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News Roundup: February 11, 2013

Home Care Aides Await Decision On New Labor Rules

Published by NPR
Laura Sullivan
February 11, 2013

Home health care aides are waiting to find out if they will be entitled to receive minimum wage. A decades-old amendment in labor law means that the workers, approximately 2.5 million people, do not always receive minimum wage or overtime.

The Obama administration has yet to formally approve revisions to the Fair Labor Standards Act that would change that classification.

On Dec. 15, 2011, Obama announced the proposal, and then-Labor Secretary Hilda Solis offered her support for the revisions in the Labor Department's blog:

"This new rule would ensure that these hardworking professionals who provide valuable services to American families would receive the protections of minimum wage and overtime pay that nearly every employee in the United States already receives under the FLSA."

The guidelines would affect a growing industry (revenues for home health care services nearly doubled to $55 billion between 2001 and 2009, according to the U.S. Census).

Missing Out On Overtime

The revision would also affect people like Lou Garcia.

Garcia is up before the sun rises in Los Angeles to prepare breakfast for an elderly woman with Alzheimer's. They do errands together. Garcia reads her books, takes her to doctors' appointments, does her laundry, cleans her house and makes her dinner.

Garcia makes $10 an hour. She works 12 hours a day and sometimes on the weekends. But while she works more than 40 hours a week, Garcia doesn't make overtime.

She's not even guaranteed minimum wage because a provision in the federal law, passed in 1974, says home health aids are exempt from those requirements. Companies can pay home workers what they want and can ask them to work as many hours or days as they'd like.

The Labor Department's Wage and Hour Division website notes that while the regulations haven't changed since they were enacted, "the in-home care industry has undergone a dramatic transformation."

Catherine Ruckelshaus, legal co-director at the National Employment Health Project, calls the exemption "an accident of history," with U.S. labor laws treating the workers like adult baby-sitters.

Ruckelshaus says Medicaid pays agencies about $18 an hour for in-home care services. Private clients usually pay a few dollars more. The worker sees about half that. Companies usually pay home workers $9 to $10 an hour, meaning the companies are bringing in $8 to $9 for every hour a worker spends in a home.

The Extra Cost

William Dombi is vice president for law for the National Association for Home Care and Hospice, a trade organization that represents the companies hiring the workers. He says they are supportive of paying workers at least minimum wage.

But Dombi says the companies cannot afford to pay overtime for nights and weekends because the companies' profits are largely fixed by Medicaid.

"Businesses can't simply add another cost like overtime through a price rise as other businesses might for a hotel room or for a rental car," Dombi says.

The workers and the companies aren't the only ones engaged in this debate over how the federal guidelines should be amended. There's also an association representing people with disabilities who use the workers.

Bob Kafka, co-director of disability rights group ADAPT, says he wants the workers to be paid overtime and minimum wage, but he says his organization can't support the overtime changes to the guidelines either.

"We don't in principal oppose that, but the unintended consequence of these rules is that people with significant disabilities will have to find multiple attendants, and many of the attendants will end up just leaving the job," Kafka says.

Back To The Nursing Home?

Kafka says families won't be able to pay more, and neither will the government. He says many of these people will be forced back into nursing homes, which will cost taxpayers significantly more.

But workers like Garcia say that is the point. In a nursing home, workers doing the same job — cleaning, bathing and caregiving — are entitled to minimum wage and overtime.

"I think it's unfair to us because we are doing a job, and we are also human, and we need to be treated as the other people doing other jobs," Garcia says.

How Home Care and Hospice Can Make a Difference

Published by Star News Online
Tony Zizzamia
February 6, 2013

Congress has been negotiating for months on ways to reduce spending while also still providing the best services to their constituents. There is one obvious step to help alleviate some of the rising costs of healthcare, while still providing top-notch service.

Home care and hospice are both proven ways to help reduce costs. A recent study showed that when used as the first post-acute setting after a hip fracture, home care saved Medicare an average of more than $5,000 per patient. Home care can also help reduce costs through lowering rehospitalization rates and improved chronic care management. Hospice care can also reduce costs. A recent Duke study stated that hospice care reduced spending by more than $2,300 per patient compared to normal care, which typically included costly hospitalizations near death.

Most importantly, both home care and hospice care improve quality of life while providing those cost benefits. The overwhelming majority of patients prefer to receive treatment in their own homes, and both home care and hospice care allow that for patients. Studies have shown that hospice patients live longer than other patients in similar conditions, and home care patients recover faster than similar patients.

These two vital care choices should be more receptive to new patients and not more restrictive. Ending costly rehospitalizations through home care and expensive hospital stays at the end-of-life should be a primary focus of how to reduce costs in healthcare.

