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Tag: Home care

  • Is Medicare’s Hospital at Home program here to stay?

    Is Medicare’s Hospital at Home program here to stay?

    Since the Covid-19 pandemic, Medicare has been paying hospitals to treat patients at home, instead of in hospital, under its Hospital at Home program. Medicare pays hospitals the same rate for the care of these patients as it pays for hospital patients, including a facility fee. But, is the Hospital at Home program delivering benefits to patients?

    Under the Hospital at Home program or H@H, patients with 60 acute conditions, such as pneumonia, urinary tract infections or congestive heart failure can sometimes opt to get their hospital care at home, reports Richard Eisenberg for Fortune. The goal of H@H is to provide a more comfortable and safer care environment to patients. Patients are prone to fall in the hospital as well as to experience delirium.

    H@H has been around a long time both in and outside the United States, but it is only recently that Medicare has adopted it. Hospitals appear to value the hospital at home program for people with Medicare. After all, they are generating the same revenue through the program that they would receive if patients were in hospital, without the facility costs.

    But, unless Congress acts, the program will end in December of this year. The American Hospital Association is arguing for a five-year extension of the program. It offers little data to demonstrate the value of the program.

    Congress is likely to extend Medicare’s Hospital at Home program another five years even though there’s no good data to show better patient outcomes from the program and it is not saving the Medicare program any money, reports Jessie Hellmann for Roll Call.

    The Medicare Payment Advisory Commission reports that the program is not structured to deliver meaningful information on health outcomes and costs or to allow comparisons between patients treated at home and patients treated in a hospital facility. It wonders whether patients in the program are falling less frequently than patients in the hospital and whether they are experiencing fewer infections.

    How does the Hospital at Home program work? Hospitalized patients at participating hospitals can decide whether they want H@H. Generally, they are in need of four or five more days of hospital care. Participating hospitals are required to send clinicians to your home twice every day. A physician must “see” the patient each day as well, though the physician can do so remotely. Patients must be able to reach the hospital 24 hours a day. And hospitals must be able to respond to patient emergencies within 30 minutes,

    Among other things, H@H can provide IV antibiotics and infusions to patients at home. They can receive EKGs and X-rays. The hospital can monitor their blood pressure. And, they can get oxygen therapy.

    The program is still relatively small. Since its inception, just 328 hospitals in 37 states have participated, and 23,000 patients have been discharged from hospital into the program.

    National Nurses United does not support the H@H program. It calls it “Home All Alone.” Indeed, people can be sent home for their hospital care without a caregiver to be with them. That leaves them without the round-the- clock nursing care they receive in the hospital. And, what if the remote monitoring technology misfunctions or there’s an emergency and the patient can’t get the prompt attention that’s needed?

    Here’s more from Just Care:

  • Critical home care is no longer affordable for most people and too often not available

    Critical home care is no longer affordable for most people and too often not available

    Caring for an older person with multiple needs can take a toll physically, emotionally and financially. Reed Abelson reports for The New York Times on how reliable home care is hard to come by and not affordable over the long-term.

    Frank Lee, the husband of one woman with dementia, was tending to his wife morning, noon and night. He ended up putting her in a respite program at an assisted living facility so he could take a short break. While he was away, she fractured her sacrum. Mr. Lee was at a loss to find home health aides he could trust, the plight of many older couples.

    Eight million older adults suffer from dementia or need help with at least two activities of daily living, such as bathing and toileting. Only a small fraction of them–one million–have paid help outside a nursing home. Three million have no help.

    Our federal government does little to help people who need home health aides. Medicare only covers very limited home health health care and, then, only for people who are homebound and who need skilled nursing on an intermittent basis or skilled therapy. People with dementia don’t usually fit these criteria. If you don’t have Medicaid, you are generally out of luck in terms of government assistance and, even with Medicaid, there are often waitlists for home care.

    Most older adults are cared for by family, not professionals. They cannot afford $27 an hour, the going rate for a home care aide. Paying for fulltime home care usually means expenses of tens of thousands of dollars a year. Usually it is the older adult’s spouse or daughter  who takes on the role of caregiver.

    People who can afford to pay for a caregiver often cannot find one with the skills to take care of their loved ones. They are often forced to hire untrained caregivers. Paid caregivers in the US rarely earn a living wage; they often can’t count on fulltime work. And, they tend not to get health insurance benefits. It’s no wonder that there is a shortage of paid caregivers; they can get better jobs for the money.

