JustCare

Tag: Home health care

  • Traditional Medicare offers better home care benefits than Medicare Advantage

    Traditional Medicare offers better home care benefits than Medicare Advantage

    If you have Medicaid or can afford supplemental coverage to fill gaps in traditional Medicare, here’s another reason to think twice before signing up for a Medicare Advantage plan. Researchers at Brown University’s School of Public Health have found that Medicare Advantage plans do not offer the high quality home health care benefits that traditional Medicare offers. Traditional Medicare home health care services are better, they report in JAMA Network.

    People in traditional Medicare, overall, have access to far higher quality providers than people in Medicare Advantage plans. Last year, researchers at Brown University found that traditional Medicare offers higher quality skilled nursing facility benefits than Medicare Advantage plans. Medicare Advantage plans contract with poorer quality providers.

    Of course, people in good health need not be too concerned about the quality of care their health insurance offers them. But, all of us can be hit by a car, or slip and fall, or otherwise develop a costly condition at any time. So, it’s important to pick a Medicare plan that will meet your needs in the long-term.

    Unfortunately, data about the quality of care in particular Medicare Advantage plans is not available. But, the Brown University researchers found that people with costly health conditions were more likely to leave their Medicare Advantage plans and enroll in traditional Medicare. That’s another sign that Medicare Advantage plans are not meeting people’s needs when they need costly care.

    For their home health care study, the researchers analyzed data from 4.4 million people who received home health care. They could not independently assess the quality of the home health agencies serving people in Medicare Advantage plans. Instead, they determined quality based on star ratings, which can be seriously flawed. They found a “significantly” greater likelihood of getting high-quality care in traditional Medicare than in Medicare Advantage. Consequently, people in Medicare Advantage plans may suffer negative health outcomes.

    The researchers posit that Medicare Advantage plans save money by contracting with lower quality home health care agencies, just as they save money by contracting with lower quality skilled nursing facilities. Unfortunately, the Centers for Medicare and Medicaid Services does not factor in the quality of home health care agencies in a plan’s network when determining a Medicare Advantage plan’s star rating.

    The Kaiser Family Foundation has also looked at the quality of providers in Medicare Advantage plans and found that people in these plans are less likely to be able to use centers of excellence when they have cancer.

    Here’s more from Just Care:

  • Need home health care? Don’t count on Medicare

    Of all the failings with the US health care system for older Americans and people with disabilities, one of the greatest is Medicare’s very limited home care coverage. Millions of Americans need home care as they age or when they have a disability. And, Medicare does not begin to meet their needs. It never covers custodial care or round the clock care. And, it generally pays for no more than 15 or 20 hours of care weekly.

    When will Medicare cover your home care? For Medicare to cover your care at home, you must receive your home health care from a Medicare-certified home health agency and meet the following three additional conditions:

    1. You must need skilled nursing or therapy services on an intermittent basis, as little as once every 60 days or daily for a finite and predictable period, usually no more than a few weeks. Skilled nursing includes observation and assessment, catheter changes and wound care. Skilled therapy includes physical, speech and occupational therapy, both to improve your condition and to maintain your condition.
    2. You must be homebound, which means that leaving home requires a considerable and taxing effort.
    3. Your doctor must certify your need for home care and sign off on your plan of care.

    What does Medicare cover? If you qualify for Medicare-covered home care, in addition to paying the full cost of skilled services, Medicare pays for a limited number of hours of home health aide services to help with bathing, dressing, feeding, toileting and transferring. Medicare covers the cost in full; patients have no deductibles or copays. Note: Medicare does not pay for home health aide services if you do not need skilled services. Medicare also sometimes pays for medical social services, if needed and ordered by your treating physician, and durable medical equipment.

    How much care does Medicare cover? Medicare pays for skilled services and home health aide services. Home health agencies generally provide no more than eight hours a day of care, with a maximum of 35 hours a week but usually no more than 28 hours.

    How long will Medicare cover your home care? Unlike with hospital and skilled nursing facility care, Medicare imposes no limit on the number of days of home care it will cover for people who meet the qualifying criteria. In a legal case settled in 2013,  Medicare agreed that patients can receive Medicare-covered care to maintain their condition or prevent decline; they do not need to be improving.

    However, Susan Jaffe reports for Kaiser Health News that homebound patients with chronic conditions whose doctors certify that they need intermittent skilled services are hard-pressed to find a home health agency to provide them the Medicare-covered services to which they are entitled. Home health agencies fear that if they provide extended home care services, Medicare will deny them payment for that care. In fact, in fiscal year 2017, Medicare found that one out of three claims billed by these agencies should not have been paid.