Tony Zizzamia, President of Liberty HomeCare & Hospice Services
Wilmington, NC

Senior Home Care expands in-home patient telemonitoring program

Published by Healthcare Finance News
February 6, 2013

As part of Senior Home Care's full complement of home health care services, the company is expanding its Telemonitoring Pilot Program to include three office locations in Florida – Gainesville, Naples and Ft. Myers.

Telemonitoring services, which Senior Home Care launched in Gainesville in July, 2012, have quickly gained traction with referring physicians and patients. They target high-risk patients with chronic conditions. Clinical visits combined with telephonic intervention have been shown to improve patients' outcomes, reduce hospital readmissions and enhance patients' understanding of their overall condition and progress.

In-home telemonitoring uses a simple system to link from a patient's home directly to their health care team at Senior Home Care. The goal is to allow the patient to have confidence and improve their ability to stay independent, while knowing their health status is being monitored, between visits, using the latest technology. Cardiocom, LLC is Senior Home Care's telehealth solutions provider. Cardiocom's Commander FLEX device enables Senior Home Care's patients to have 7-days-per-week monitoring of their vital signs, including pulse, blood pressure, daily weights and more (see cardiocom.com for more information). Data is transmitted to Senior Home Care, becoming part of the patient's established Electronic Health Record (EHR), which clinicians monitor, review and follow up as appropriate.

Maintaining real-time data in each patient's EHR is invaluable to Senior Home Care's referring physicians, especially those using Provider Link, Senior Home Care's online physician portal. Through Provider Link, participating physicians have 24/7 access to patient records for review, which also makes the process of electronically signing orders, authorizing referrals and documenting Face-to-Face encounters more efficient.

Patient Education, Self-Advocacy
Senior Home Care's Director of Disease Management, Judy Fenton, explains that "while telemonitoring services are a valuable tool when the patient is recovering from an acute illness or exacerbation of a chronic condition, Senior Home Care's patient-centered approach focuses on ongoing self management for the future." She adds, "During telemonitoring, our clinicians prepare patients for post-monitoring, so they are able to recognize their key signs and symptoms – such as weight gain and swelling of the feet -- that may require early intervention to prevent avoidable hospital re-admissions."

Innovation Enhances Quality Care
Technology is only as good as the clinicians behind it. Senior Home Care's clinicians utilize Telemonitoring as a tool for augmenting one-on-one clinical visits with patients, during which they use evidence-based guidelines for providing care.

"Senior Home Care continues to look for innovative ways to help improve patients' lives," Fenton says. "Telemonitoring is just one more way our home health care supports quality outcomes and seamless patient care, as well as adds value to the health care continuum."

Senior Home Care, Inc. has been treating seniors throughout Florida and Louisiana with quality home health care services since 1994. With nearly 50 branch locations (Senior Home Care in Florida and Synergy Home Care in Louisiana) and 1,800 employees, the company is one of the largest home health care providers in the Southeast. Working in conjunction with patients' physicians, Senior Home Care's nurses and clinicians treat more than 50,000 seniors each year in their homes and assisted/independent living facilities. The company's mission is to provide quality patient care in a compassionate and ethical manner while encouraging a lifestyle of independence. For more information, visitwww.seniorhomecare.net.

Hospitals Try House Calls to Cut Costs, Admissions

Published by Wall Street Journal
Laura Landro
February 4, 2013

To keep patients out of the hospital, health-care providers are bringing back revamped versions of a time-honored practice: the house call.

In addition to a growing number of doctors treating frail patients at home, insurers and health systems are sending teams of doctors, nurses, physician assistants and pharmacists into homes to monitor patients, administer treatments, ensure medications are being taken properly and assess risks for everything from falling in the shower to family care-giver burnout. Some are adopting programs called "Hospital at Home" to provide hospital-level care in the home, including portable lab tests, ultrasounds, X-rays and electrocardiograms.

In large part, the aim is to avoid new financial penalties from the Centers for Medicare & Medicaid Services. Last October, the federal government agency started withholding certain payments to hospitals with higher-than-predicted readmission rates for patients with heart attacks, congestive heart failure and pneumonia. Nearly a fifth of its beneficiaries end up back in the hospital within 30 days, according to Medicare, costing $26 billion annually.

But there is also growing pressure to keep patients from being admitted to the hospital in the first place, especially if they have chronic disease. Such patients, particularly older ones, are more vulnerable to infections and complications like bed sores in the hospital, and are actually safer at home, experts say.

