by M | Jun 24, 2020 | Blog, News |
The infection began with a dry cough that Michael Novielli couldn’t shake.
He soon developed fatigue, aches and a low fever.
As a 71-year-old with underlying health conditions, living on Long Island near the American epicenter of the COVID-19 outbreak, Novielli wasn’t taking any chances. So as his symptoms worsened, he went to the hospital, where he was diagnosed with COVID-19.
“I had never felt this sick my whole life,” he said.
Novielli spent four days in the hospital before he was sent back home. “I was going to wait it out,” he said. “I thought I could get rid of it at home.”
As a precaution, Novielli’s VA providers placed him on a telehealth program to monitor his symptoms at home. Once his recovery took a turn for the worse, Novielli says the VA telehealth program saved his life.
“The Best Move I Ever Made”
Michael Novielli served as a U.S. Marine during the late 1960s. He developed chronic lymphocytic leukemia after exposure to Agent Orange in Vietnam. Later in life, he was also diagnosed with diabetes.
Novielli’s care team at the VA Medical Center in Northport, New York, first suggested Remote Patient Monitoring – Home Telehealth (RPM-HT) about five years ago. They gave Novielli a blood pressure monitor that he could use at home to keep track of his health.
“It was the best move I ever made,” said Novielli. “For me, my blood pressure is very important, and using telehealth, they are able to monitor that from home.”
After being hospitalized with COVID-19, Novielli was happy to use RPM-HT to track his recovery once he returned home on April 3. Through the COVID-19 RPM-HT program, Novielli began sharing his temperature, oxygen levels, and heart rate every day with the VA telehealth team at the Northport VAMC.
On April 22, more than two weeks after Novielli was discharged from the hospital, Marjorie Rogers, a registered nurse with 14 years’ experience with VA, noticed something unusual in Novielli’s symptoms. Although his temperature and oxygen levels were normal, Novielli’s heart rate was elevated.
Rogers called Novielli immediately. “She said, ‘Your heart rate is up. Something’s definitely wrong. Go to emergency right away,’” Novielli said.
When Novielli arrived back at the hospital, doctors found that COVID-19 had caused fluid to build up in his lungs. Novielli had developed pneumonia.
This time, Novielli was in the hospital for almost two weeks. He was on oxygen and antibiotics, felt weak and tired, and lost 40 pounds. But after 13 days, he said, “The monster had left me.”
“Marjorie saved my life,” said Novielli. “If I wasn’t on the telehealth, I would have stayed home with the pneumonia, and who knows what would have happened.”
Using Telehealth To Stop the Spread
For VA providers like Marjorie Rogers, RPM-HT has been an important tool in fighting the spread of COVID-19 at the Northport VA.
“Because it’s a new disease, there is so much we don’t understand about it and that we’re learning,” Rogers said. “Through telehealth, we are keeping our Veterans safe from exposure. They’re not going into the VA facilities if they don’t have to, since we’re able to monitor them in their homes.”
Alisa Tribley, a registered nurse who is the Northport telehealth coordinator, said that telehealth has grown to meet the needs of Veterans with COVID-19. She said that at the peak of the local outbreak, over 140 Veterans were enrolled on Northport’s RPM-HT COVID-19 protocol.
“With RPM-HT, we are monitoring mild symptoms that can be managed at home and recognizing if Veterans reach the point where they should go for in-person care,” Tribley said.
Making a difference
Some of the Veterans in Northport are using telehealth for the first time. Tribley said that while it is an adjustment for some, many are appreciative of the added care.
“Veterans are very grateful that they have a health care team member watching over them and being in touch with them on a daily basis,” said Tribley. “It’s very rewarding knowing that you’re making that difference for them.”
Rogers said that she felt honored when Novielli called her to thank her for intervening on his behalf.
“I really felt that his story was a testament to all the VA telehealth coordinators nationwide,” she said. “To hear him say that really gave me a sense of pride that we’re contributing to Veterans health — that we’re helping them stay alive.”
