Home Health Care Expanding its home care turf

Expanding its home care turf


A 112-year-old home health agency in Westchester County is expanding its geographical reach and adding staff to meet new demand for its services in the nation’s and New York’s changing health care landscape.

Based in White Plains, the former Visiting Nurse Services in Westchester & Putnam has been renamed VNS Westchester as it expands its Medicare-certified services this year to the Bronx, Rockland and Dutchess counties. The agency, the largest nonprofit, community-based home health care provider in Westchester, began serving Putnam County residents two years ago. Putnam County sold the license to the agency for $250,000.

The expansion, which already has led VNS Westchester to increase its skilled nursing staff by 10 percent since September, follows an approximately 20-year moratorium

in New York on the creation of new certified home health agencies, said Elias M. Nemnom, president and CEO of VNS Westchester. The moratorium was lifted by the state Department of Health in late 2011, as the state began implementing measures recommended by Gov. Andrew Cuomo’s Medicaid Redesign Team to provide less costly and more efficient and coordinated long-term care for Medicaid patients needing more than 120 days of home care service and keep them out of nursing homes.

Nemnom said VNS Westchester was one of 14 agencies approved for expansion among 137 first-round applicants statewide, and one of seven agencies approved among 35 applicants in a second round, when the Bronx was added to its service territory.

Bronx residents often are referred to southern Westchester hospitals with which VNS Westchester works, Nemnom noted. “This is a very strong opportunity for them to do one-stop shopping with us,” he said.

That one-stop shopping now is also available to patients from the lower Hudson Valley at Westchester Medical Center and for Dutchess County residents referred to Putnam County hospitals with which VNS is affiliated, Nemnom said.

The nonprofit, which Nemnom has led for about two years, has about 250 employees, including 200 clinicians, in its VNS Westchester operation. The organization employs an additional 250 workers, including 200 home health aides, in Westchester Care at Home, which provides personal care services to about 200 patients.

VNS Westchester’s skilled nurses see about 1,200 homebound patients daily, Nemnom aid. “Our growth would be even more if we had the staff to service the population,” he said.”Recruiting nurses is a very difficult process. It’s not that easy to get a new, qualified home care nurse.”

With home health care a key element of federal and New York health care reform initiatives, “There’s much more interest now” among care providers, said Mary Gadomski, VNS Westchester’s director of community education. “There’s a lot more competition for the same professionals.”

Agency officials have estimated the expansion will bring a 10 percent to 15 percent increase in patients for VNS Westchester. “We’re starting at ground zero,” Nemnom said. “We think there’s going to be a ramp-up period of one to two years.”

Currently the agency’s annual revenue is about $35 million, about 70 percent of which comes from Medicare reimbursements and 15 percent from Medicaid, said Nemnom.

The agency anticipates more opportunity and a higher demand for its services in parts of its newly expanded territory. The Bronx has 1.3 million residents, 40 percent of which are eligible for Medicaid benefits, Gadomski noted. By comparison, 10 percent of Westchester’s approximately 1 million residents receive Medicaid, she said.

VNS Westchester has a Brewster office that directs patient services in Putnam and Dutchess Counties. Patient cases in Rockland and the Bronx will be managed by the White Plains office.

Among home care providers, “Definitely there’s more competition,” said Gadomski. In Westchester, five certified home health agencies have opened since VNS Westchester’s expansion was approved, she said.

Even with the increased competition, “There are enough patients to go around,” Nemnom said. But the health care services they receive must be coordinated rather than “siloed” as they have been, he said.

Nemnom said home care will determine the success of federal Affordable Care Act initiatives to improve the quality of health care in the U.S. while lowering its costs. “If home care fails in this whole process, the whole goals of the system will not be met. For us, it’s an exciting time because we’re a key player in this environment as it progresses over the next few years.”

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