"People may think of the house call as this quaint idea of a doctor heading out in his horse and buggy, but it is an excellent and necessary model for taking care of vulnerable high-cost patients," says Bruce Leff, a professor of medicine at Johns Hopkins University School of Medicine who developed the Hospital at Home model and is president of the American Academy of Home Care Physicians.

Payment models vary. Private insurers who contract with Medicare to offer benefits through Medicare Advantage plans may offer home-based care after hospital discharge. The Veterans Administration has a home-based primary-care program for chronically ill veterans, and some VA centers run Hospital at Home programs. Medicare has also been reimbursing a growing number of physician house calls for fee-for-service beneficiaries and covers a few other home services after hospital discharge. Last year, Medicare began a three-year demonstration project called Independence at Home to test whether home-based care by teams of doctors, nurses and other clinicians can reduce the need for hospitalization, improve patient and caregiver satisfaction and lower costs.

Existing research on house-call programs point to their benefits. A study published last June in Health Affairs showed that costs for patients in a Hospital at Home program at Albuquerque, N.M.-based Presbyterian Healthcare Services were 19% lower than for similar inpatients, in part because of shorter stays, and fewer lab and diagnostic tests. Patients with conditions including pneumonia, congestive heart failure and urinary-tract infections who are sick enough to require hospitalization and live within 25 miles are "admitted" in their home. They are then visited daily by a physician and once or twice daily by nurses who administer infusions and perform routine lab tests and procedures.


Patient satisfaction scores were also higher. "Patients who have been in the hospital multiple times realize it is not always the healthiest place for them and they are thrilled to be at home instead," says Melanie Van Amsterdam, lead physician for the Presbyterian program and a co-author of the study. They also get more time with doctors, who might spend two hours on an initial visit compared with as little as 10 minutes in the hospital, Dr. Van Amsterdam says.

Mercy Health, a not-for-profit health system in Cincinnati, Ohio that owns six hospitals, was able to reduce its 30-day readmission rate to 14.5% as of November, from 16.9% in 2011, with a Care Transitions program that assigns nurses to high-risk patients to keep them out of the hospital.

Verne Wisby, 68, suffers from chronic obstructive pulmonary disease, a lung disease linked to smoking that can cause respiratory infections and breathing trouble. He also has arthritis and chronic pain from a childhood auto accident that broke his legs and hips and crushed his pelvis. He was admitted to the hospital last April after he came to the ER with a flare-up of his COPD, but within a month of his release, he was readmitted for a seizure.

At discharge, Mercy paired him with transitional care nurse Pamela Sevrence. On her first visit to his home, he was feeling so discouraged by his many medical problems, they both recall, he told her, "I'm just going to sit here till I die."

Ms. Sevrence worked with him to quit smoking within 30 days, and instructed Mr. Wisby and his wife Bonnie in the use of oxygen and medications to avoid flare-ups in his lungs. She also fielded calls from Mrs. Wisby whenever a problem came up. Ms. Sevrence lined up a new primary care doctor and a neurologist, as well as a pain specialist.

"She gave me hope, encouragement, and support," says Mr. Wisby. "I have no plan to go back in the hospital."

Health plans are also using claims data to identify patients at high risk for rehospitalization and helping coordinate care at home "so patients don't slide back," says Karen Ignagni, chief executive of America's Health Insurance Plans, an industry association.

For example, insurer Aetna AET -1.46% is contracting with home health agencies to expand a transitional care program for customers of its Medicare Advantage plan in a number of communities around the country. A pilot for the program reduced readmissions by 20% and saved $439 per member. "It is costly to send nurses into the home, but not nearly as costly as readmissions," says Aetna national medical director Randall Krakauer.

Cigna Medical Group, the medical practice unit of Cigna HealthCare of Arizona, with 25 health centers in the Phoenix area, has a Home-Based Care Team that includes nurse practitioners and physician assistants. Robert Flores, the group's medical director of population health management, says primary care physicians use the team to help them manage patients at high risk of hospitalization or re-hospitalization who can't easily get to a doctor's office. "We have lots of patients who would have undoubtedly ended up back in the hospital had the team not been in their homes," Dr. Flores says.

The home team has helped Sandi Roland of Mesa, Ariz., care for her 84-year-old father, Charles Wilburn, who came out of a six-week hospital stay two years ago for multiple health problems. Ms. Roland says complications from that hospital stint left him in worse shape than when he was first admitted. A nurse practitioner came regularly at first to help with bed sores, and check his blood and lungs, and a physical therapist helped with rehabilitation.

"For me as a caregiver, it gives me so much support and puts me at ease that if things were to go wrong I would call and they would come at any time," Ms. Roland says. The nurse still follows up with a call every six weeks and her father has not returned to the hospital.

