A Nursing Home's Journey into HCBS

Isabella Geriatric Center, a not-for-profit, non-sectarian organization in New York City pioneered the care of older adults since 1875. Isabella has grown from a traditional nursing home to a leading healthcare organization providing a continuum of services on its own campus and in the community-at-large.

Today, Isabella offers a variety of community programs designed to help older adults remain healthy while living at home, including moderately priced senior housing, adult day health care, child day care, home care, certified home health, licensed home health and short and long-term rehabilitation.

What impact has HCBS had on your organization?

Mark Kator, president and CEO of Isabella Geriatric Center, said the expansion into home and community-based services was mission-driven. At first they subcontracted with 15 home health agencies, and then they evaluated the effectiveness of the care, and came to the conclusion that they could provide quality care by operating their own home health agency, according to Mr. Kator. They wanted the continuity in quality of care from the community into the nursing care facility. Isabella Geriatric provides over 1 million hours of services for older adults through their programs. When asked about the challenges of expanding into home and community-based services, Mr. Kator replied that Isabella is ensuring effective communication throughout the organization, and moving from fee-for-service to managed care.

Mr. Kator believes that managed care companies must be close partners with providers. Isabella’s care-management program contracts with managed care companies. They currently have 700 care-management cases. The managed-care companies may want to use another home health agency. It is their choice and the consumer’s choice. Isabella's home health agency currently has 600 home health aides, and about 500 home health cases in 2014. The certified home health agency, one of its newest services, currently serves about 42 clients. Isabella’s adult day health program serves about 70 individuals, with an average daily census of 33. This unique program serves mainly Hispanic older adults.

Isabella Geriatric Center programs are known for the ethnic and cultural diversity of the older adults that they serve, including Chinese, Russian, and Hispanic older adults. The staff is also ethnically diverse. They speak the language and know the cultural traditions of the individuals that they serve.

Isabella Geriatric recognized the importance of having affordable housing as a platform for long term services and supports. Mr. Kator said that his organization created 2 Naturally Occurring Retirement Communities (NORCs) and one neighborhood NORC. The Neighborhood NORC serves older adults who reside in a 15-block area in Manhattan. They used grants that were funded through NCOA and the Medicare Rights Center to open a Resource Center for the community located in a store front. They have become a vital resource for their community, not only a care provider. The secret is reaching out to the community through different programs. There is no one-size-fits-all program. The Bristol Meyer Squibb Foundation and United Hospital Fund funded Isabella’s Diabetes self-management program. They also have a 50-plus club that provides seminars and exercise programs for older adults. The expansion into home and community based-services has had a positive impact on workforce. Isabella trains its own home health aides, and contracts its home care staff to work in the nursing home when needed.

The home health agency is a separate not-for-profit corporation, but it does share some services with the parent organization including some billing and human resource functions. The management team across all provider types and services interact on improving quality. For example the nursing home directors sit on the Advisory Committee for the home care agency. Isabella Geriatric Center’s Board oversees the entire continuum. As Mr. Kator said, “we don’t want to compartmentalize our services. All the staff at Isabella Geriatric Center work together to achieve their organization’s mission.”

Peter Notarstefano is the director of home and community-nased services at LeadingAge.