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News Roundup: June 26, 2015

3 Changes to Make Aging-in-Place a Reality for Seniors

Published by Home Health Care News
Cassandra Dowell
June 26, 2015

As America’s aging population continues to grow so too do the demands on local communities to meet that population’s changing health care needs.

“There’s a real push for people not to be in nursing homes unless they absolutely have to be,” said Robyn Golden, director of health and aging at Rush University Medical Center, during the National Healthcare Innovation Summit on Wednesday in Chicago. “People don’t want to live in institutions.”

But many aging Americans face significant challenges when trying to remain in their homes, including homes that cannot support their changing health needs, burned-out family caregivers and a lack of community services. At the same time, those challenges also present opportunities for communities to adapt and promote aging in place, industry leaders said.

“People say they want to age in place, but really they want to age in community,” said Dr. Paul Tang, vice president and chief innovation and technology officer at Palo Alto Medical Foundation.

Modify the Home

Older Americans often leave their homes because it lacks necessary modifications to meet their health care needs, Golden said.

“We’re spending more [to place them] in a nursing home when all we had to do was modify their home,” she said. “If we put home modification in a [home-based community service budget] we could show the impact of cost savings compared to being institutionalized.”

Housing is a critical component of senior wellness, said J. Thomas Briody, president and chief executive officer of the Institute on Aging.

The Institute on Aging is piloting a program to help transition people in skilled nursing who “don’t belong there and those at risk of being in skilled nursing” following release from a hospital into the home, Briody said, noting the programs also include other services such as transportation and groceries.

“We’re talking about millions of potential dollars saved each year and transforming a person’s life,” he said. “This is just a glimmer of what the future can be.”

Support Family Caregivers

The No. 1 challenge for caregivers is knowing where to go to get the supports they need, Briody said, citing a recent program involving caregivers in California’s Bay Area.

“There is a vast array of services,” he said. “But how do they find it? How do they pay for it?”

Without much-needed supports, the health of caregivers themselves can derail, creating a larger population health care concern.

“We do not have a long-term care policy in this country,” said Golden. “The closest thing we have are family caregivers, who are often times compromising their careers and finances. They’re depressed.”

Reaching family members before all resources are exhausted is key, Golden said.

Provide Community Services

Ultimately, community service organizations need to recognize the role they can play in both supporting caregivers and providing care beyond a hospital’s walls.

“The team of care for a hospital patient is not within the four walls,” Golden said.

Communities can’t rely on federal social services to address all of its residents’ needs, Tang said.

“We need to tap into what’s already there,” Tang said, naming churches, temples, senior centers and organizations such as the YMCA as examples of places for aging residents to find resources.

Acute care should be the exception, Briody said.

“The hospital should be where you go when everything in the community cannot support you,” Briody said. “That’s the fundamental change — we need to look at preventative and post acute care in a new light.”

Home health care changing rapidly as technological advances

Published by Utica OD
Amy Neff Roth
June 26, 2015

The first home health agency in Utica grew out of a citizens’ committee to fight the city’s high infant mortality rate 100 years ago.
A century later, the Visiting Nurse Association of Utica and Oneida County has a far different focus, a pool of patients that spans all ages and most medical conditions, and technological skills never imagined even 20 years ago.
“One thing you can guarantee in health care is change,” said Kim Ellis, the executive director of home care services for the Mohawk Valley Health System, which includes the VNA. “I don’t think I’ve ever seen such rapid change as I’ve seen in the last five or six years.”
In that time, the role of home health care has changed as state and federal policies have placed it front and center in a redesign of the health care system meant to provide better care at lower cost.
So, it’s the job of home health workers to make sure that patients being released from the hospital don’t end up being readmitted or going to the emergency room.
“It’s just been one new, amazing transition to home,” said Jeanne Gymburch, clinical nursing supervisor for the VNA, who’s been there for 33 years and witnessed the transition from paper charts to laptops, and beepers to smartphones. “Everyone’s coming home sicker, quicker, and we are the place to go to have those services where you want to be. Who doesn’t want to recover at home rather than in the hospital?”
To help with that transition, though, home health agencies have had to take on increasingly complex technology, offering things such as wound vacuum care, chemotherapy, IV therapy and care for chest tubes and respirators.
“Things you used to do in the hospital, you’re seeing come home,” Gymburch said.
To fulfill its modern mission, home health care has expanded to include more kinds of workers, including physical, occupational and speech therapy.
And unlike its predecessor, the VNA no longer is the only home health agency in the county, which has four certified home health agencies (those able to accept Medicaid reimbursements directly) and 30 licensed home health agencies.
In New York, about 175,000 Medicare patients and nearly 190,000 Medicaid patients – plus some patients in private health plans – receive home health services, according to the Home Care Association of New York State.
Home care also is part of the big trend in long-term care, keeping patients in their own homes and out of institutions as long as possible. Most long-term care, though, is offered within Medicaid managed care plans; the VNA no longer has its own long-term care program.
Like other home care agencies, the VNA also has launched a telemedicine program so that nurses can check on things such as blood pressure and pulse rate over the phone. That’s something Ellis expects to expand in the future.
“I think you’re going to see more telemedicine in the home where you’re going to be able to do virtual visits,” she said.
Nurse practitioners or doctors will check on the patient via telemonitor, possibly discussing the patient with a nurse assessing the patient in person, she said.
But as much as the breadth of services offered by home care has changed, many aspects of home care still are reminiscent of 1915. The first nurses cared for big immigrant populations and modern nurses care for Utica’s big refugee population, Gymburch pointed out. And nurses have and always will focus on basic nursing skills, checks on health status and teaching, she said.
That teaching is particularly important in helping patients to stay well, Ellis said.
“If they understand their disease, if they are part of that process, they’re going to have that ownership to make sure they don’t have that salt that they’re not supposed to be eating or they’re having their blood pressure checked regularly,” she said.