    What to do? Plan ahead. Talk to your loved ones about likely long-term care needs. Even if you have limited resources, it is better to be prepared. Most people do not have these conversations. Families are often unprepared. Many families cannot save enough to offset the cost of long-term care. But, if you plan ahead, you could qualify for Medicaid.

    Keep in mind that long-term care needs can be extensive. Sometimes, two people are needed just to move someone from one place to another. Without assistance, simple tasks become huge burdens.

    Mr. Lee wonders “What’s the end game look like?” Is it right that he should watch his wife, who is already severely demented and unable to take care of herself or speak, deteriorate further? “As she disintegrates, I disintegrate.” When people are terminally ill–six months or less of life–Medicare covers hospice care, which covers some home care. But, good luck getting it if you’re in a Medicare Advantage plan. And, even in traditional Medicare, finding an agency that will provide hospice care can sometimes be challenging.

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  • Long-term care insurance is broken

    Long-term care insurance is broken

    An article in the New York Times by Jordan Rau and JoNel Aleccia explains the broken long-term care insurance system in the United States. Not only are long-term care insurance policies expensive, they often don’t cover some or all of the long-term care services people need. And, though 70 percent of older Americans are expected to need long-term care at some point, only a small percentage of them can afford it.

    What’s wrong with long-term care insurance? Long-term care insurance policies can have 90-day waiting periods before they kick in, forcing people to pay thousands of dollars out-of-pocket for care while they await coverage. And, these policies generally only cover care when people need help with at least three activities of daily living, including bathing, toileting, dressing, feeding and transferring. They also generally have caps on the amount they pay out and rarely cover people’s full long-term care costs.

    One 91-year old woman profiled in the New York Times story had children who paid into her policy for 35 years. Even though older long-term care policies tend to be more generous than newer policies, this long-term care insurance policy did not cover home health aides. Without home health aides, the woman could not remain in her home.

    The reporters make clear that private long-term care insurance is “wildly inadequate in providing financial security” to most older Americans wanting to age in place. But, they claim the issue is poor planning on the part of the insurers as to the cost of long-term care when people cashed in on their policies. As likely, insurers knew full well what the cost would be and got people to sign up for long-term care insurance by misleading them into thinking that their low initial premium would not rise dramatically over time. (The reporters say that insurers lost $2.3 billion in 2019 and then profited $1.1 billion in the following two years during Covid. In 2022, they allegedly lost $304 million.)

    The insurers have far less to worry about when they sell a policy that could cost them more down the road than the individuals who buy their policies. The insurers can protect themselves by refusing to cover people with health conditions. And, when they do cover people, they can raise their premiums significantly. “Level premiums,” which people are usually promised, are not what most people think they are. Level premiums can increase significantly to the point where people are forced to drop their policies, getting nothing in return for all their premiums.

    One person profiled in the article gets it just right: “‘It’s a giant bait and switch,’ said Laura Lunceford, 69, of Sandy, Utah.” Her annual premium jumped $1,900 to $5,700 in a few years. But, Lunceford argues that the insurers had a bad business model and didn’t realize it. That’s not evident. The insurers had a model that served them well, at least in the short term, with lots of people unable to pay premiums over time and forced to let their policies lapse.

    The reporters say that the long-term care insurance lapse rate is only 1 percent. When I was a consumer representative at the National Association of Insurance Commissioners, the insurers refused to disclose their lapse rate. I would like to see the data. It’s hard to believe so many older adults with long-term care insurance, living on fixed incomes, could manage to pay significantly higher annual premiums– sometimes a doubling of premiums–each year.

    Long-term care insurance does help some people protect their savings. But, these people are few and far between, generally, the people with a lot of money to spend on premiums. Some, if not many people, who should get benefits struggle to get insurers to pay them in a timely fashion if at all, according to the National Association of Insurance Commissioners. And, some who receive benefits have paid in more in annual premiums than they receive.

    Experts say that most people can do better saving money to pay for long-term care on their own than paying for a long-term care policy or spending down to Medicaid and getting government-provided long-term care services.

    The big issue is that our government, unlike the Netherlands and Singapore, does not protect most people when they need long-term care. And, care is so expensive that most people are left struggling, reliant on family caregivers whom they do not need to pay. Savings are rarely enough to cover the cost of long-term care services. The luckiest Americans spend down their savings to qualify for Medicaid in states that are able to provide them with home care or nursing care when they need it.