Novielli says he is thankful for all the care he received from the VA telehealth team and at the hospital. When he finally overcame the pneumonia, the health care workers on his floor applauded as he left the hospital. “It’s nice to have people like that take care of you — people who really care,” he said.
Novielli is still being monitored by RPM-HT – but his cough is finally gone, he is off oxygen, and he’s starting to go on walks with his physical therapist. He said that once a COVID-19 vaccine is developed, he wants to visit Europe and go on a cruise with his fiancé.
Novielli said he hopes that his experience encourages his fellow Veterans to take COVID-19 seriously and take advantage of VA telehealth resources.
“Going through something like this makes you feel for other people who weren’t as fortunate,” Novielli said. “I hope it encourages people to take more care, and to have a better outlook on life.”
Taken from Official Blog of the U.S. Department of Veterans Affairs
Posted on Monday, June 22, 2020 9:30 am
by M | Jun 22, 2020 | News |
Last month, I had the immense honor of testifying before the U.S. Senate Special Committee on Aging to take part in an important discussion on caring for America’s aging population in the midst of the current public health crisis.
The COVID-19 pandemic has upended American life in nearly every possible way. And while it’s difficult to find silver linings amidst the chaos it has caused, the novel coronavirus has offered us this: a frank lesson in where our health care system needs improvement – and also what we’re doing right.
Perhaps the most alarming lesson we’ve learned is that our country wasn’t prepared to meet our unprecedented preventive resource needs or the care needs of individuals suffering from COVID-19. We simply lacked the testing capacity, hospital and emergency room resources, and personal protective equipment to handle this pandemic. But, fortunately, we’ve also witnessed the strength of our individual health care providers – across all sectors – and their commitment to providing safe and exceptional care, despite tremendous obstacles.
As a member of the nation’s home health care community – which serves more than 3.5 million Medicare beneficiaries each year – I have never seen the system so strained, but I also have never felt prouder of the skilled, compassionate, and courageous people I work with day in and day out.
Across the nation, our more than 1 million home health and home care professionals have stepped up, in spite of all the challenges and risks, to help medically fragile seniors get home from hospitals and nursing homes – and in some cases, to help people avoid leaving their homes in the first place. We’ve kept older, vulnerable patients safely out of crowded care settings, helping to slow coronavirus transmissions. In fact, an estimated 41 percent of home health agencies have reported caring for COVID-19 positive patients in the home – effectively managing symptoms, providing treatments, and freeing up inpatient beds for those who need them most.
Even in the midst of this frightening virus, there has been opportunity to get excited about the future. For example, home health providers, like many others, have been able to step up and make a difference thanks to the spirit of innovation. Expansion of telehealth and virtual visits has been crucial to providing care, allowing providers to remotely assess patients and monitor vital signs like oxygen levels and other symptoms of COVID-19. Home health agencies have made it work – despite the fact that there is currently no direct reimbursement for telehealth in the Medicare program. Even before the pandemic, we knew that telehealth could improve the quality of home care, and COVID-19 has proven it is worth the investment for the future.
Our community has been proud to serve on the front lines during this coronavirus pandemic, but we have not been immune to its effects. The future – and our ability to remain strong for future waves of COVID-19 and the growing Medicare population – depend on the support from leaders in the administration and our champions in the Congress.
The home health community needs the support of Congress because, while the CARES Act was certainly a tremendous first step, further support is still needed. For example, in spite of the central importance of telehealth use within home health agencies, there is no direct reimbursement for these services. While flexibilities were provided under emergency waivers to ensure patients could maintain access to care during the COVID-19 crisis, these flexibilities will be needed over the long term. Home health agencies also continue to have added expenses related to personal protective equipment, infection control, employee testing, and added compensation of front-line caregivers working in the highest risk situations.
When making future policy decisions, lawmakers must recognize that Medicare reimbursement is estimated to have fallen off by 20 percent, and the recovery may be slowed by new outbreaks and setbacks. We also saw patient admission volume decrease significantly because of reductions in elective surgeries – like joint replacements that often require post-surgical home health. Further, some patients have refused care for fear of contracting COVID-19.
