Tag: Nursing home care

It’s time to rethink nursing home care
For decades now, nursing homes in the US have failed to provide older residents with a dignified and humane life. Their horrifying response to the COVID-19 pandemic and inability to provide residents safe shelter or quality care only underscore the need to rethink nursing home care. We need to replace large institutional nursing homes with smaller facilities that feel more like home.

For a long time now, most institutional nursing homes have had persisting deficiencies. Of late, more than 54,000 nursing home residents and staff have died as a result of the novel coronavirus. COVID-19 provides an opportunity to see the grave vulnerabilities of institutionalized nursing home care today.

The Green House model of nursing home, small and focused first on the needs and desires of residents, is a great model. Green Houses offer a dignified way and patient-centered way to provide long-term care.

Dr. Joanne Lynne, an analyst at the Program to Improve Eldercare at Altarum, explains why we should defund today’s nursing homes, shut them down and provide care to people in need of long-term care in the community.

Dr. Lynne argues that different types of nursing care are best suited to older adults, depending upon their conditions. Small nursing homes are appropriate for people in need of a lot of assistance and of sound mind who need care over a long-stretch of time. Dr. Lynne sees five categories of people who need nursing care.
1. People discharged from the hospital who need short-term care so that they can return home or to another place in the community.
2. People with brain damage, including dementia and stroke, who do not know where they are and do not have family or friends to provide them assistance.
3. People who need a lot of assistance and don’t mind moving out of their homes and having someone take care of them in a home-like setting.
4. People who need a lot of care because of significant disabilities and favor congregate care, and can either afford it or who have coverage to pay for it.
5. People at the end of life who need hospice care for a short period of time.
People who have been discharged from the hospital and need short-term care and people who have dementia or otherwise do not know where they are could manage in a less-homelike setting. A small nursing home might not be best for them.

But, people with serious disabilities need a comfortable living space, where they can socialize, build relationships with others, and their personal needs can be tended to. A small nursing home could be appropriate for them. No more than a small group of people should live together to ensure good outcomes.

People in hospice also need a home-like and comfortable setting, but they do not need an environment conducive to establishing long-term relationships.

Nursing homes in the age of COVID-19 are more like prisons for their 1.3 million residents. No visitors. No family or friends with whom to socialize. Often, residents are isolated in a single room. They have had no choice in this arrangement for four months now. They have been disenfranchised and their well-being jeopardized. Smaller nursing homes would make it much easier to contain the spread of a deadly virus.

Medicaid must be able to pay for smaller nursing homes, as it does in many cases with Green Houses. And, in order to help ensure patients needs are met, these homes must be required to spend at least 85 percent of their revenue from insurers on direct patient care.

Here’s more from Just Care:
July 22, 2020
VA program offers older veterans care in private homes
Patricia Kime reports for Kaiser Health News on foster homes for older veterans. At these private homes, licensed caregivers attend to their needs and often treat them like family. These private homes are part of an effort of the Veteran’s Administration to move vets out of long-term nursing home care.

The Medical Foster Home program is a VA initiative designed to improve the quality of life for vets with physical or mental disabilities. It moves these vets out of nursing homes and into private homes. It offers them the opportunity to live in the community. It provides a private or semi-private room and board, 24-hour one-on-one attention and personal care. It also gives vets some flexibility in their daily activities.

Vets in the program must use the VA’s Home-Based Primary Care Program. One Brookings study showed that the care Vets receive in these homes is not only less expensive than nursing home care but far better. They have significantly fewer hospital admissions and shorter hospital stays when they are admitted.

Today, 1,000 veterans in 42 states avail themselves of this program. They must be diagnosed with a serious chronic disabling condition that requires a high level of care, including care coordination and access to VA services. Given the amount of care these vets need, the average $2,300 monthly cost to veterans is low relative to most home care environments. Costs range from $1,500 to $3,000 a month for room and board, depending on location. The government subsidizes the cost of care and still saves about $10,000 a month on what it would have spent on nursing home care.

