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News Roundup: February 25, 2013

New “Wonderwall” Technology Helps Keep Seniors at Home

Published by Home Health Care News
Elizabeth Ecker
February 21, 2013

A new development from the Munich University of Technology is improving the changes that older people have to remain in their homes even as their care needs increase, writes a Gizmag report this week.

The university’s new “Wonderwall” technology is a touch-screen “wall” that lives inside a home and can perform tasks from finding keys to checking blood pressure and glucose levels. It can also be used in an emergency to contact a doctor or care service.

Gizmag writes:

“Based around a tablet computer mounted in its wardrobe-like panel, the wonderwall system blends into the look of a normal house – it even comes with all the usual hall fittings, including coat hooks and even a shoe horn right at the bottom.

It features an “indoor positioning system” that keeps track of mislaid items like keys and has an integrated air conditioning system which automatically keeps air circulating in the apartment if the resident forgets to turn it on.

The system also includes with biosensors which zero in on key vital signs like blood pressure and blood sugar levels. After assessing the health of the individual, it could be programmed to come up with suggestions like going out for walk, or perhaps even suggest medication. If things turn critical, it can notify a physician or other health professionals who can also be hooked into the system to regularly check on the patient.

The system would also provide access to regularly used information from bus timetables to family phone numbers to the weather forecast.”

1.6 Million New Direct-Care Workers Needed in Next 7 Years

Published by Home Health Care News
Alyssa Gerace
February 20, 2013

To keep pace with the expanding senior population, 1.6 million direct-care workers will need to be added to the existing workforce by 2020, according to a recently updated PHI (Paraprofessional Healthcare Institute) fact sheet.

As of 2010, there were currently about 3.4 million in the direct-care workforce, according to long-term employment projections by the Bureau of Labor Statistics, and that number will need to grow to nearly 5 million to meet demand.

Demand is certainly growing, as the nation shifts away from institutional care and toward home- and community-based care. By 2020, 68% of direct-care workers will work in home- and community-based settings, up from 61% in 2010, according to PHI.

“The growth of the home and community-based sector, in which aides tend to earn lower wages and have fewer benefits than in facility-based settings, demands particular attention,” the report says.

This shift is expected to continue throughout upcoming decades, says the PHI fact sheet, but that could pose a problem: Unless job quality in this field is improved, demand for new workers won’t be met.

“Our analysis indicates that demand for direct-care workers…will continue to outpace supply dramatically—unless policymakers and employers work together to make these jobs competitively attractive compared to other occupations,” the report says.

Demand for services is growing faster than the labor pool, says PHI, as the number of women aged 25-54—the main labor pool that supplies direct-care workers—will only increase by about 1% compared to demand for these workers increasing by 48%.

If the direct-care workforce does add 1.6 million new workers by 2020, it will be the single-largest occupational grouping in the country, according to PHI, just ahead of retail salespersons.

Personal care aides and home health aides are projected to be the fastest-growing occupations in the country between 2010 and 2010, expanding by 71% and 69%, respectively.

Models Needed To Peg National Healthcare Workforce Needs

Published by Inside Health Policy
Michelle Stein
February 20, 2013

Health care experts say the health care sector lacks adequate models to estimate the country's increased workforce needs -- a growing concern accompanying the ACA's Medicaid expansion -- due partly to the likelihood that a cross-section of professions will be involved. There is currently no accurate way of measuring supply or demand for health professionals on a national or cross-professional basis, the experts say, as lawmakers float legislation aimed at the beefing up the primary care workforce and as CMS implements ACA provisions that aim to do the same.

New Medicaid beneficiaries will bring with them a lot of pent-up demand for services, and one of the biggest challenges moving forward with the Medicaid expansion will be providing enough services to meet that demand, former CMS administrator Gail Wilensky said. But the Bipartisan Policy Center and Deloitte Center for Health Solutions say in two recently released reports that current models for calculating supply and demand are inaccurate, and the country needs new national, modernized workforce planning models.

Demand is usually analyzed by looking at utilization rates, the report on health care demand says, but that leads to a "business as usual" view point -- and the ACA will not be business as usual for the health care sector. Utilization rate assessments have also proven to be largely inaccurate, according to the BPC.