    Here’s more from Just Care:

  • PACE helps older adults stay in their community

    PACE helps older adults stay in their community

    The Program of All-inclusive Care for the Elderly (PACE) is a home and community-based program designed to keep older adults who are at risk for nursing home placement living in their community.  PACE is a partnership between a local sponsoring organization, and Medicare and Medicaid health insurance programs. To become a PACE “participant,” a person must be nursing home eligible. While a person can pay privately for services, most participants have Medicare, Medicaid, or both insurance programs.

    The PACE philosophy: PACE members are called “participants” because they are encouraged to participate in their care–decision making and active care–whenever possible.  The overarching goal of the PACE Model of Care is to keep people living in the community and out of institutional care.  While an individual does not need to visit the PACE Center, which offers adult day programs with wrap around health services, it promotes socialization and addresses common problems of isolation, loneliness, and boredom.

    Who can get PACE? Programs of All-Inclusive Care for the Elderly (PACE®) serve individuals who are age 55 or older, certified by their state to need nursing home care, able to live safely in the community at the time of enrollment and live in a PACE service area.

    How does PACE work? PACE works by providing care and services in the home, the community, and at the PACE center. It is team-based care that provides everything covered by Medicare and Medicaid if authorized by your health care team.  If your health care team decided you need care and services that Medicare and Medicaid doesn’t cover, PACE may still cover them.  The team provides comprehensive coordinated care and includes the PACE participant, physician, nurse, social worker, recreational specialist, rehabilitation specialists, and transportation specialists.

    Services: Delivering all needed medical and supportive services, a PACE program is able to provide the entire continuum of care and services to older adults with chronic care needs while maintaining their independence in their home for as long as possible. Services include the following:

    • adult day health care that offers nursing; physical, occupational and speech/language therapies; recreational therapies; meals; nutritional counseling; social work and personal care;
    • medical care provided by a PACE physician familiar with the history, needs and preferences of each participant;
    • home health care and personal care;
    • all necessary prescription and over-the-counter medications;
    • medical specialties, such as audiology, dentistry, optometry, and podiatry and speech therapy;
    • respite care; and
    • hospital and nursing home care when necessary.

    See more at: http://www.npaonline.org/policy-advocacy/value-pace#services

    Find a PACE program near you: Currently, there are 144 PACE organizations in 30 states serving 58,000 people. To find out if you or a loved one is eligible, and if there is a PACE program near you, visit www.pace4you.org or www.Medicaid.gov, or call your Medicaid office.

    Beware of for-profit PACE programs: Government audits find for-profit PACE program neglects patients, delays needed care and cancels critical care.

    Learn what to do to ensure safety at home for people aging in their communities. And, see how one new program is helping older adults remain at home with assistance from a handyman, occupational therapist and nurse. For those who like technology solutions, check out how sensors can offer peace of mind to caregivers.

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    This post was originally published on March 2, 2016

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  • US House passes Build Back Better Act

    US House passes Build Back Better Act

    Last week, the US House of Representatives passed the Build Back Better Act, legislation designed to improve the lives of tens of millions of Americans. The Senate still needs to pass the bill before President Biden can sign it into law. In all likelihood, the Senate will water it down some. But, as it stands, here’s what it will do to reduce the cost of health care for people with Medicare and all Americans:

    1. It strengthens Medicaid to cover more home and community-based services. Millions of people with Medicare who also have Medicaid can benefit from this provision. Medicare only covers home care in limited situations, for people who need skilled nursing or therapy services on an intermittent basis.
    2. It adds a hearing benefit to Medicare. If passed, Medicare would cover audiology services and hearing aids.
    3. It allows Medicare to negotiate the price of some popular high-cost prescription drugs that have been on the market for at least nine years. Over time, Medicare would negotiate the price of up to 60 prescription drugs.
    4. It caps out-of-pocket costs in Medicare Part D, outpatient prescription drug coverage, at $2,000 a year.
    5. It caps the coinsurance cost of insulin for people with Medicare and people with private insurance at $35 a month.
    6. It limits the amount pharmaceutical companies can raise prices on their drugs from one year to the next to no more than the rate of inflation.
    7. It helps low-income people in the 12 states that have not expanded Medicaid access health insurance coverage through their state health insurance exchanges at low or minimal cost.

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  • Let postal workers help care for older Americans

    Let postal workers help care for older Americans

    Elisabeth Rosenthal writes for Kaiser Health News on how postal workers could help care for older Americans. They have the time and they reach millions of homes a day.

    Postal workers have less mail to deliver nowadays since so much correspondence is electronic. They could raise additional revenue for the USPS if they were paid to spend time doing home visits and basic health checks of isolated older adults. It sounds like a crazy idea. What skills do they have for this work?