The VA would like to increase the size of the program. But, a licensed caregiver can care for no more than three veterans. And, the VA has strict requirements for homes and caregivers, which slows its growth. For example, each foster home must be licensed by the state as an assisted living facility and must agree to VA and state inspections, as well as inspections by nutritionists, pharmacists and nurses.

Licensed caregivers must pass a background check and complete 80 hours of training. They must take another 20 hours of training annually. They must also permit the VA to make unscheduled home visits. They must be certified in first aid, CPR and administration of medications.

Today there are some 120 Veterans Administration facilities and 700 licensed caregivers participating in the program.

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Here’s more from Just Care:
June 5, 2018
Cohousing: Independence, companionship and community
Sharon Jayson of Kaiser Health News reports on cohousing, a new trend in housing for older adults that recognizes the value of social networks. Cohousing offers older adults independence, companionship and community in one housing complex. At the same time, it can bring down people’s housing costs.

The idea behind cohousing is that a group of people, who likely do not know each other from the get-go, get to know each other and then agree to move in to a cohousing community together. They may design the housing together, collectively deciding how to structure common areas.

Cohousing is a way of downsizing while retaining everything you need. For example, instead of each community member owning a home with a guest room, a lawnmower and a washer-dryer, the cohousing members may pool resources and own these items jointly. They effectively create their own customized neighborhood, sharing what they decide they want to share.

Cohousing can be designed any number of ways, depending upon the community. People may live in private homes or apartments. There might be a common house for caregivers and guests. But, whatever the set up, there is a lot of shared space.

Today, there are 168 cohousing communities. Most of them are intergenerational. Now, several of them are exclusively for older adults.

Cohousing communities address the problem of social isolation that confronts many people who remain in their homes as they get older. Continuing care retirement communities are an alternative housing option worth considering, as are assisted living facilities. PACE is yet another option that provides all-inclusive care to people in their communities. And, for people looking for nursing home care, there’s the Eden Alternative.

Whatever your choice, make sure to maintain a social network and stay engaged as much as possible. Too often, people have few people to talk to or otherwise engage with as they get older. And, that can lead to both mental and physical decline.

Here’s more from Just Care:
November 15, 2017
Long-term care insurance likely won’t deliver what you need
You may already know that seven in ten of us will eventually need some type of long-term care services and supports. But, you may not know that most people today receive that care at home and not in a nursing home. The inevitable question is how to pay for it when it is needed, and is it worth getting long-term care insurance as a way to afford this care?

Long term care insurance may not deliver what you need. Fewer than one in ten people now buy this insurance and there are many good reasons why they do not. Judith Graham explains for Kaiser Health News that this insurance is often very expensive, and it primarily covers nursing home care and not the home care people want.

Indeed, long-term care insurance may never meet people’s needs, both in terms of cost and coverage. Some people believe that long-term care insurance would be less expensive if it only covered home care. Nationally, home care is less costly on average than nursing home care, $46,000 (daily for about six hours a day) v. $82,000 a year. But, home care can be extremely costly if it is needed round the clock, and costs vary by community.

Moreover, the cost of care has risen rapidly, far faster than inflation. Even a five percent inflation adjustment in a long-term care policy is likely not to keep up with rising costs. You could not count on a policy with a one-percent inflation adjuster, which some plans now offer, to meet your needs. And, unless you can foresee being able to pay an ever increasing premium over ten to twenty or more years—“level premiums” can and too often do rise significantly—you will likely be throwing away your money.

Similarly, if you do not buy as much home care coverage as you will need, you will likely be wasting your money. More than a quarter of people needing long-term care services will need these services for as long as two years. Around one in eight of them will need services for between two and four years. And, one in seven of them will need these services for more than five years.

