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News Roundup: July 17, 2015

Home Care: A Smart Way to Deal with CT's Aging Population

Published by Hartford Business
Hartford Business
July 17, 2015

Connecticut policymakers often get a bad rap, sometimes deservedly so, for their inability to properly manage the state's affairs. The recent state budget that raised taxes by $1.3 billion, for example, cast a dark shadow of discontent over Hartford's Golden Dome.

One area, however, where state government is actually on the right track is dealing with its aging population. Specifically, the state's focus on moving older residents into homecare settings, rather than much higher cost institutional care, is smart policy and should continue and even be expanded.

As the Hartford Business Journal has been reporting in recent weeks, Connecticut is one of the 10 oldest states in the country, and its population is getting grayer by the day. In the next 15 years, more than 247,000 Connecticut residents are expected to move into the 65-plus age group, representing a 45 percent increase compared to 2013, according to the U.S. Census Bureau.

That will usher in an era of higher demand for healthcare services, and unless the state figures out ways to keep seniors healthy and rein in costs, the financial burden will be overwhelming.

Home care is a logical way to keep costs in check. The median annual cost for home health aide services in Connecticut, for example, is $50,336, versus $66,900 for an assisted-living facility, according to the Genworth 2015 Cost of Care Survey. A semi-private room in a Connecticut nursing home costs about $146,000 annually, while a private room goes for $158,775, the survey said.

As HBJ's Matt Pilon reports in this week's issue, state policymakers between 2008 and 2015 leveraged the federally-funded "Money Follows the Person" program to transition 2,974 nursing home patients into community settings. The state's goal is 5,000 by next year. We encourage the state to meet that benchmark and set even more aggressive goals in the future.

We understand, however, that home care is not a panacea to easing the cost burden of the state's graying population. There are many elderly residents who need round-the-clock, more advanced care that nursing homes offer. Institutionalized care still must be part of the equation, just less so than it is now.

There is also a major concern about the long-term health of the homecare industry, which has warned that inadequate Medicaid reimbursements make it hard to attract and retain low-wage personal care aides. Meantime, the Department of Labor predicts the state will need 9,000 more personal care aides by 2022, creating a potential workforce shortage.

It's unlikely state government will dramatically boost Medicaid reimbursements, so personal care will remain a low-wage industry for the foreseeable future. That could be a threat to the industry's talent recruitment.

Even still, home care must remain a viable option for Connecticut's burgeoning class of seniors, allowing more elderly residents to remain in the comforts of their own home and the state and federal government to rein in healthcare spending.

Why We Need Innovation in Care for the Aging

Published by The Hill
Seth Sternberg
July 17, 2015

Our parents need help.

Every day another 10,000 people turn 65. By 2050, that will add up to nearly 84 million Americans. And yet, the way we care for older adults in this country — our parents and grandparents — is deeply inadequate.

The reality of aging in our country is frightening for most Americans. Medicaid covers in-home care for only those with the greatest financial need, and the wealthy can pay for their own top-notch home care. But what about everyone else?

Yesterday the White House hosted a Conference on Aging, an event which happens only once a decade, to help spur change in how we think about care for older adults. It’s a great start. But we can’t just think about change any longer, we have to make it happen — both in the private sector and on Capitol Hill.
The first thing to change must be Medicare. If we expand Medicare coverage to include in-home care, and if we apply rigorous technology and analytics to that care to ensure we're helping older adults in the best possible way for their unique circumstances, we can lower the cost of health care. More Americans will stay healthy in their homes as they age rather than needing frequent visits to the hospital.

And this is where the greatest opportunity for innovation comes in — at home. Technology can both improve home care and bring down the cost. It’s time to start innovating for our parents the same way we innovate for kids, teens and adults.

If we can build Snapchat, Instagram and Twitter, we can build a way for our parents to comfortably stay in their homes as they age, with joy and grace.

There are three things we must do. First, entrepreneurs must start using their creativity to imagine a better future for older adults. Too few entrepreneurs innovate in the senior space — and too few investor dollars fund those rare entrepreneurs who take the plunge.

Why is that? Many people assume that tech and older people don’t mix, that it’s too risky to invest in innovation for this sector. But our parents use tablets. They drive cars. They use ATMs. All were innovations in their time, and now we can’t remember living without them.

Next, we must support our care professionals — and value the work they do. According to the Bureau of Labor and Statistics, roughly two million people in the United States work providing non­-medical home care to older Americans. Shockingly, these skilled professional caregivers earn on average $9.50 per hour and can only get 34 hours of work per week. It shouldn’t surprise anyone that 56 percent of these professional caregivers receive government assistance.

The fact that you can make more money flipping burgers in this country than you can caring for seniors — our collective parents — reflects a tragic imbalance in our core values as a society. This must change. Not only do the care professionals deserve better, the individuals who rely on them for help deserve the best possible care. By focusing our innovation on better, faster, smarter ways to provide this care, we can also better provide for this fast-growing segment of working Americans.

Finally, we must support our unpaid caregivers — family and close friends who help a loved one, often every day. More than 40 million Americans care for an elderly person, reporting that their own health declines as their stress increases. Many are caring for their children and their parents at the same time.