    Believe it or not, other countries are using postal workers to perform this work. These countries understand the dangers of social isolation. In response, they have successfully enlisted postal workers to check on vulnerable citizens. France and Japan both do so. It’s one way to address the shortage of home care workers and would help the US Postal Service earn needed revenue.

    Today, literally tens of millions of elderly Americans are aging in place. They are living at home, but need help in order to remain in their communities. But, there is not enough help to go around.

    Many older Americans with mental and physical conditions are forced to fend for themselves, even though they do not have the means to do so properly. For sure, they are not taking their medicines as they should and likely not eating properly either.

    Rosenthal argues that the US Postal Service could make time for home visits by ending daily mail service and, instead, delivering mail three times a week. They would then have three off days to take on some of the home care services people need. They do not need a health care certificate to take a few minutes to speak to homebound elderly and make sure they have the food and prescription drugs they need. If trained, they could check blood pressure and blood sugar levels for diabetics.

    The US Postal Service is losing money and at risk. Rosenthal argues that we should not lose our postal service because people are not mailing as many letters as they used to. We should make use of the postal workers in ways that help them and isolated adults living at home. There is a critical need.

    To be sure, postal workers cannot cover the $160 billion US Postal Service budget gap through home visits to isolated older adults. But, Congress could take this first step of relieving postal workers of the requirement of delivering mail six days a week and allowing them to offer “nonpostal” services.

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  • Coronavirus: More home and community-based services needed

    Coronavirus: More home and community-based services needed

    For all the tragedy that Covid-19 has wreaked on this nation, there are a few silver linings. COVID-19 has cast a spotlight on the failings of nursing homes and the need for more home and community-based services and more affordable services so that older and disabled adults can age in place. The New York Times reports that many people today do not have the option to remain in their homes as they age because it can be so costly.

    People living in nursing homes and other adult care facilities during this pandemic have suffered mightily. As of now, about 181,000 have died. They represent one in three of all COVID-19 deaths, according to the Kaiser Family Foundation.

    What can communities do to help people and keep them from having to be institutionalized? Fewer and fewer people would choose institutionalization if they could remain in their homes. In the last three months of 2020, one in four nursing home beds were unfilled.

    Age-friendly communities offer a range of services to older people who need help caring for themselves. They might provide affordable age-friendly housing, good transportation and care services. Age-friendly housing generally provides living space on one floor without steps, walk-in showers, and hallways and doors that can accommodate wheelchairs.

    In some cases, apartment buildings can offer an array of services beyond shelter, such as grocery stores and pharmacies. In that way, older adults can have several community essentials at their fingertips, without having to leave the building. This set-up could benefit a lot of older adults.

    But, as people move into their 80’s and 90’s, they often need long-term care services as well. Medicare does not cover long-term care. At most, it covers 100 days in a skilled nursing facility, and that’s only if you’ve been hospitalized for at least three days prior to admission and need daily skilled services.

    Medicaid covers long-term nursing home care. But, it often does not cover home and community-based care. A little more than half of its spending for long-term services and supports covers home and community-based care. More than 40 percent goes to nursing-home care.

    What’s worse, even people who qualify for Medicaid might not get it. In many states, there’s a long Medicaid waitlist. Forty-one states limit Medicaid enrollment. Right now, 820,000 Americans are on a waiting list. On average, they wait more than three years. Fortunately, the American Rescue Act gives more money to states to expand Medicaid services. And, Biden’s new infrastructure proposal includes $400 billion more for home and community-based care.

    Here’s more from Just Care:

  • President Biden proposes funding for long-term care infrastructure

    President Biden proposes funding for long-term care infrastructure

    John Nichols reports for The Nation on President Joe Biden’s American Jobs Plan, which is designed to address America’s failing infrastructure. Billions would go to bridges, roads and other public transportation engines. Wisely, billions would also go to fund America’s failing long-term care infrastructure, supporting at home and community care.

    Joe Biden’s plan calls for Congress to allocate $400 billion to ensure the availability of more affordable home and community-based care. The goal is to foster a more humane life for hundreds of thousands of Americans. In the process, it will create hundreds of thousands more jobs for caregivers, along with better wages and benefits. Today, one in six care workers live in poverty.

    Right now, about four million people turn 65 every year. As they age, they often need help caring for themselves. But, the US offers precious little in the way of long-term supports and services, except for some people on Medicaid–and often people cannot access that care because they don’t meet the strict eligibility criteria or their state has a long waiting list. Medicare pays for only a small amount of nursing home care and home care, and only in limited situations.