As the nation adjusts to its new COVID-19 reality, home health care providers are prepared to continue doing what we can to keep Americans safe. And we hope we can count on the administration and Congress to help by ensuring ongoing support for home health providers by addressing the gaps in telehealth reimbursement and continuing to make funds available to our sector through the Provider Relief Fund in the CARES Act. Doing so will help us to maintain the delivery of quality home-based care to our patients and their families.
The coronavirus emergency shines a light on much that we’re doing right as a nation to care for the most vulnerable patients. Support from lawmakers in these challenging times will help us to succeed.
By Steven Landers, Opinion Contributor — 06/19/20 07:00 PM EDT
Source: The Hill
by M | Jun 20, 2020 | News |
The benefits of palliative care have been highlighted in a major way during the COVID-19 crisis.
Agencies that are able to safely manage chronically ill patients in the home are more valuable than ever. As that sort of care becomes more visible, and, in turn, easier to collect payment for, it has the potential to become another business line for home health care providers.
“We’re making sure that patients understand their medications and are just, in general, taking care of their illness,” Terri Maxwell, the chief clinical officer for Turn-Key Health, told Home Health Care News. “Because what we were really worried about were the sort of long-term consequences of people not accessing their primary care.”
Philadelphia, Pennsylvania-based Turn-Key Health is a community-based palliative care agency that serves health plans and their members, who usually have a serious or advanced illness.
That ability to avoid a decrease in health for those sort of individuals is part of the reason that CareCentrix — a large home-focused care management company — acquired Turn-Key Health in early May.
During the last few months, however, that proactive care has been even more vital, given the current state of the health care system.
“We didn’t want people to suddenly end up … in the emergency room in the middle of the worst time of the pandemic,” Maxwell said. “We really emphasized self-care. We did a lot of patient teaching and medication management over the phone. We were also using video to make sure that people were staying safe. And if they had a problem, they knew who to call and what to do.”
Increasingly, these types of services are reimbursable through Medicare Advantage (MA) plans, providing an opportunity for home health care agencies who already had the capabilities to step in.
More than 60 MA plans across the country are offering in-home palliative care as a supplemental benefit in 2020, according to an analysis by ATI Advisory.
Palliative care has continued to gain popularity in the U.S. due to its cost-saving benefits and also family health care decisionmakers taking a liking to the idea. Of those who were educated on palliative care and what it entails, 90% said they would be likely to consider the service if their loved one had a serious illness, according to a survey from national polling firm Public Opinion Strategies.
COVID-19 has made everyone feel a bit more helpless when dealing with the care for a loved one — from family members to other health care facilitators.
“One of the large provider groups that we work with in the South Florida area started referring us some more [patients] who they wanted us to keep a close eye on, as much as possible,” Maxwell said. “Because they normally see their patients really frequently. They were trying to get telehealth set up and everything, but they knew that there were some people that are at high risk, who could be potentially falling through the cracks without [additional support.]”
Palliative care will also likely get a boost from the distrust forming against other long-term health facilities during COVID-19, such as nursing homes.
What TurnKey Health offers is, in a lot of ways, a service that resembles the kind of visibility that family decisionmakers desire when placing a loved one in a nursing home. But it comes without the risks.
“I think that this is really an inflection point in the delivery of health care overall,” Maxwell said. “The [expansion] of just supporting people at home and preventing people from going to the hospital in the first place. So we sort of pride ourselves on the [idea that] we’re not a post-acute model. We’re a pre-acute model. We’re identifying people who are at risk for hospitalizations and have complex needs. And our goal is to go in and meet them, do very comprehensive assessments, understand what their needs are, understand what their goals are — and make sure that their treatment is aligned with their goals.”
The palliative care market is largely untapped, especially for home health care providers. Just like telehealth and other remote services, it’s growth is primed to accelerate during the public health crisis.
“Sometimes benefits are made available, but not necessarily adopted by health plans,” Maxwell said. “I’m hoping that there’s a greater adoption of the benefits that are now available.”
