Too often, hospitals in the US discharge patients before they are able to care for themselves. After a complex surgery, managing for yourself in your own home, where most people want to be, can be challenging. Paula Span reports for The New York Times on innovative new approaches to expanding the home care workforce and delivering home care cost-effectively.
What do people do to get by after leaving the hospital? How do they get dressed, bathe, go shopping for groceries or abide by a complex prescription drug routine? People with Medicaid typically have home care coverage. If not, people mostly rely on family members. Others are fortunate enough to be able to find and afford paid home care. Still others rely on Medicare, which covers home care for people who are homebound and need skilled nursing or therapy services on an intermittent basis.
If you have Medicare and will be homebound after being hospitalized, ask the hospital before discharge about setting up Medicare-covered home health services. Medicare should cover at least 12 hours of skilled nursing and home health aide services each week, if your doctor deems these services medically necessary. If you are in a Medicare Advantage plan, you are theoretically entitled to these services, but they will likely be harder to get; the insurers running Medicare Advantage plans tend to second-guess treating physicians and take a narrow view of what are medically necessary services.
Regrettably, the demand for paid home care providers far exceeds the supply. Thankfully, there are new options emerging. As the hourly rate paid to aides through agencies has gone up–$17 an hour, on average, with another $17 going to the agency–the number of home health aides has grown to 3.2 million, well more than double what it was ten years ago.
Still, the US will need about three quarters of a million more home health aides in the next ten years. And, home health aide turnover remains high because aides work hard for relatively little pay.
To address this issue, home care workers are establishing home care cooperatives, which allow them to work for themselves and earn about $2 more an hour for their services. For example, Cooperative Home Care Associates in New York–a worker-owned business–employs 1,600 home health aides. Today, there are 26 of these cooperatives across the US. For the aides, higher pay appears secondary to having more autonomy and better working conditions.
Home health aide registries are another way for aides to work with patients without corporate middlemen. Massachusetts and Wisconsin operate registries. The Carina registry in Oregon and Washington works with the Service Employees International Union, a health care union, to make home health aides available.
With Carina, patients can find home health aides online. The state takes care of administrative functions, including background checks. Aides receive somewhat higher pay than they would working for a corporate agency, along with health insurance and other benefits; patients pay somewhat lower rates than they would if they used an agency.
Direct Care Careers, which operates in four states, offers a slightly different model. It allows home health aides to pick their patients. This gives the aides more autonomy.
Ideally, the US would cover the bulk of the cost of these home care services. Until then, these innovative approaches to building the home care industry in a cost-effective way are a good step forward.
Here’s more from Just Care:
- Sensors offer peace of mind to caregivers
- How to be a good long distance caregiver
- Japanese develop tech innovations to help caregivers and enable people to age in place
- Older adults struggle to age in place and get care
- Traditional Medicare offers better home care benefits than Medicare Advantage