Home health aides serve a growing population; here’s what you need to know

Published by Washington Post
Consumers Union of United States
February 4, 2013

The demand for home-care aides — also known as personal-care aides and home health aides — is skyrocketing as the number of seniors continues to grow. The Department of Labor projects that in-home assistance will be the nation’s fastest-growing occupation by 2020. Those workers help seniors, the infirm and people with intellectual or developmental disabilities with personal hygiene, taking medication, preparing meals, doing household chores and other tasks.

Getting help


To find the right help for a family member, ask his or her doctor for a referral to a social service worker. The doctor also may be able to provide a list of home-care agencies that serve your area (and should disclose any financial interests he might have).

If the services required are primarily medical, such as wound care or home chemotherapy, the best choice might be a visiting nurse; to learn more, contact one of the organizations affiliated with the Visiting Nurse Associations of America.

If the necessary services are more personal than medical, a home-care aide might be best. He or she can help with shopping, cooking, cleaning and laundry as well as personal activities such as dressing, eating, bathing and using the toilet. A homemaker aide might be the right choice if your relative needs help with housekeeping, laundry, shopping and meals, but not personal hygiene.

Next, make sure your relative will accept home care. Many older or ill people resist because they don’t want strangers coming into their home or because they view home care as a sign that their independence is slipping away. Consider asking your relative to try a two-week trial to see if they like home care. People do, in most cases, says John I. Buck, chairman of the accreditation commission of the National Association for Home Care & Hospice, a trade group.

As a last resort, it sometimes helps to tell a “therapeutic fib” that a doctor or nurse has made home care a requirement, says Lois Escobar, a licensed clinical social worker in San Francisco.

Who will pay?

Once you’ve determined what type of aide is best and you’ve established that your relative is on board, check to see whether he or she is covered for home care through a private health or long-term insurance policy, the Veterans Administration, Medicare or Medicaid.

Medicare beneficiaries have access to the Home Health Compare Web tool (www.medicare.
gov/hhcompare), which allows you to compare the services of agencies in your area and assess their quality against state and national averages.

Note that Medicare typically covers home health aides for just 60 days at a time, and only if patients are housebound and require a certain level of care (for instance, intermittent, skilled nursing care). It won’t pay for personal or homemaker services if that’s the only care needed.

In contrast, some states allow Medicaid recipients to hire almost anyone for home care, including relatives. Eligibility and benefits vary by state, so check with your state Medicaid office.

If you’re paying out of pocket, contact your relative’s local Area Agency on Aging (800-677-1116, or www.eldercare.gov) for information about home-care agencies and sources of funding that your relative may be eligible for, such as social service programs or grants.

Some people prefer to ask friends or family members to be caregivers through formal agreements and private financial arrangements. Or they find independent workers through word of mouth, classified ads or online registries, sometimes hiring them at below-agency rates.

As many as 800,000 workers offer in-home services under such private arrangements, according to the Paraprofessional Healthcare Institute, a nonprofit home-care advocacy group. But this market is unreported and unregulated, and the terms may skirt basic employment standards. Relying on someone who might be untrained, unscreened and unsupervised could be perilous for your family member.

Bottom line

Home-care aides can improve the quality of life of the people they help. Stay involved and make adjustments when necessary so you can keep your family member living independently for as long as possible.

Healthcare jobs continue to increase at start of 2013

Published by Healthcare Finance News
Stephanie Bouchard
February 1, 2013

In the first month of the new year, the healthcare industry added 23,000 jobs – conforming to the industry’s average monthly gains throughout 2012, noted the Bureau of Labor Statistics in a statement accompanying the department’s jobs report released Friday morning.

Ambulatory healthcare services gained 27,600 jobs, including 9,200 jobs in doctors’ offices and 3,600 jobs in hospitals. The job gains were offset by a loss of 8,400 jobs in the nursing and residential care facilities sector.

Across all industries, total nonfarm payroll employment increased by 157,000 and the unemployment rate remained essentially unchanged at 7.9 percent. The number of long-term unemployed also remained about the same at 4.7 million, accounting for 38.1 percent of those who are unemployed.

Healthcare, retail trade (33,000), construction (28,000) and wholesale trade (15,000) were the industries adding the most number of jobs in January, while transportation and warehousing (14,000 combined) dropped.

The manufacturing, finance, professional and business services, leisure and hospitality and government industries showed little or no changes.

The Dow Jones Newswires reported that January’s job numbers did not come as a surprise to economists, who had forecast that the country would add about 166,000 jobs and that the unemployment rate would stay the same at 7.8 percent.