By Andrew Donlan | June 17, 2020
Source: Home Health Care News
by M | Jun 18, 2020 | Blog |
Home care agencies have been trying to figure out how to partner with Medicare Advantage (MA) plans since the Centers for Medicare & Medicaid Services (CMS) announced the possibility back in 2018.
Anne Tumlinson, CEO of ATI Advisory, has the answers. She’s an expert on the economics of aging, a panelist at the upcoming Home Health Care News Virtual MA Summit and the latest guest on HHCN’s Disrupt podcast.
In our newest episode of Disrupt, Tumlinson breaks down the MA opportunities for home care providers by the numbers — from the number of plans offering in-home benefits to the financial considerations driving MA decisionmakers. Additionally, she briefs agencies on how the coronavirus is rocking the industry, what providers should say when pitching to plans and why home care’s future in MA is looking especially bright.
To hear that conversation and others, you can subscribe to Disrupt via Apple Podcasts, Google Play Music, SoundCloud or your favorite podcast app.
Tumlinson will dive even deeper into the financial considerations guiding MA decision makers at the Virtual MA Summit, which runs June 24 through 26. You can register here.
Until then, you can catch portions of HHCN’s conversation with Tumlinson below, edited for length and clarity.
HHCN: While many home care agencies want to work with MA plans, only a few are. In 2019, about 3% of MA plans offered in-home support services. Your team released some new data for 2020, pre-coronavirus, but what does that figure look like today?
Tumlinson: Today, there are 223 plans offering the new supplemental benefit in-home support services. That’s the category referring to in-home personal care services.
That is an increase over the previous year, which was only about 80. So the good news is we’re definitely seeing an increase from 2019, when these benefits could first be offered.
At the same time, this is also the first year plans could offer a whole new set of benefits much more focused on social-support needs. They’re called Special Supplemental Benefits for the Chronically Ill (SSBCI). It’s a category that lets plans offer benefits not related to health care at all — food, produce, meal, pest control, transportation, social-needs benefits.
Between the non-medical primarily health-related benefits and new non-medical services, we have 619 plans that are doing one and/or the other. That’s not a high percentage of the about 3,000 or 3,500 plans, but the fact that there are 619 plans doing this at all, to me, is like a small miracle.
Are all of those plans working with home care providers to offer those services?
It varies tremendously.
We’re definitely seeing the approach where somebody in the health plan has reached out specifically to a home care provider in their market — or two or three — to say: “Hey, we want to offer this benefit. Are you guys equipped to deliver it, and can we start to talk about what that relationship would look like?”
It might be a regional plan, like Geisinger or SCAN Health Plan. They want to work with regional local providers with whom they can build long-lasting relationships and can be collaborative to their approach to collecting data and information.
Another model we see [is from] some of the larger insurance companies like Humana (NYSE: HUM), Anthem (NYSE: ANTM) and WellCare (NYSE: WCG).
Some [larger plans] haven’t done anything, really. They just put these benefits in their benefit package, and they haven’t really built out a contracted network yet. It’s still a really immature set of relationships where there’s a lot of floundering around.
Model No. 3 is where there’s an intermediary that’s serving kind of like an aggregator. We have a relationship with a company called healthAlign. A couple health plans have contracted with them to essentially find all of the different home care providers and aggregate them in one platform to play the go-between role in terms of contracting and things like that.
That’s my favorite kind of model.
How has the coronavirus shaken up the MA industry?
It’s a little hard to say right now.
Many MA plans are in this very weird position where their costs are way down for medical care because doctors’ offices and everything else has been closed. They’re kind of sitting there with the pot of money they’re supposed to be spending that they haven’t been able to spend.
Secondly, they’ve been given this incredibly broad flexibility from CMS around these supplemental or non-medical benefits, which previously only a handful of them had been offering as formal benefits.
But now CMS is saying: “If you need to change that in the middle of the year, which is normally not allowed, [you can]. We get it. You did your benefit packages way back before anybody knew what COVID-19 was, and now you’ve got a bunch of people stuck at home, who need things like meals, groceries and in-home support services. We’re going to allow you health plans to make those changes in your benefit packages … so that you can meet your member needs and redirect the resources.”
