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News Roundup: January 8, 2016

In-Home Sensors Help Slash Hospitalizations 50%

Published by Home Health Care News
By Tim Mullaney
January 8, 2016

Home care providers looking to keep more clients out of the hospital now have further evidence that in-home sensor technology might be a major boon.

In a small pilot project, seniors utilizing monitoring technology had about 50% fewer emergency room visits and hospitalizations than peers with similar health status but no in-home sensors, according to STAT, a health and science publication from Boston Globe Media.

The project involved monitors from Healthsense, a company that already is working with many assisted living providers to help track residents’ health and safety. Now, the company is looking to expand into private homes.

Violette Roberts is one participant in the pilot, interviewed by STAT. The sensors track everything from her sleep patterns to how often she opens the refrigerator, and a care manager calls to check in if there any red flags. While some geriatricians and other experts warn of the privacy dangers of sensors and even unintended health effects, such as making seniors’ everyday life seem like a disease state, Roberts told STAT she feels safer with the technology in her home.

Prior to the devices being in place, she once fell down and then had to drag herself to a telephone to call for help. The process took hours, STAT reported.

Roberts has had heart issues and kidney stones, but has not experienced a serious health issue in the roughly two years that she has had the monitors. The care manager has sometimes called in to check up on her—for example, when Roberts stayed up all night knitting a scarf.

Like Roberts, other participants in the pilot project also seem to be in relatively good health, which could be skewing the results somewhat, according to Al Lewis, an independent consultant who took a look at the Healthsense numbers. Still, Lewis was positive about the impact of the technology.

“It appears to be working very well,” he told STAT. “The monitoring system is triggering nurses to get in touch with these folks and get them in to see the doctor in a timely way.”

Home Health Aides: Unsung Health Care Heroes

Published by Huffington Post Blog
Steve Landers MD,MPH
January 8, 2016

Loneliness and the loss of control over the basics of life are dreaded consequences of serious illness and aging. Needing help with toileting, bathing, walking, and managing ones household is sometimes feared more than death. Many older Americans struggle in these "shadows of life," and the aging of the baby boomer generation will lead to more people in such circumstances. One ray of light in these difficult moments is the help of home health aides.

Home health aides, an often overlooked part of the health system, can make the difference between comfort and dignity vs. suffering and neglect. Aides are lifelines for elders in need and family caregivers who often have extensive caregiving duties on top of their work and other responsibilities. At challenging moments in life, aides' contributions to human health can be greater than that of doctors, nurses, and medications.

Home health aides can create great financial value by helping at risk individuals remain in their homes. This lowers the costs of unnecessary hospitalization and nursing facility use for families and the taxpayer supported Medicare and Medicaid programs.

Aides are mostly women, and are among the lowest paid categories of workers. This is a role that requires substantial skill and special personality traits. They do difficult and intimate work tending to our parents and grandparents, our veterans and retired community leaders--the people who made our country great. Home health aides are typically working for people with complex medical conditions like Alzheimer's disease and dementia, heart disease, stroke, and cancer. This isn't easy work and it's really important that this is an attractive job for caring and talented people.

Much of the funding for aides comes through state Medicaid programs (and insurance companies that subcontract with some state governments), these funds are generally restricted to disabled elders who have spent down or outlived their monies and are now living in poverty. For people not meeting poverty criteria, personal out-of-pocket payments are typically required to hire aides. In some cases, Medicare home health and hospice benefits pay for narrowly defined, time-limited aide services. Long term care insurance, the Veteran's Affairs system, and local programs also play a role in funding home health aide services.

Unfortunately, the rates that many state Medicaid programs (and their insurance company subcontractors) pay home health agencies are so low it's difficult for agencies to remain in the black while following all the regulations, paying a "living" wage, offering benefits, providing close supervision, and creating career development opportunities. In private out-of-pocket financed home health care there's widespread "under the table" hiring by cash strapped families; avoiding taxes, immigration laws, employment laws, and home health regulations. These arrangements are potentially risky for disabled elders who are vulnerable to neglect and exploitation, and they also diminish stable job opportunities for aides.