The BPC and Deloitte reports recommend that the health reform law's National Health Care Workforce Commission be funded, and that the group work on a national, modernized workforce planning model.

"The American health care system is on the cusp of transformation: changing demands on the health care system will inevitably alter who, how and where health care services are provided. It is critical that a more comprehensive and dynamic workforce projection model that can capture dramatic shifts in the health care marketplace and more accurately inform future demands is developed," the report says.

Wilensky, who ran CMS under President George H. W. Bush, told attendees at a National Rural Health Association Conference that providing enough services for new populations accessing the health care system will be a big challenge moving forward.

Medicaid, in 2014, will essentially become a program to cover all poor and low-income populations -- which was not the way the program was originally structured, nor it's original intent, Wilensky said. Many of these new beneficiaries will have pent-up demand for services, as they have not previously had reliable access to the health care system, she added.

Providing for this influx of people would already be difficult if this population of newly covered people were evenly distributed across the country, Wilensky said. It will be even more challenging as the big increases in demand will occur in some of the poorest areas with some of the strictest scope of practice laws in the country, she said. If Massachusetts had problems with dislocations between supply and demand - while one in five people there work in health care and the uninsured population was relatively small - other places will face it as well, she cautioned.

Wilensky noted that some states had expressed some interest in relaxing their scope of practice laws "so that they can make better use of their nurse practitioners, their pharmacists and physician assistants without all of the restrictions in place in the past." The Los Angles Times recently reported that California state lawmakers are considering proposals that would allow physician assistants, nurse practitioners, pharmacists and optometrists to take on bigger roles in patients' health care -- including allowing physician assistants and nurse practitioners to open up independent practices.

But it's hard to say how that will effect the health care workforce, according to the BPC and Deloitte. Most analyses of the health care workforce tend to focus on one profession, like doctors or nurses, and these traditional supply and demand analyses discount the possibility of other professionals providing care. This, in turn, makes it "difficult to measure the impacts of workforce policy changes and to track interchangeability across health professional groups." The BPC looked at several professions to give a starting point off, which to build a "whole of workforce" perspective it says is necessary to understand health care needs: chiropractors; dentists; home health aides; personal and home care aides; practical, registered and advanced practice nurses; nursing aides; pharmacists; physical therapists; physician assistants; doctors; and psychologists.

But outside of these professions, "The growth of telehealth, clinical informatics, and decision support systems -- as well as broad structural changes to the health system and traditional care delivery settings -- may dramatically alter the need for health professionals in certain geographic areas," the group says.

Wilensky said stakeholders need to push hard in the states to make sure health care services are available for these newly eligible beneficiaries. It will be very frustrating to them, the physicians, nurses, hospitals and communities otherwise, she said.

Allina Health Teams With Care Providers on Home Care Transition Model

Published by Home Health Care News
Alyssa Gerace
February 19, 2013

Three health care providers are teaming up to create a transitional care model to provide post-acute care patients with a clinically enhanced environment that’s still conducive to facilitating a smooth transition between the hospital and home.

Allina Health, Benedictine Health System (BHS) and Presbyterian Homes & Services (PHS) are collaborating to combine their hospital-based acute care expertise and experience in managing inpatient rehabilitation and transitional care services to develop a “consistent model and care philosophy for the future of transitional care.”

The goal is to make branded centers available to franchise operators. THe centers will focus on hospitality, wellness, and service delivered in a resort- and spa-like environment. Features include technologically advanced rehabilitation and recovery programs that will aid a smooth post-acute transition back to the home.

“As health care reform moves forward our communities will need new approaches to ensuring that after people leave the hospital they receive the care they need to make a successful transition back home and don’t end up back in the hospital,” said Kenneth H. Paulus, president and CEO of Allina Health, in a statement. “By bringing together the acute care and rehabilitation expertise of our three organizations, we will be able to forge new paths that ease the transition from hospital to home.”

The first two “next generation” transitional care centers are in the planning stages. The first will managed by BHS on the campus of Unity Hospital in Fridley, part of Allina Health.

PHS will manage the other one, located on the campus of Abbott Northwestern’s WestHealth, also part of Allina Health. Construction on the $17 million center will begin this summer.

Amedisys Responds to Wall Street Journal on Hospital Readmissions Problem

Published by Home Health Care News
Jason Olivia
February 19, 2013

An article posted last week by the Wall Street Journal reported that the steps to reducing hospital readmission rates is “without an easy fix.”