But the third thing is there’s an enormous amount of uncertainty, so it’s really hard, especially for larger plans, from a financial standpoint, to say, “Let’s start buying in-home support services.”
They don’t know if three or four months from now there’s going to be this huge pent-up demand for all these elective procedures. So there’s some hesitation on their part to jump in with both feet and start paying for things that they haven’t been paying for before.
My opinion is given how long we expect this pandemic to dramatically affect our lives, it’s going to dramatically change the way that MA plans and health care, in general, are delivered — and these flexibilities will be more and more deployed.
It looks really good for home care right now. That is the bottom line.
I know there’s not a lot of data on those mid-year MA flexibilities, but this essentially means that MA plans could be adding new home care benefits right and left right now, right?
That’s right.
This all sounds really good for home care, but I don’t want to sound flippant because I know there are a lot of challenges to delivering home care as a result of the virus. But I think there will be a need.
What other recommendations would you have for providers looking to get involved with MA plans?
You’ve got to attack this in a variety of ways.
Look at the local health plans. Who in your market is a real leader at a community level? It could be a hospital, a health system, a physician group.
I always give the example of Geisinger or SCAN Health Plan. They’re a little bit less bureaucratic, and they’re a lot more focused on meeting the needs of [the] community.
Those are going to be the organizations that are more receptive to working with you. There’s fewer people to deal with, and you can find the decisionmakers and get in front of them.
If you’re part of a national organization, … think about, at your corporate level or at a regional level, what is going to be your strategy or your approach?
You’ve got power in numbers. You’ve got a quasi-network. How do you organize yourself in a way that gives you something to take to those conversations?
Finally, you have to have something to say about who you are when you make that approach, really making sure that you understand what is valuable to these health plans. “How can we as an agency be helpful in delivering [these services]?” And what are the benefits to you in offering them?
On the flip side, what are MA decisionmakers taking into account when they’re creating plans?
It’s a long process in deciding what’s going to go into a benefit package. We’re in June 2020, … and their [plan] decisions are all made for 2021.
In a month or two, if they haven’t already, [plans] are going to start thinking about what’s going to go into their packages for 2022.
How much extra money are they going to have under their bids and how are they going to divide that up? A lot of it goes into what other plans are doing in that market and how they can be competitive.
At the end of the day, what Medicare Advantage plans really want to do is be very, very competitive on enrollment. That’s No. 1. “How can we structure our benefit package to be attractive, both in terms of attracting new members and retaining current members?”
And then, “How can we do this in a way that doesn’t … increase spending in any way, shape or form above and beyond what we estimate it will?” They want to feel comfortable that they know what they’re doing when they price [supplemental benefits].
Finally, they care a lot about what we call coding — information that can help their care managers manage their population better. And then also, you know, what kind of information can help in the coding that they need to get paid well by CMS.
Finances are obviously an important part of the equation. We’ve heard from some providers working with MA plans that the payments they’re getting aren’t always great.
That’s exactly right.
[Imagine] for illustrative purposes every health plan getting $1,000 per member, per month.
Let’s just call that the benchmark right now. Then the plan says, “Hey, I think we can do this for $900 per member per month.”
CMS says: “That’s awesome. Of that difference of $100, you get to take $50 of it and do whatever you want with it.”
Not anything, but all that fun stuff that’s going to help you attract enrollees like lowering the cost of the plan premium, lowering out of pocket costs, offering supplemental benefits.
This is not a lot of money relative to the rest of the spend. Within that, they have to prioritize. This is very hypothetical right now, but there’s really a small amount of dollars available designated for the category that we’re talking about.
In many ways, this opportunity [for home care providers] is more strategic and symbolic than it is financially a big win.
The actuaries have to price the risk. They think, “Hey, how about if we pay $4 for every 15 minutes.” They don’t really know what they’re doing, so the rates are not great. Not always, but in many instances.