    President Biden’s team recognizes that “increasing the pay of direct care workers greatly enhances workers’ financial security, improves productivity, and increases the quality of care offered.”

    Specifically, Biden’s plan will expand access to home and community-based services under Medicaid. It will also pay for caregiving jobs with benefits, and will enable collective bargaining and union membership for workers. The question is will Congress support it?

    If all goes well, the Biden administration will build on these benefits. Older adults and people with disabilities who do not qualify for Medicaid also need help paying for at home and community-based care. And, families need paid family and medical leave. We have a long way to go to build a more humane society.

    Here’s more from Just Care:

  • Government-administered long-term care insurance is long overdue

    Government-administered long-term care insurance is long overdue

    Since the start of the novel coronavirus pandemic, more than 46,000 people have died in nursing homes.  The private health care market is failing, and government-administered long-term care insurance, ensuring government oversight, is long overdue.

    Alexander Sammon makes the case in the American Prospect that the private long-term care insurance market has failed Americans more than any other piece of the health insurance market. Long-term care is the term used to describe an array services and assistance provided to older adults and people with disabilities. It includes help with activities of daily living such as bathing, feeding and toiletting, as well as nursing and therapy services.

    For sure, the number of deaths of older adults in long-term care facilities are easy to track and horrifying. Though, without good data and knowing that out-of-pocket costs keep people with complex conditions from getting medical and hospital care, it is not at all clear that the number of deaths of working people with serious illnesses and injuries stemming from their private health insurance is not equally chilling.

    What the long-term care story reveals is how a for-profit health care market endangers people’s lives by putting profits first and cannot be relied upon to guarantee our health. More than one in ten long-term care residents are no longer with us, in large part because long-term care facilities were not prepared to care for them.

    At some point in your life, there is a good chance that you will need long-term care. Seven in ten people 65 and older require long-term care. Most people rely on family and friends or Medicaid for long-term care. Only about three percent of Americans have long-term care insurance; it is expensive, often not available to people with pre-existing conditions, and generally not worth the cost, delivering little bang for your buck.

    Because the cost of long-term care is so high, private insurers are hard-pressed to profit from selling coverage and the market has shrunk considerably.

    When it was being drafted, the Affordable Care Act included government coverage for long-term care. But, it was designed as a voluntary program with high costs. And, it would not have paid for itself. So, it was dropped from the law before enactment.

    Sammon reports that Americans do not appreciate how likely it is that they will need long-term care. And, many also do not know that Medicare only covers a limited set of long-term care services: up to 100 days of care in a skilled nursing facility if certain qualifying criteria are met, some home care for people for whom leaving home is extraordinarily difficult and who need skilled nursing or therapy services, and durable medical equipment.

    The cost of long-term care keeps rising. It costs seven times more in 2015 ($225 billion) than it did in 2000 ($30 billion). The private market is not up to the task of providing good coverage.

    There are smart ways to provide everyone long-term care coverage through social insurance. Washington state enacted a social insurance program, imposing a small payroll tax on workers’ salaries. It will pay out $100 a day for up to a year of in-home care. Hawaii did something similar. It’s time that the federal government stepped in and offered similar or better coverage to everyone in the nation through social insurance.

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  • Many older adults cannot afford home care

    Many older adults cannot afford home care

    Home care is significantly less costly than nursing home care. And, most Americans would far prefer to age in place, in their homes, and receive home care than move to a care facility. But, the latest Urban Institute research by Richard Johnson and Claire Wang shows that nearly half of older adults will not be able to afford care in their home when they need it.

    Researchers looked at the cohort of older adults with severe need for long-term services and supports (LTSS), assistance with bathing, feeding, cooking and the like. They found that nearly half could not afford two years of paid home care on their own even if they sold all their assets. Overall, about two in three adults over 65 not on Medicaid can afford two years of paid home care if they rely on income and other savings that can easily be turned into cash.

    The researchers found that three in four older adults could afford home care for two years if they sold less easily liquidated assets, including their cars and businesses, but not their homes. And, four in ten older adults could afford home care as long as needed based on their income alone. Half as many with severe LTSS needs, two in ten, could afford indefinite home care based on their income alone.

    But, most older adults end up relying on unpaid family caregivers and not paying for home care. In the 14 years between 1998 and 2012, fewer than one in five adults 55 and older needing help with four out of five activities of daily living–bathing, feeding, toileting, transferring and dressing–received it.

    If you are interested in learning more about care options outside the home, including assisted living facilities, continuing care retirement communities, nursing homes and more, click here.

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