Detailing recent studies linking readmission rates to poor post-care coordination, the article caught the attention of Amedisys’ Chief Medical Officer Michael Fleming, MD, FAAFP.

Because the nation’s healthcare needs are changing, Fleming urges for a collaboration between hospitals and post-acute care providers since the current healthcare system is not designed to meet such needs.

Recent studies revealing a number of patients readmitted within 30 days after discharge has caught the attention of the healthcare community.

Medicare has penalized hospitals with higher-than-expected readmission rates, often by cutting reimbursements by as much as 1%.

Amedisys proposes several recommendations for hospitals to reduce avoidable readmissions including visits from a registered nurse within 24 hours of hospital discharge; real-time information exchange of medical records across the care continuum; medication therapy management; and pre-determined transfer and care plan protocols.

“We at Amedisys believe strongly that collaboration with post-acute care partners including implementation of effective care transitions of patients from acute care settings back home can help patients manage post-hospital syndrome as well as the on-going management of their condition, especially if it involves a chronic disease,” he stated.

Home health care growing

Published by San Antonio Express
Beth Brown
February 18, 2013

After running her own business for 30 years, Fair Oaks resident Lisa Lyles says she wanted her next venture to touch people's lives.
By going into home care services for the elderly, she is finding that the number of lives she can touch will be increasing rapidly.
By 2030, nearly 20 percent of Americans will be 65 or older, according to the Federal Interagency Forum on Aging-Related Statistics.
San Antonio can expect its own bubble of baby boomers in that group. More than 10 percent of the city's population was 65 or older in 2010, according to U.S. Census data.
“As we hit that aging tsunami, there are opportunities for business folks like myself,” said Byron Cordes, president of Sage Care Management, which works with seniors to identify their appropriate level of care based on their health and personal finances.
For her part, Lyles applied in early 2012 with her son Scott, a recent graduate of Texas A&M University, to launch the local franchise of Nurse Next Door, a senior home care services provider with headquarters in Vancouver, British Columbia.
Lyles said she saw a need in the San Antonio area, and her business now is serving Boerne, Fair Oaks Ranch, Stone Oak, Spring Branch and San Antonio. In late November, the state gave her franchise the go-ahead to begin hiring employees. Since then, it has picked up more than 100 clients.
“I knew from personal experience that home care was going to be something we would all need,” Lyles said. “I knew that industry was there, and I knew it was a financially rewarding industry.”
Her franchise's services range from three hours of caregiver companionship a few days a week to around-the-clock assistance. It allows seniors to stay in their own home, which is an emerging trend in senior care, said Martha Spinks, director of Bexar Area Agency on Aging.
“What all seniors want to do is what we call in our industry 'age in place,'” Spinks said. “They say, 'This is my house, and I prefer to stay right here.' So if that's the choice we make, then family caregivers get pulled into the mix. ... There are a lot of agencies that provide home health care, so it indicates that there is a business opportunity there.”
With so many options for senior care — and weighing what options are covered by various kinds of insurance — some are capitalizing on helping seniors manage their care options.
Sage Care is one of them. Its staff, with backgrounds in nursing, social work and physical therapy, helps clients determine what level of care they need. Its clients tend to be more affluent.
“You may need a 'nursing home' level of care, but if you've got $30 million in the bank, we can create a nursing home in your house,” said Cordes, who's also board president of the National Association of Professional Geriatric Care Managers. “You can hire nurses around the clock and have a ventilator in your house.
“But if you're on Medicaid, there's very little help you can get in the home.”
Sage Care serves about 150 clients a year and recently has hired more care managers.
Cordes said there's a national movement to expand the number of care managers by 50 percent in order to prepare for the aging population.
Kayla Hester, a caregiver with Nurse Next Door, began working with Alzheimer's patients after becoming a certified nursing assistant and now believes this is the industry where she should stay.
“This industry is growing so fast and people think it's such an easy industry, but you really have to have the heart,” Hester said.
The field of health care assistants will only grow larger. The Bureau of Labor Statistics estimates the field will increase by 28 percent by 2020, adding more than 100,000 jobs in that time.
“Seniors are going to be big business,” Cordes said.