The last thing I’ll say about all this is that the policy environment is very fluid right now. This is an election year. We have a huge pandemic going on. Nursing homes are under fire. Medicare’s never been more flexible.
Going into next year maybe, there are going to be some proposals on the table to make the pot of money available for home care from public paying sources bigger because there’s a recognition that people really do need these services to stay home and to stay out of nursing homes.
Overall I’m hopeful that will go up. That’s why it’s so important to strategically position yourself with these payers now.
By Bailey Bryant | June 17, 2020
Source: Home Health Care News
by M | Jun 15, 2020 | News |
John Stagliano never was much of a hospital guy.
“Anytime he ever went was when something bad happened,” said his son, also named John Stagliano. “I guess he had that, ‘Nothing ever good is gonna be coming from there,’ kind of thing.”
That made it all the more difficult when the elder Stagliano contracted the novel coronavirus at the end of February. At 82, he was statistically at a high risk for the disease to become serious, and potentially fatal. But despite his children’s pleading, he would not be admitted to the hospital.
“He just didn’t want to be there,” said his son John.
So he got his father set up to receive fairly intensive care in the basement of the Exton home the elder Stagliano shares with his wife, Catherine Stagliano. A home health care team through Penn Medicine brought an oxygen machine down to what the family calls the “man cave” and set up an app so his kids could monitor their father’s heart rate, temperature and other vital signs remotely.
For about two weeks, Catherine Stagliano, also 82, trekked up and down the steps to the basement, bringing her husband food and caring for him in the man cave.
Until, predictably, she started feeling sick, too.
For older adults, staying healthy often involves rotating in and out of skilled nursing facilities after an injury, a fall, or a joint replacement surgery. Sometimes, those short-term stays become long-term ones, in the same facility.
If the Staglianos hadn’t made a fuss, they would have likely ended up receiving care in a hospital for COVID-19 and then been discharged to a skilled nursing facility once they were stable — the same facilities that have been ground zero for the coronavirus pandemic. In Pennsylvania, two-thirds of COVID-19 deaths have happened there.
As families watch nursing homes struggle to contain the virus, many have started to consider bringing health care for their loved ones into their own homes.
The trend isn’t new. As the baby boomer generation ages, hospital systems, government agencies and insurers have been shifting long-term care away from costly institutions and toward the home for at least a decade. Many experts predict that the risks posed by COVID-19 may accelerate that process, whether the system is ready for it or not.
Is telemedicine the ‘new normal’?
The pandemic is already shifting the day-to-day logistics of seeing a doctor.
As soon as models began to predict that hospital systems could be overwhelmed by a surge of COVID-19 patients, the federal Centers for Medicaid and Medicare Services changed its policies surrounding telemedicine, allowing health systems to bill for remote appointments that previously would not have been eligible for reimbursement. That meant more people were able to receive care at home who would have otherwise created crowded hospitals and taken up valuable bed space.
At health systems around the Philadelphia region, doctors started treating more people virtually, at home, for a variety of illnesses, from addiction medicine to cancer treatment — as well as those with COVID-19, like the Staglianos.
“This situation … is shining a much brighter spotlight,” said David Baiada, CEO of Bayada Home Health Care, the largest long-term provider of at-home care in Pennsylvania. “It’s also creating innovation,” such as the remote monitoring of symptoms and increased use of telemedicine.
As people are discouraged from visiting the hospital for routine care, they’re also getting used to accessing it from home and could be more willing to keep doing so even after the pandemic lifts — especially if the loosened Medicare regulations remain in place.
“It’s going to be really hard to go back from that because now we’ve seen that it’s possible to do this and patients like getting telehealth and care at home,” Rachel Werner, head of the University of Pennsylvania’s Leonard David Institute of Health Economics, said of the relaxed telehealth restrictions. “In the next year or two, I think we’re going to find that nursing homes are going to have to close because there just won’t be as much demand for the care that they provide. I think we’ve probably turned a corner on that.”