It is time to help more Americans age in place by improving the situation for home health aides and the people who need their help. Here are a few ideas to do just that:

Create more opportunities for home health aides to learn and grow
• Develop educational grants and loan forgiveness targeted toward aides seeking new skills.
• Expand the role of aides in the Medicare home health program to include broader and more flexible duties related to chronic illness management when performed under nurse supervision.
• Provide grants for experimentation to promote innovation in the home health aide role in working with new technologies such as robotics, videoconferencing, mobile applications, and remote monitoring.

Create stable private care jobs for home health aides by shrinking the black market
• Eliminate all taxes and penalties on 401k, IRA and other tax-deferred retirement account withdrawals that are used for privately hiring home health aides in legitimate arrangements.
• Develop savings plans, similar to 529 plans for college education, to use for privately hiring aides.

Make home health care desirable work for healthy older people
• Eliminate payroll taxes for Americans over age 65 that work as aides; because of demographics we need healthy older Americans to work in the care of the sick and disabled.
• Develop grants for special training initiatives that target older people for 'twilight' careers as home health aides.

Pay for these initiatives by broadening the tax base by reducing "under the table" arrangements, and through expanding innovations in Medicare and Medicaid that increase the proportion of beneficiaries that stay healthy at home rather than in more costly facilities. We must reward the essential contributions of home health aides and make this an attractive job. By lifting up the aides we can elevate independence, keep families intact, support women, improve Medicare and Medicaid, and make a big difference in the lives of millions of older Americans.

White House: Target Staffing, Tech for Home Care’s Future

Published by Home Health Care News
By Amy Baxter
January 8, 2016

The White House is pushing for more public and private sector collaboration in technology and home health staffing solutions to address the coming “age wave” in order to help more older adults remain in their home longer during retirement. That’s one idea recently released in the final report from the sixth Conference on Aging that was hosted by the White House in July.

The aging conference has been conducted every decade since 1961 and brings together older Americans and their families, caregivers and advocates. 2015 was the 50th anniversaries for some of the most important federal programs for seniors: Medicare, Medicaid and the Older Americans Act. Not to mention, Social Security also turned 80 this year.

2015 was also the first year the conference was virtually broadcast in a live webcast in which individuals and groups could ask panelists questions via social media. On the day of the conference, more that 700 watch parties relayed their input, and stakeholder groups in all 50 states and Washington, D.C. organized groups to watch the lifestream, discuss ideas and submit feedback.

The conference was prefaced by a year-long conversation that brought out four common themes for discussion: retirement security, healthy aging, long-term services and supports and elder justice. The White House Conference on Aging (WHCOA) released four policy briefs on each of these areas in its final report.

Public and Private Initiatives

During the conference, the administration announced a number of new public actions and initiatives to help ensure older adults can maintain health and dignity in retirement, including maximizing their independence and ability to age in place. One of the key announcements included a proposed rule from the Centers for Medicare & Medicaid Services (CMS) to thoroughly update the quality and safety requirements for more than 15,000 nursing homes and skilled nursing facilities. The update would be the first in the last 25 years.

The updates are aimed to improve quality of life, enhance person-centered care and services for nursing homes, improve resident safety and bring regulatory requirements closer to current professional standards, according to the White House’s report on the conference.

There is also a new proposal from the U.S. Department of Agriculture that would increase accessibility to nutrition for homebound seniors by allowing the Supplemental Nutrition Assistance Program (SNAP) benefits to be used for food delivery services to these households.

Many private organizations announced similar commitments during the conference, including Home Depot’s “how to” video release that highlights simple home modification steps to help seniors age in place and remain in their homes longer throughout retirement.

Looking to the Future of Home Health

The topic that attracted the most attention was caregiving, according to the WHCOA report. For most older Americans who live at home, family caregivers are doing most of the legwork for a variety of tasks. As more adults age in place, it is more likely this reliance on family members will shift to paid caregivers. As such, the conference dug into policy recommendations that would ensure the home health industry is able to attract and retain “a sufficient number of paid caregivers in the profession.”

One of the biggest victories in this area was the Department of Labor’s final rule to extend Federal minimum wage and overtime protections to many home care workers, the report stated. But this has been controversial within the industry, with some providers saying that increasing wages could actually cause them to reduce staff.

