specialty service areas that include:
• Treatment of pediatric respiratory issues
including vent-weaning but also complex
pulmonary issues. We have full-time
respiratory therapy 24 hours a day, seven
days a week for 365 days a year.
• Full time medical staff that allows us
to care for very sick children and avoid
rehospitalizations.
• An intestinal rehabilitation program for
children with short bowel syndrome.
• A neuro-rehabilitation program which
has some of the most state-of-the-art
neuro-rehab equipment in the New York City
metropolitan area.
• A feeding program for infants and toddlers
that refuse to eat, where we not only get
kids to eat but train parents in the feeding
modalities so they have long term success.
We even use technology such as Skype to
train families that come from a distance
• An award winning palliative care program
that has been very active for over 30 years.
What are the challenges you feel are
unique to serving your particular niche?
What are your challenges in terms of
funding? What has the move to a long term

care managed care environment meant for
your organization?
We really expected to get bombarded with
these transitions from fee-for-service Medicaid
to managed Medicaid but we currently only
have about a 20 percent penetration on the
medical model adult day health program. On the
inpatient side there’s only about 25 percent but
that 25 percent really takes its toll both on the
bottom-line and on outcomes.
Outcomes are directly affected because we are
often forced to discharge children earlier than
we would like and the next thing that you hear
is that they are back in the emergency room,
or readmitted to the hospital, and then back
to us. These are classic cases of premature
discharges that happened because there is
no recognition of the unique needs of these
children and families as part of managed care
plan operational procedures. In addition, the
managed care plans require considerable
communication including weekly updates in
order to continue to authorize coverage on the
outpatient side requiring a lot of staff time that
really impacts our bottom line.
Managed care is a challenge for every provider,
both adult and pediatric. What might be unique
is that in our attempts to move children through
the continuum we are finding there aren’t
enough services for children in the community
that are as robust enough for medically complex
situations. The challenges associated with
getting kids home include housing issues,
social supports or finding private duty nursing
and the lack of understanding by managed
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Adviser a publication of LeadingAge New York | Winter 2015