At a June 11 White House town hall meeting, senior Obama administration officials discussed the ways in which the Affordable Care Act improved Medicare coverage for seniors, including the promotion of wellness and primary care and the closing of the so-called doughnut hole in coverage of prescription drugs under Medicare Part D. They also emphasized the Affordable Care Act’s initiatives to more effectively coordinate care and provide more coverage of home and community-based services (HCBS).
Home healthcare is the most cost-effective post-acute care setting for patients discharged from hospitals when comparing average payments across settings such as skilled nursing facilities, inpatient residential facilities, and long-term care hospitals, according to a Dobson | DaVanzo & Associates study commissioned by the Alliance for Home Health Quality and Innovation.
The Washington, D.C.-based health care consulting firm analyzed the use of home healthcare (compared to other methods of care) throughout three years of Medicare claims data for post-acute care settings within 60 days of hospital discharge. Nearly 40% of Medicare patients discharged from a hospital into a post-acute care setting use home healthcare.
Despite the fact that home healthcare as a post-acute care “first setting” represents 38.7% of all Medicare episodes, it comprises just 27.8% of payments—shown by the study to be the “least costly” alternative.
“The variation in Medicare episode payments across different first settings is attributable to first setting and subsequent care used,” said the Alliance about the study. “When comparing average payments across settings, home health is the most cost-effective.”
Although patients receiving home healthcare had a slightly longer care process compared to someone discharged from a hospital into a skilled nursing facility, so-called “sequence stops” throughout the process tended to be ambulatory (services provided by physicians, outpatient therapy, and hospice), rather than facility-based, for a less-expensive cost to the Medicare system, as shown by the chart above.
“In considering the importance of patient pathways, the need for coherent coordination of care becomes evident,” wrote Dobson | DaVanzo in the paper. “The issue of patient pathways in post-acute care must be addressed if delivery system reform and, ultimately, cost control are to be achieved, as patient pathways are at the core of the current post-acute care system.”
Click here to access more information about the research.
Written by Alyssa Gerace
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Workforce development and long term care professionals met earlier this month in Washington, D.C. to address the challenges that direct-care workers face today and will continue to face in the coming years. The gathering, initiated by the Aspen Institute Workforce Strategies Initiative, featured a panel of experts who sought to answer the question of why many of these jobs are low-wage, but not low-skill.
A May report from the Paraprofessional Healthcare Institute (PHI) recapped the findings: the approach to direct-care workers needs improvement. Featuring input from Steven Dawson, PHI president; Marki Flannery, Partners in Care president; and Laine Romero-Alston, Ford Foundation Program Officer, PHI reported the following:
Maureen Conway, executive director of the Aspen Institute Economic Opportunities Program, framed the conversation by explaining that 40 percent of the jobs created since 2010 are low-wage jobs and direct-care occupations are the “lowest-paid jobs” with “uncertain hours.” She asked whether poor quality, direct-care jobs had “to be that way?”
Dawson explained the employment and income characteristics of the direct-care workforce and that personal care aides and home health aides were projected to be the first and second fast-growing occupation in the nation by 2020.
He highlighted the particular challenges of home care workers, such as working in isolation and the need to have “emotional intelligence” to navigate a client’s home and the relationships within it.
“These are low-wage jobs but certainly not low-skill jobs,” Dawson said.
Flannery reported that her agency employs 9,800 home health aides — the largest licensed home care agency in the country — and described the profile of people seeking jobs as home health aides since the economic downturn.
Partners in Care has a turnover rate of 23 percent — significantly lower than the 60 percent national average, Flannery said. She attributes her agency’s high retention rate to its training partnership with PHI.
Read the original PHI report.
Written by Elizabeth Ecker
Senior housing design has come a long way in the past 25 years or so, says an architect who has designed skilled nursing facilities, independent and assisted living communities, and memory care wings among other senior care-oriented projects.