Family and friends need help deciphering the complex code of caring for their aging loved ones. They need affordable respite care to get a break for an hour or two. They also need better information, including accurate, fast reporting on the care their loved one is receiving, in real-time.

With vision and innovation, all of this is possible.

At Honor, we’re working as hard as we can to serve our collective parents, their care professionals and their families. Yesterday at the White House Conference on Aging, we announced that Honor will be giving away $1 million in free care across ten cities in the United States. We also recently announced $20 million in funding, led by Marc Andreessen at Andreessen Horowitz.

Now is the time for all of us — legislators, entrepreneurs, investors, companies, individuals — to come together and come up with actionable solutions to address one of the biggest crises this generation could face.

It is time to learn how to care for all of those who cared so deeply for us.

Home Health 2.0: Connecting Uber, Peapod and Providers

Published by Home Health Care News
Tim Mullaney
July 17, 2015

Today, new payment models that reward coordinated care are incentivizing home health agencies to forge partnerships with hospitals and other health care providers. In the future, home health companies might be working out deals with private sector companies such as Peapod or Uber, which already are helping seniors age in place by harnessing innovative technology.

At least, that’s the perspective of Bruce Chernof, M.D., one of the nation’s foremost experts on senior care and aging issues. He headed up the Congressional Long-Term Care Commission, which in 2013 turned in a 130-page report with recommendations on how to revamp the delivery and financing of long-term services and supports in the United States. He currently is president and CEO of The SCAN Foundation, one of the largest organizations in the country dedicated to promoting high-quality services for seniors.

Chernof recently sat down with HHCN to share his thoughts on the recent White House Conference on Aging, a once-a-decade event bringing thought leaders together to discuss ways to improve seniors’ quality of life. The conversation turned to what “Home Health 2.0” might look like and how agencies can get there.

HHCN: The White House Conference on Aging took place Monday. Do you think it was a success?

Bruce Chernof: I thought it was particularly good that the president spoke, and as forcefully as he did, about the need to think about aging in the U.S. Aging generally is one of those issues that doesn’t get the kind of attention it needs to in Washington. The previous White House conference, the president didn’t attend at all. So White House visibility is an important part of the discussion.

It really took a different tack than previous conferences. At its core, the underlying theme was to reimagine how we think about aging in this country. I think that’s important, because often the discussion goes immediately to the poverty discussion, the ‘sick, poor and alone’ discussion, and we get deep in the weeds of Medicaid policy and those programs are incredibly important for the most vulnerable among us.

But the reality is, we’re all going to age and the vast majority of us will have needs as we age. That doesn’t necessarily mean nursing home care. It could be in the community or in an assisted living environment, a whole range of things, but we need to see aging as a positive thing, a part of life. The conference really showed the value of that broader discussion.
And it was great to see leaders from private industry, from technology companies, to see senior execs from Airbnb and Uber talking about how they view the importance of the aging population and how they view their products evolving to meet the needs of an aging country.

HHCN: I know Uber announced a new pilot to work with senior living communities. Are companies like Uber also making an impact on home health?

BC: Given the really interesting and broad mix of industry and technology, the diverse partners that the White House conference brought to the table, it raised the question: What does a technology-enabled environment look like?

Home Health 2.0 is a much broader discussion of technology and care coordination. There’s a much broader way to imagine the home health provider as the glue to drive better outcomes, lower costs. What does the next evolution of that model look like? What is there connectivity to an Uber of the world? What is their connectivity to a technology like wearable devices? Or a grocery delivery service like Peapod. It’s this sort of broader connectivity that is the future, not a narrow, “Hi, I’m your home health provider and I’m here to provide X service, because it’s what your doctor prescribed.”

HHCN: So you envision home health providers contracting and coordinating with companies like Peapod or Uber to offer a broader array of services to clients, including transportation and food delivery?

BC: Are there opportunities for larger relationships? Yes. Those will take time to develop. But today, there’s already lots a home health provider can do to help a senior thrive in the community.

HHCN: Specifically by working with these sorts of tech companies?

BC: It’s not about spending the home health dollar, necessarily. But even now, when a home health caregiver is in somebody’s home, they’ll have a sense about whether folks have transportation issues, whether they have food needs. They have the opportunity to talk to the individual or family members, pointing people to different options like Uber, Peapod. Then, they can make their own decision about connecting with these services. That’s the Home Health 1.0 step.

I think it’s where everything in the space needs to go, whether you’re a medical, housing, home health, or community provider, care coordination and connectivity will be where the biggest opportunity is in next five to ten years.

HHCN: And it seems that the Ubers of the world also are seeing the opportunity to become a more important piece in the senior care puzzle?

BC: There’s a huge role for the business sector, and I think the White House conference really put a spotlight on this. We need the next generation of tech solutions to be not so focused on Millennials and Gen-X’ers. And technology companies are seeing the economic value and market opportunity that older adults represent.

HHCN: What are some of the senior-focused solutions that are needed?

BC: It’s not just about canes and walkers for physical support anymore, but tech for safer homes, transportation, the kinds of supports that will help people live with dignity, choice and independence.