    If Medicare denies payment for a home health service, the home health agency is liable, not the patient. So, home health agencies want to reduce their risk of having Medicare deny services they provide.

    What should you do if an agency refuses to provide home care and your doctor says that you meet the qualifying criteria? You should appeal. You will likely win. However, you will likely assume the responsibility of paying for the services you receive if Medicare denies your appeal.

    How can you find a Medicare-certified home health agency? Call 1-800-Medicare (1-800-633-4227) or contact your local hospital for Medicare-certified home health agencies in your area.  If you’re in a Medicare Advantage plan, a commercial health plan offering Medicare benefits, call the plan directly to find out what agencies can provide your home care.

    Keep in mind: Medicare will not cover home care for people who need round the clock or extensive home health services. You should call your state health insurance counseling program to learn about programs for older adults available in your community.

    Medicaid sometimes provides home care and, if not, it covers nursing home care, including custodial care.  Long-term care insurance might also pay for home care, though many people are better off saving the money on those premiums and paying for home care directly.

    Here’s more from Just Care:

  • What Medicare covers

    What Medicare covers

    In order to plan for your care as you get older, it is good to know what Medicare covers and what it does not cover. You can then budget for your out-of-pocket costs. Because Medicare generally does not provide full coverage and does not cover some high-cost services, annual out-of-pocket health care costs with Medicare average $5,500. And, if you need to pay for long-term care services, unless you have Medicaid as well as Medicare, your costs will likely be much higher.

    Services Medicare covers: Medicare Part A–which is generally premium-free if you or your spouse paid Medicare taxes–covers hospital, skilled nursing facility, skilled rehabilitation facility, hospice and other inpatient services. Medicare Part B–which has a standard monthly premium of about $134, though people with higher incomes pay more–covers medical services from doctors, therapists and other Medicare-certified health care providers, along with medical equipment and supplies. (To be enrolled in traditional Medicare or a commercial Medicare Advantage plan, you need Medicare Parts A and B.) Medicare Part D–which has a monthly premium that varies depending upon the plan you choose–covers prescription drugs and is optional.

    Note: People who enroll in a commercial Medicare Advantage plan also have Medicare Part C.

    Click on the links below to learn more about Medicare’s benefits and the services it does not cover.

    Keep in mind that some costly services are expressly excluded from Medicare coverage.

    Services Medicare does not cover:

    If you qualify for Medicaid as well as Medicare, Medicaid may cover some of these services.

    Here’s more from Just Care:

  • Telehealth services do not save money

    Telehealth services do not save money

    Over the last several years, there has been significant investment in telehealth services–which allow you to get care from a doctor via telephone or computer–as a low-cost convenient way to provide care for simple conditions. However, a recent study by RAND, a non-profit research organization, finds that telehealth services do not save money. Rather, RAND finds that telehealth services can lead to additional medical treatments, increasing costs.

    For the study, RAND looked at 300,000 people receiving telehealth coverage through CalPERS. Researchers found that in almost nine out of ten cases, telehealth services led to additional medical services. Only 12 percent of the time did people’s use of telehealth keep them from visiting the doctor or emergency room.

    “Like some other new patient care models that promise to cut costs and reduce the hassle of receiving medical care, it appears that in some cases, direct-to-consumer telehealth may increase spending rather than trim costs,” said J. Scott Ashwood, who was the lead author of the study. Ashwood and his colleagues found the cost of telehealth services for acute respiratory infections to be half the cost of a doctor’s visit and one-twentieth of the cost of a trip to the emergency room. But, they also found that most people getting the telehealth treatment ended up getting additional care, leading to higher overall costs for their treatment.

    Telehealth services have grown significantly. In 2015, 1.2 million people used these services. And, this year, the overwhelming majority of employers are offering telehealth services to their workers. The employers benefit to the extent the telehealth services allow workers to get care without leaving their office, increasing productivity. Workers can easily spend two hours traveling to and from the doctor’s office and waiting to be seen by the doctor.

    Of note, these same RAND researchers found last year that local health clinics also do not end up saving money on care. They found that more than half of all visits to these retail clinics for simple health needs were additional services, not replacements for doctors’ visits.

    Medicare covers some telemedicine services, both real-time audio and video, for some conditions in certain situations. If you don’t have Medicare, check with your commercial insurer about the coverage available through your plan.

    While Medicare only covers limited home care services, it is now in the midst of a demonstration project that pays for doctors and nurse practitioners to make house calls. That could be a better option than telemedicine.