Link Wilson, co-principal of Minneapolis-based Kaas Wilson Architects, has seen “dramatic changes,” reports the Minneapolis Star Tribune, and expects the industry will continue to evolve as senior living communities continue to incorporate and improve memory care services and add enhanced amenities such as theaters, cafes, fitness/wellness centers, and restaurant-style dining rooms.
Senior housing is “night versus day” compared to when Wilson began his career as an architect.
“Housing then resembled hospitals: two beds in a room separated by a curtain, a shared bathroom and long, sterile white hallways,” he said in the article. “Today, we focus on giving residents choices and creating small homes within a larger home-like neighborhood. We think about silence, natural light, views, interior gardens flowing out to exterior patios, and access to assistance without ringing a loud alarm or switching a flashing light over a hallway door.”
His design firm is experiencing “enormous” demand and is growing thanks to favorable demographics and other factors, he said.
Read the full interview here.
Written by Alyssa Gerace
The Veterans Administration needs to improve the qualifications process for its pension program to protect elderly veterans from poor estate and financial advice that could affect their ability to pay for their care, and to make sure that only veterans with financial need receive pension benefits, the Government Accountability Office (GAO) said in a report to Congress.
Senior veterans face the danger of being misled by financial and estate planning services who are supposed to help them meet financial eligibility requirements for benefits.
The GAO selected a sample of 25 organizations offering financial and estate planning services to elderly veterans and found that about half advised claimants to place their assets into some type of annuity. But some financial products, such as deferred annuities, may not be the best choice for elderly people because they may not be able to access funds needed for their care within their expected lifetime unless they pay high withdrawal fees.
These products might also strip eligibility for Medicaid for a period of time, GAO points out.
VA programs can help give senior veterans and their families more choices when they need long-term services but don’t need or want to enter an institutional setting, so it’s important to prevent exploitation, says senior living trade group the Assisted Living Federation of America (ALFA) in a statement to the U.S. Senate Special Committee on Aging for its Wednesday hearing on the GAO’s report.
“It is our view that if a financial advisor to a veteran in any way misleads a veteran and misrepresents the Aid and Attendance program to his or her advantage at the expense of the veteran, it is an insidious form of elder abuse. It should not be tolerated and those responsible should be sanctioned to the full extent of the law,” said Rick Grimes, president and CEO of ALFA, in a prepared statement.
Grimes recommended setting clear eligibility standards for the VA benefit and creating guidelines for those who closely serve seniors, such as senior living community operators, along with requiring a “look-back period on veterans finances, similar to the Medicaid process.
Unlike other means-tested programs, the VA doesn’t currently conduct a look-back review to determine whether a benefits applicant transferred assets below fair market value prior to applying, and doesn’t prohibit the practice.
In one case, a pension claimant transferred more than one million dollars less than three months before applying, and was granted benefits, the report said. But if the administration did adopt a similar look-back process, along with certain other determinations as to income and asset source, the VA could have more control in making sure only those in financial distress receive benefits.
Read the GAO report and recommendations here.
Written by Alyssa Gerace
Aegies Living recently purchased property in Seattle, Wash., for an undisclosed price, with plans to build a senior living community.
The community, set to open in Fall 2013, will feature 75 assisted living and 29 “Life’s Neighborhood” memory care apartments, with amenities that include a private movie theater, library, man cave, spa suite, sky lounge, and secured underground parking. Services will include a game room, fitness center, activity garden, and outdoor sensory garden for memory care residents.
“The Puget Sound area is in need of more senior living communities. When this property became available we knew it would be an ideal location to serve the growing senior population,” says Dwayne J. Clark, founder and CEO of Aegis Living. ”Even in these tough times, we provide a service that is needed by so many families.”
The property is located at 22nd and Madison in Seattle. Aegis has contracted with Andersen Construction Company, and groundbreaking is scheduled for later this month.
Designers out of Via Architects’ Seattle office provided architectural services, with civil and structuring engineering by KPFF and landscape design by Harrison Landscape Design.
Wells Fargo is providing the financing.
Written by Alyssa Gerace