Within the private sector, technology was a clear focus of the conference, as companies such as Uber announced new community-based services to serve older adults living at home. The report also noted that evolving technology on smart phones and engaging games are helping make strides in memory care and better cognitive function later in life that can help seniors remain independent.

Medical house calls are catching on in Portland

Published by Portland Business Journal
Sue Vorenberg
January 8, 2016

Visiting the hospital isn’t easy for Bobbi Tucker.

With a confluence of problematic medical conditions, including fibromyalgia, asthma and high blood pressure that make it difficult for her to stand without passing out, the 70-year-old Portland woman requires an ambulance every time she has to go to the emergency room.

And that's not only costly, it's time-consuming, she said.

But under an in-home health care service run by Landmark Health, the septuagenarian has dramatically reduced her emergency room visits and improved her health, she said.

“Before I was going to the emergency room like 10 times in six months,” Tucker said. “Now, I don’t have to go as much, maybe three or four times in the last eight months. So now I just feel much better.”

Tucker’s visits from Landmark are part of a growing national trend toward in-home health care.

A recent analysis by Grand View Research valued the U.S. home health care market at $756.8 million in 2014, a number expected to grow 10.9 percent by 2022. And according to U.S. Bureau of Labor Statistics, health aides and personal care aides used in home settings are expected to rise by 70 percent from 2010 levels to 13 million in 2020.

Landmark, which is headquartered in Huntington Beach, California, and started services in Oregon in the summer, covers about 2,500 patients in Portland and so far has visited about 500 of them, said Jill Donovan, Landmark’s Portland General Manager.

House calls have also been shown to save money. Portland-based Housecall Providers participated in Medicare’s Independence At Home Demonstration Project, saving the agency more than $25 million in one year by providing primary care in the home setting for patients with multiple chronic conditions.

With the help of mobile labs, X-rays and other portable devices, home-based care tends to be more high tech than old school house calls, but the focus on preventative health care is what really helps increase patients’ quality of life, said Julie Crites, a nurse who works with Tucker.

“When Bobbi has the first sign of symptoms, we can come out and treat her before she gets pneumonia,” Crites said. “Prevention is really a huge part of what we do.”

The Landmark service is covered by Health Net in Oregon for Medicare Advantage patients and saves money by cutting down on ER trips, Donovan said.

“Patients prefer it and it’s cheaper than acute care, because the costs of emergency room visits are so high,” Donovan said. “Patients have no copays and it cuts down on readmission issues.”

The company partners with health plans across the country and analyzes data on the highest-use patients.
Patients with five or more chronic conditions benefit most from the service, since they are almost always admitted when they go to the ER.

“We see this as a holistic approach,” Donovan said. “We also have a psychiatrist and psychological case management for patients. A lot of the chronically ill suffer from anxiety and depression. We see a lot of patients in Portland with those issues, and so we have professionals who can go into homes and provide those services.”

The service also includes dietitians who can go through a patient’s home, look at what they’re consuming and give advice or even go shopping with the patient, Donovan said.

The company, which has 25,000 patients nationally, hopes to expand in the Portland region even further and is looking for more trained staff, Donovan said.

“It takes passionate individuals,” she said. “And this trend is going to get even bigger as Baby Boomers continue to age. We’re almost always growing faster than we can handle. We actually had to slow down some because we want to assure quality.”

Landmark is a bit different than other in-home care services in the area because the company’s teams work with the patient’s regular doctor to coordinate care.

“We supplement,” Donovan said. “We have a team of three physicians that see the most sick patients, and we have several nurse practitioners and physician’s assistants. But what sets us apart is that we work with the patient’s regular health care providers rather than taking over those services.”

For Tucker, the care has been immensely helpful, especially since she can call for in-home care at pretty much any time, she said.

“Whenever I need them, (my nurses) will come,” she said. “I’ve called at almost midnight and they came and gave me an IV. They know what to do, and what they do at my house. I get the same care as I would in the ER.”

It also helps her stay healthy so she can keep volunteering at her church and in her community with Meals on Wheels, she said.

“I’m 100 percent happy with them,” Tucker said. “They know what to do. I can call anytime. It’s a lifeline.”