    Here’s more from Just Care:

  • Need for more home care workers to care for older adults at home

    Need for more home care workers to care for older adults at home

    An increasing number of older adults are choosing to age in their homes rather than in nursing homes or other institutionalized settings. With the population aging, there are too few home care aides and nursing assistants to care for older adults in their communities. But, in August the D.C. Circuit upheld a new Obama Administration Labor Department regulation providing home care workers minimum wage and overtime protections, which should encourage more people to enter these professions.

    Nursing assistants and home care aides help older adults bathe, dress, transfer from their beds to a wheelchair or walker, use the toilet and eat. They also talk to patients about their health care needs and may report concerns to nurses. They sometimes take people’s blood pressure and temperature as well. Some are trained to give patients their medicines. Many of the people they care for are chronically ill, disabled or cognitively impaired.

    According to the Bureau of Labor Statistics, in 2012 the median pay for nursing assistants was $11.73 an hour or $24,400 a year. And, there were 1,534,400 jobs. Home care aides had even lower hourly wages of $10.25 and average yearly earnings of $20,820. There were 875,000 of these jobs. Training for these jobs is limited at best.

    The new Obama Administration Labor Department rule designed to provide 2 million home care workers better pay was set to go into effect in 29 states in January 2015 but then was challenged. Those states did not have a minimum wage law that applied to these workers because they did not consider Medicaid payments to be wages. These workers are now eligible for the $7.25 hourly minimum wage, as they already were in 21 other states, as well as overtime pay.

    In the 10-year period between 2012 and 2022, the Bureau of Labor Statistics projects a 21 percent average growth rate for nursing assistants and a 48 percent growth for home care aides, as compared to 11 percent average growth rate for all jobs.

    An increasing percentage of people will be over 65 in the coming years, and about 70 percent of them will require long-term care services and supports. Eleven million people needed paid long-term care services in 2013.

    Here are three tips for planning for long-term care services and supports, including questions to consider regarding long-term care insurance. Keep in mind that Medicare only covers limited home care and skilled nursing care under certain conditions.

    Until now, home care aides, like babysitters, were not eligible under federal law for overtime pay and not covered under labor rules.

  • Medicare finding ways to cover house calls and save money at once

    Medicare finding ways to cover house calls and save money at once

    Can Medicare deliver better care at home to older patients with multiple chronic conditions and save money in the process? Based on Year One practice results of Medicare’s Independence at Home Demonstration, the answer is a resounding “Yes.” In its first year, the Demonstration both improved health outcomes for patients with multiple chronic conditions and saved Medicare $25 million.

    The Demonstration is funded through the Affordable Care Act with the goal of improving quality of care and quality of life for older patients with multiple care needs. It is designed to keep patients at home and out of institutions—be they hospitals or nursing home. The Demonstration gives doctors and nurse practitioners more time with their patients and allows them to assess their home environment. And, it is designed to improve both caregiver and patient satisfaction.

    Patients in the Demonstration must be enrolled in traditional Medicare, have two or more chronic conditions and have been hospitalized in the prior 12 months. They receive comprehensive primary care tailored to their needs for a three-year period. The care team coordinates their care. The Centers for Medicare and Medicaid Services is tracking the patients’ care experiences through quality measures. Providers in the demonstration that succeed at reducing costs receive incentive payments.

    Begun in 2012, fifteen sites throughout the country are engaged in this project, including Boston Medical Center, Cleveland Clinic Home Care Services, North-Shore Long Island Jewish Health Care and Dallas VPA.

    This demonstration is one of a number of pilots Medicare is supporting to test ways of delivering care that allow older adults to age in place. Click here to read about another such project. Right now, other than through these demonstration projects, Medicare only covers limited home care services for patients needing physical therapy or nursing care and for whom leaving home requires a considerable and taxing effort.

  • Medicare begins rating home health agencies

    Medicare begins rating home health agencies

    Much like surgeons, home health agencies are not created equal. To help people better compare Medicare-certified home health agencies, Medicare just launched Home Health Compare. It’s a web site that helps you see some quality differences among home health agencies in your community rates.

    There are a lot of factors that go into whether a home health agency is good, bad or great. So, you should talk to your doctor and other people you know and trust about home health agencies in your area as well as look at Home Health Compare. The Informed Patient Institute provides good information about health care quality, patient safety and health care costs as well as the usefulness of report cards.

    Right now, Medicare is rating agencies for the quality of their patient care based on nine of 27 process and outcomes measures.