Penn Medicine went to such great lengths to keep people out of the hospital that by mid-May the numbers of patients being treated at home and in the hospital were roughly the same. Traditional care at home was supplemented with multiple telemedicine visits a day and a lot of communication with family members. Still, said Nina O’Connor, chief medical officer for Penn’s home health care, the model asks a lot of family caregivers.
“At-home care does depend on informal caregiving from family members or friends,” said O’Connor. Though loved ones may have had more time than usual during the pandemic as shutdowns rendered many jobless, there is no guarantee that will continue to make the model sustainable, she noted.
“That is a real barrier, one that we haven’t completely overcome,” she said.
John and Catherine Staglioni, both 82., pose for a photo during a trip to Key West over the Thanksgiving holiday. Both were treated for COVID-19 at home in Exton, Pa. (Provided by John Staglioni)
John Stagliano said he was grateful his parents could remain at home, but he ultimately would have preferred if they had been in a setting where they had 24/7 monitoring.
“If they’re OK, the home care’s fine,” he said. “However, if they start not being able to take care of one another, then it becomes a problem. And all the home health care’s not gonna help you with that.”
While both parents were sick, Stagliano moved from his home in Reading to stay with his brother who lives nearby, so he could make the 10-minute drive to their house if necessary. He is able to work from home, so he had some flexibility. Even so, the care took a toll.
“My stress level was ridiculous,” Stagliano said.
Financial tides have begun to turn
Though the bulk of the residents at any given nursing home may be there for the long term, it’s the patients discharged from the hospital to recover after operations like joint replacements, or short-term illness like COVID-19, that come with higher reimbursement rates. Many nursing homes subsidize the care of their long-term patients through those short-term patients, who stay for just a few weeks.
The operations of nursing homes depend on both streams of patients, but the risks posed by COVID-19 could change both for the foreseeable future.
The notion of shifting more elder care into the home was brewing long before the coronavirus tore through nursing facilities. By 2050, the U.S. population over age 65 is expected to be nearly double what it was in 2012. Pennsylvania is particularly old, with 19% of its population over 65, compared to the national median of 14%.
“There are a lot of old people coming here soon, and we’re gonna have to figure out what to do with that and how to pay for it,” said Kirstin Manges, a national clinician scholar who studies post-acute care for older adults and a registered nurse by training.
Because of the anticipated rising costs that come with caring for more older adults, government officials and health system operators have been thinking about how to reduce the costs of elder care for more than a decade. Plus, people overwhelmingly want to stay at home.
“People express the desire to be able to age in place as much as possible, in their homes and in their communities,” said Kevin Hancock, deputy secretary of the state Department of Human Services’ Office of Long-Term Living. “That view has underwritten the development of long-term care services really for about the last 25 years.”
However, Medicaid-funded care through Social Security was initially set up to pay for nursing home stays, not care in the community.
Nationally, 87% of state Medicaid spending on long-term care went to nursing homes in 1990, according to a report from the Kaiser Family Foundation.
That started to shift after the passage of Americans with Disabilities Act in 1990. Lobbyists and advocates continuously made the point that home care is safer, more humane and more cost-effective than institutionalized long-term care.
The industry has adapted to challenges: Stymied by a limited stock of ADA-compliant housing, home health and government agencies have expanded their scope to focus on housing development, too. Philadelphia-based Liberty Resources has built 103 units through its own development arm, and priority is given to individuals transitioning out of nursing home care.
Pennsylvania has come a long way. By 2018, the state Department of Human Services had launched Community Health Choices, a program to codify and streamline community care for people with disabilities over age 21 and seniors who received Medicaid. The state also has a department dedicated to transitioning individuals out of nursing home care into their homes.
In Pennsylvania, 62% of the people now drawing those federal funds for long-term care receive that care outside of a nursing home. The funding is now split around 50-50, between institutional and community-based care.
Preliminary numbers for January through April of this year do not show an increase in the number of people moving out of institutional settings compared to previous years, so it’s too soon to know whether the pandemic will accelerate that shift.
By Nina Feldman, Laura Benshoff | June 12, 2020
Source: WHYY