So Many Elderly, So Few Care Workers

Published by CBS News
Aimee Picchi
July 17, 2015

Molita Cunningham has worked as a health aide for more than 30 years. But in the last two decades, she says her wages have barely risen.

"In the 90s, I was making $8.25 an hour, which wasn't a whole lot to try to survive on. I was living paycheck to paycheck," Cunningham said. "I haven't seen a whole lot of change."

Cunningham said her current wage of $10 an hour as a home health aide in Florida keeps a roof over her head but still requires her to rely on government assistance to make ends meet. She added that she loves her job, which involves taking care of a woman in her 90s who suffered a stroke, and so Cunningham doesn't plan on leaving the industry, which many of her colleagues have done.

The industry trends Cunningham is noticing -- stagnant wages and high turnover -- are poised to create a major crisis in the coming years, when the aging baby boomer population creates a tsunami of demand for home care workers. Currently, about 19 million seniors need long-term support and services, a number that will double by 2050, according to a study from the Fight for 15, a labor movement that's advocating for higher wages for home health care workers and other low-paid Americans.

"Our long-term care system isn't equipped to meet their needs," Andrew Hamilton, research coordinator at Service Employees International Union, which is backing the Fight for 15 movement, said on a conference call to discuss the study. Higher wages and better training are required to ensure the best quality care for older Americans, he noted.

Given the country's aging population, the number of home health care jobs is expected to grow five times faster than jobs in all other occupations, according to a report published earlier this year from the National Employment Law Project. Yet despite the higher demand, average hourly wages have actually declined by 6 percent during the past decade.

With those low wages, it's not surprising that Cunningham isn't alone in relying on government assistance. About half of all home care workers need public programs such as food stamps or Medicaid, according to NELP.

The Fight for 15's call for higher wages for home health care workers coincides with the White House Conference on Aging, which took place on Monday. It featured sessions that examined caregiving, retirement security and other issues related to aging. As part of the conference, the White House is proposing a new rule to update the quality and safety requirements for more than 15,000 nursing homes and skilled nursing facilities.

Home health workers make a median annual wage of about $10 per hour, or less than $21,000 per year, according to the U.S. Department of Labor. Wages have suffered because of issues such as federal laws that exclude home health personnel from wage protections, weak union representation and the large number of low-skilled workers in the field, many of whom are minority women.

Aside from the low pay, working as a home health worker can be difficult. The Department of Health and Human Services notes that the occupation exposes workers to a number of serious and life-threatening hazards, such as abuse, unhygienic conditions and overexertion. In 2007, the agency recorded 27,400 injuries among the industry's roughly 900,000 workers.

That may deter more workers from joining the profession just as more aging Americans will need help. Currently, there are about nine seniors for each home care worker, although the care gap varies by state. Florida, with its senior-heavy population, has a 35-to-one ratio, giving it the biggest care gap in the country, according to the Fight for 15.

"With $15 an hour, I could breathe a little easier," Cunningham said. Why don't more home health workers demand higher wages? Her answer: "People are afraid of losing their jobs."

Mobile care coordination app for home health aides gets pilot study

Published by MedCity News
Stephanie Baum
July 17, 2015

Practice Unite has developed a mobile communication app geared to home health aides serving vulnerable seniors. The idea is to provide more efficient coordinated care and urgent care for seniors to help them stay in their homes longer.

Independence Care System is taking part in the pilot with Paraprofessional Healthcare Institute. ICS is a managed care system for 5,000 New Yorkers with multiple chronic conditions, such as late-stage ALS and multiple sclerosis. Many are dual eligible and 65 percent use a wheelchair, which makes them more vulnerable to urinary tract infections, wounds and respiratory infections which can trigger hospitalizations.

ICS coordinates care in several New York home care agencies, such as JASA Care, Cooperative Home Care Associates and Sunnyside Community Services.

In an interview with Adam Turinas, Practice Unite CEO at the ENGAGE conference this week, he explained that it is intended to be used by home health aides to fast track questionnaire results to ICS staff.

He explained that the goal of the pilot program is to reduce ER visits and avoidable hospitalization. It provides a way for home health aides to be in in constant communication with the care management team at ICS. Caregivers send daily clinical reports and updates on patients by answering a short list of questions. Photos can also be attached to these messages to highlight problems such as wounds or other problems. These messages are encrypted.

“It provides real-time feedback on the member that will help ICS stay ahead of problems and act more quickly,” Turinas said.

There has been a growing push for digital health tools that not only address some of the care coordination needs for seniors but also reduce their isolation and help them manage health needs more proactively. Although remote monitoring tools have been one of the active areas for product development, care coordination has become a higher priority of late.

This week has been an especially active one for senior care digital health news, particularly with the White House Conference on Aging. Philips announced plans to develop a research lab around Boston and to work with MIT AgeLab so they can advise on the lab design and research program. Honor also deployed its online care coordination tool in San Francisco following a beta test in Costra County. AARP also revealed the results of the first study in its Project Catalyst initiative to work with adults over age 50 to roadtest digital health apps and devices.