    • Process measures include how quickly the patient received needed care, whether the patient got a needed flu shot and whether the agency educated the patient about his or her medications.
    • Outcomes measures include whether the patient got better at walking, bathing, and getting into and out of bed, as well as whether the patient experienced less pain and shortness of breath.

    Some home health agencies may not offer the full range of Medicare-covered services you need. On Home Health Compare, you can find out which services different agencies provide, including nursing care, physical therapy, speech therapy, occupational therapy, social services, home health aide services.

  • Home care: How the Netherlands delivers good care at a good price

    Home care: How the Netherlands delivers good care at a good price

    Unlike the classic home care agency that uses a range of personnel to provide care and support to homebound patients, one new model in the Netherlands relies on a cadre of nurses to deliver the full range of services homebound patients need. The Buurtzorg model has received significant attention for its seeming ability to deliver good quality care at lower cost than other models.

    Started in 2007 with a single team of nurses, today Buurtzorg boasts 8,000 nurses in 700 teams caring for 65,000 patients, according to a new report from the Urban Institute.  And many countries, including Japan, the United Kingdom and the United States are following its lead and exploring ways to adapt the model to their populations.  How not? The Buurtzorg model not only gets high satisfaction ratings from patients but surprisingly high satisfaction ratings from its nurse providers. And, it provides home care in fewer hours than other organizations for comparable services.

    The Buurtzorg model recognizes that patients value continuity of care from the same providers. Typically, home care agencies rely on a range of different providers to perform different services at different times. So, Buurtzorg nurses not only provide nursing services, but they help with bathing, toileting, dressing and other activities of daily living.

    Buurtzorg offers a holistic approach, working within a neighborhood to improve people’s independence in the community. Ten to 12 nurses work together in a community to provide home care for 50-60 patients. Nurses train patients in self-care and help create neighborhood resources for patients. They also work with family members and primary care doctors to help ensure that patients maintain or improve their ability to function independently. Interestingly, nurse visits average 25 minutes.

    The nurses are self-managing, with help from a sophisticated information technology system that does scheduling and billing as well as tracks nursing assessments. They assess patient needs, develop and execute on the care plan, and otherwise ensure patients receive needed care. One study found that Buurtzorg did a better job of meeting people’s home care needs and helping them live independently in fewer hours than other organizations; in addition, patients had fewer hospital emergency visits, shorter hospital stays and were less likely to go into nursing homes.

    In the U.S., while many older adults end up in nursing homes, there is increasing focus on helping older adults to age in place.  Lots of new models are being studied, including CAPABLE, which you can read about here. And, there is much focus on helping people plan for long term care services and supports, which most of us will need.

    Buurtzorg USA was launched in Stillwater, Minnesota in 2014 and is now a legally recognized non-profit organization licensed to provide home care in Minnesota. It is still in its early stages, making itself known in the community. Time will tell whether this home care model can work in the United States, where insurance payment systems for home care can be extremely complex and most people do not have the means to pay out of pocket.

    Medicaid often covers the cost of home care for older adults with low incomes; Medicare only pays for limited home care, In the Netherlands, the Dutch government is the single payer and pays for home care for a range of conditions, regardless of income.

  • Community Aging in Place—Advancing Better Living for Elders (CAPABLE)

    Community Aging in Place—Advancing Better Living for Elders (CAPABLE)

    As the population ages, many experiments are underway to understand how best to keep people living in their homes as long as possible, sometimes called community aging in place. Not only is nursing home care extremely costly, but most older adults prefer to live at home. And, some experts believe that a few low-cost interventions can keep people in their homes months or even years longer. CAPABLE (Community Aging in Place—Advancing Better Living for Elders) is testing that proposition, helping low-income older adults with chronic conditions increase their mobility and functionality at home.

    CAPABLE relies on occupational therapists, nurses, and handymen who can help make a home safer and easier to move around in, to enable older adults to age in place.  The theory is that neither providing supports for individuals nor making changes to the home alone is adequate to help meet the needs of vulnerable older adults at risk of serious disability. But, a small investment–$4,000—in both could make a large difference in their lives and save significant money as well.

    Initial study results show that CAPABLE could improve health and daily life for many older adults, while reducing health care costs. Older adults in the study group received 10 one-hour to one-hour-and-a half visits over five months.  The handyman might lower shelves and install handrails.  The nurse might help a person organize her medications to ensure medication compliance.

    The study found that 79 percent of the 100 people receiving the CAPABLE intervention improved their self-care in five months and experienced fewer symptoms of depression.  The average participant reduced her disabilities by half and was far better able to take care of herself.

    The project was funded by a grant from the Centers for Medicare and Medicaid Services Innovation Center.