Home care saves wear, tear on veterans

Published by CT Post
By Derek Torrellas
January 8, 2016

U.S. Army veteran Bob Swirsky’s face lights up when home health care nurse Jeanette Hutchinson enters his room to check his blood pressure and attend to his body to prevent bedsores.

“It’s going to be 120 over 60,” Swirsky says, as Hutchinson inflates the cuff on the meter on his left arm. “Close,” she said, “124 over 60.”

In Connecticut, there are 209,882 veterans, according to the most-recent U.S. census data, and 29.4 percent are over the age of 75. This group forms the core of veterans with chronic medical issues who are targeted by a VA program to treat them in their own homes.

Most of the patients in the VA’s Home Based Primary Care (HBPC) program are like Swirsky, who is bed-bound and not able to easily get to the West Haven VA Hospital. He enrolled in the HBPC program in August.

Swirsky’s daughter, Mindy Hart, said, “It is tremendously tiring for him to get into a car, or even just to move around.”

Home Based Primary Care, “is a team approach in which we have multiple disciplines that come out to the house and visit our veterans who typically have a difficult time getting into the hospital to see their provider on a regular basis,” Hutchinson said.

The team comprises the program director, physicians, psychiatrists, nurses, social workers, registered dieticians, physical therapists, clinical pharmacists, and program support staff.

Saving miles
Prospective patients are veterans who are already registered in the VA health care system. Veterans are referred to HBPC by the hospital, or their doctors, or sometimes veterans request the service themselves, said Aileen O’Connell, HBPC program director. A registered nurse assesses referrals.

Swirsky, 96, lives just a few miles from the West Haven VA and falls within the territory HBPC covers. Across the state, the general guideline is 30 miles or 30 minutes from the VA facilities in West Haven or Newington, or from one of the community-based outpatient clinics, located in New London, Winsted and Waterbury.

August Palmer, of Stratford, was recommended to the program after receiving an implanted defibrillator.

“I’m 93,” he said, “I can hardly walk.” Staying at home to obtain care has put less of a burden on Palmer’s children.

“My son David takes me — or my daughter Mary — and so they don’t work and everything,” he said. “That’s not fair.”

Pawcatuck resident and Army veteran Donald MacLean, 67, has been an HBPC patient for about four years, after he suffered a fall while being treated for tumors, and he was transferred to a nursing home.

He still needed care when he was released to his house, MacLean’s wife, Leslie, explained over the phone. The problem was, she couldn’t provide it.

“When they first started coming, I had nothing,” she said. “Cindy (Anderson, MacLean’s HBPC nurse) walked in the door and immediately she ordered a hospital bed, she ordered stuff for the showers. She got everything I needed that I had no idea how to get, or that I even could get.”

The nurse visits her husband once a month to check on him and review all his medication, ordering more if needed. Maclean said she was under a great deal of stress around the time her husband began receiving care at home. When Anderson noticed, she asked permission to bring one of the team’s social workers to meet her.

“I think that the other side of home-based care is the social worker,” MacLean said. She’s grateful for the social worker’s personal assistance, she said, especially when needing help completing any paperwork relating to the VA or insurance.

Some still waiting
It costs the VA about $16,000 to take care of a veteran at home, not including other non-HBPC expenses incurred by the VA and Medicare for these patients. The program has resulted in a 36 percent reduction in the number of days veterans spend in a hospital once they begin receiving home care. This decrease leads to an about 12 percent reduction in combined VA and Medicare annual cost per patient, according to the VA.

In fiscal 2015, a daily average of 444 patients were enrolled in Home Based Primary Care in the state; the number has remained steady the past several years. Nationally, the average daily total is 35,982 patients, an increase from 27,102 in fiscal year 2011, according to the VA.

In November, Stars and Stripes reported on an increasing number of veterans on waiting lists for home care. Five facilities — Los Angeles, White City, Ore.; Puget Sound, Wash.; Richmond, Va.; and Beckley, W.Va. — accounted for more than half of the 2,566 waiting veterans.
In Connecticut, there is no waiting list, according to the care team. Referrals are immediately addressed and sent to the nurse that covers the patient’s geographic area.

For Swirsky, the benefits are numerous.

“You let us have our dignity,” he said to Hutchinson. “It’s being in your own bed, being in your own environment, and people who you know come in and visit you. That’s important.”