Unless you have family you can count on for round-the clock care, you take a gamble with partial coverage from a long-term care policy. People wealthy enough to afford round-the-clock home care may be better off simply setting aside the money than buying long-term care insurance. And, millions of older adults qualify for Medicaid coverage of long-term care.

If you have limited income and assets, depending upon where you live, Medicaid will often cover your long-term care needs. In many states, even if your income and assets are too high to qualify for Medicaid, you can spend down to the Medicaid eligibility level once you need a lot of care.

So, before spending the time and resources to consider a long-term care policy, speak to an independent expert, such as a State Health Insurance Program (SHIP) counselor. Do not rely on the advice of an insurance agent or long-term care insurance salesperson.

It’s important to plan ahead. The U.S. Department of Health and Human Services estimates that more than six million people over 65 have a “high need” for home care or nursing home care. They need help with two of five activities of daily living such as eating, bathing, toiletting, dressing or moving from their beds to a chair for 90 days or more. Or, they need a lot of help because they have dementia.

Here’s more from Just Care:
August 2, 2017
Student housing in a Dutch retirement home
Here’s an innovation. With few resources to keep residents active in a Dutch retirement home, the CEO decided to open up rooms to six students. In exchange for free student housing, the young adults spend at least 30 hours a month with the older residents. The students take the nursing home residents around town in a specialized tandem bicycle, play beer pong with them and build friendships and provide comfort to dementia patients.

Many Dutch students in their 20s are hard-pressed to find housing. It’s so expensive. So, this marriage of students and older adults is a win-win. They are “good neighbors,” part health care provider, social worker, friend, grandchild, and more. Check out this video:

Here’s more from Just Care:
September 12, 2016
For-profit PACE programs: Cause for worry?
Sarah Varney reports for Kaiser Health News that the for-profit sector will now be providing a program for all-inclusive care for the elderly (PACE). Click here to learn about PACE on Just Care. Until recently run exclusively by non-profit organizations and paid for by Medicare and Medicaid, PACE has provided valuable services. But it has reached only a small fraction of older adults. Are for-profit PACE programs cause for worry or can they reach more adults and deliver as good results as non-profit PACE programs?

Last year, Congress changed the law governing PACE to permit for-profit companies to run PACE programs. The alleged goal is to reach more people. And, now private equity firms are funding companies to deliver for-profit PACE programs, reaching many more people.

PACE is intended to help older adults age in place through comprehensive medical and social supports. Medicare and Medicaid pay for the services because they can save money on people in PACE who remain at home, do not need nursing home care and are not as likely to be hospitalized. But, only 40,000 people were enrolled in the program at the beginning of 2016.

With for-profits in the picture, more people will receive PACE services. And, that could have great value to patients who want to remain at home, as most do, and still be able to socialize and enjoy the services available in their communities. Without PACE, many would remain isolated and homebound, jeopardizing their health and well-being and putting them at increased risk of an early death.

PACE programs provide key services many older adults would not otherwise be able to afford or access. People may get comprehensive rehabilitation services. They also generally receive critical dental care that Medicare does not pay for outside the PACE setting. Dental care helps prevent infections that can land a person in the hospital. It also helps to ensure good nutrition.

And, PACE programs also help patients with basic services at home, such as housecleaning and laundering.

The question remains whether the for-profit sector will deliver the value that non-profit PACE programs have delivered. When for-profit companies began delivering hospice services, the U.S. Office of the Inspector General found that they were treating patients with less costly conditions, avoiding patients who would cost them more money, and they were holding back on services people needed.

The for-profit programs are paid a flat fee and lose money if PACE enrollees spend too much time in hospital or visit the emergency room frequently. So, for-profit PACE programs may try to avoid patients more likely to use these services, like the for-profit hospice agencies, avoiding patients who would cost them more money. To save money, they may also be more inclined to deliver care through telehealth rather than transporting patients to facilities, failing to recognize the negative health consequences of social isolation and the value of socialization.

Here’s more from Just Care:
September 7, 2016