Harvard: Rising Debt Jeopardizes Aging in Place

Published by Home Health Care News
Cassandra Dowell
June 26, 2015

Increased supports will be needed to care for America’s large and growing senior population in their homes, new research shows. And affordability of these supports—and housing options generally—is particularly pressing, as seniors’ debt load is rising.

Many older adults live alone, have at least one type of disability, and have limited resources to pay for suitable housing, according to the latest report by Harvard University’s Joint Center for Housing Studies (JCHS). “The State of the Nation’s Housing” provides an annual assessment of the housing outlook, and summarizes trends in economics and demographics.

“As a result, the demand for units that are affordable, accessible, and provide social connection as well as supportive services will grow increasingly acute over the next two decades,” JCHS said in the report.

Aging baby boomers will lift the number of older households aged 65 and over 42% by 2025, and double the number aged 80 and over by 2035, data show.

“In another decade, the oldest members of this generation will be in their late 70s, a time of life when living independently often becomes difficult,” JCHS said. “By 2025, the large and growing population of seniors is likely to drive up demand for alternative housing arrangements that offer a combination of affordability, accessibility, and supportive services.”

Senior homeowners’ financial picture is worrisome, as those who choose to age in place face rising debt and wealth constraints that may leave many retired homeowners struggling to meet their mortgage payments.

More than a third (38%) of owners aged 65 and over had mortgages in 2013, up from a little over a quarter in 2001, data show.

“Moreover, the median amount of debt they carried doubled over this period in real terms,” JCHS said. At the same time, the real median equity of older owners in 2013 was down to $125,000—lower than in any year since 1998.

“Having less equity and large mortgage payments late in life is a troubling prospect for households on fixed incomes,” JCHS said.

Independence at Home model saves $25 million in first year, CMS says

Published by Healthcare Finance News
Susan Morse
June 19, 2015

The Centers for Medicare & Medicaid Services will award $11.7 million in incentive payments to nine participating practices that succeeded in reducing Medicare expenditures and met designated goals for the first year of Independence at Home.

All 17 participants saved over $25 million in the program’s first performance year, according to CMS.

The CMS analysis found each Independence at Home participant on average saved $3,070 while delivering high quality patient care in the home, CMS said.

All 17 participating practices improved quality in at least three of the six quality measures for the demonstration in the first performance year, and four met all six quality measures, CMS stated.

[Also: CMS finalizes rules for Medicare Shared Savings Program ACOs]

The nine which will receive practice incentive payments, and the amounts, are: Doctors Making Housecalls, $275,427; Housecall Providers, Inc., $1.2 million; North Shore-Long Island Jewish Health Care, $542,323; VPA Jacksonville, $711,527; VPA Dallas, $1.7 million; VPA Flint, $2.9 million; VPA Lansing, $1 million; VPA Milwaukee, $1.4 million; and Mid-Atlantic Consortium, $1.8 million.

The other participants include Boston Medical Center, Christiana Care Health System, Cleveland Clinic Home Care Services, Doctors on Call, MD2U-KY, MD2U-IN, House Call Doctors, Inc., Treasure Coast, and Innovative Primary Care.

The year-one spending target and expenditures per beneficiary per month ranged from $2,434 to $5,756 for over 8,400 Medicare beneficiaries.

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The Independence at Home Demonstration provides chronically ill Medicare beneficiaries with primary care services in the home setting.

CMS analysis found these beneficiaries have fewer hospital readmissions within 30 days; have follow-up contact from their provider within 48 hours of a hospital admission, hospital discharge, or emergency department visit; have their medications identified by their provider within 48 hours of discharge from the hospital; have their preferences documented by their provider; and use inpatient hospital and emergency department services less for conditions such as diabetes, high blood pressure, asthma, pneumonia, or urinary tract infection.

The Independence at Home Demonstration is part of the Affordable Care Act’s initiative to rewards doctors based on quality, not quantity of care.