Signs Your Loved One Needs Care

As individuals age, many of the things they used to do with ease sometimes become much more difficult to do.  Acknowledging the need for help and then accepting assistance is not easy for individuals as they get older. Often, the decision and responsibility falls on one or Aging Mothermore family members to recognize the signs that your loved one might need support and aide in completing the activities of daily living. Many of these include simple tasks such as bathing, dressing, and cooking.

So, how do you know if it is time for in-home care for your loved one? There are some obvious signs that could signal a red flag that are listed below.  One may not be enough, but when these come in combination you should seriously look to have a caregiver aide in the home.

Reduction in Physical Abilities and/or Mental Status

  • Difficulty keeping track of time / forgetting appointments
  • Sleeping for most of the day / not waking properly
  • Poor diet or weight loss
  • Rapid weight gain
  • Loss of interest in hobbies, activities or in socializing
  • Uncertainty and confusion when performing once-familiar tasks
  • Changes in mood or extreme mood swings
  • Difficulty getting up from a seated position
  • Difficulty with walking, balance and mobility
  • Unexplained bruising or injuries from falls or hitting furniture
  • Forgetfulness, including forgetting to take medications or taking incorrect dosages
  • Consistent use of poor judgment (e.g. falling for scams or sales pitches, giving away money)

Deterioration in Personal Hygiene

  • Unpleasant body odor due to infrequent showering or bathing
  • A strong smell of urine in the house or on clothing
  • Noticeable decline in grooming habits and personal care (e.g. unkempt hair, untrimmed nails, lack of oral care, wearing dirty or stained clothing)

Neglecting Household Responsibilities and Upkeep

  • Inability to independently complete Instrumental Activities of Daily Living (ADLs)
  • Little or no fresh, healthy food in the fridge
  • Unkept, uncleaned house and/or extreme clutter
  • Unwashed laundry piling up
  • Stains or wet spots on furniture or carpet
  • Spoiled or outdated food that does not get thrown away
  • Stacks of unopened mail or an overflowing mailbox
  • Late payment notices, bounced checks and calls from bill collectors
  • Utilities being turned off due to missed payments

Hiring a Caregiver or Caregiving Service
If many of these indicators are present, it does not mean you have to place mom or dad into an assisted living or a nursing home facility. These are often very expensive and may not be the right choice.  However, these red flags do indicate that some form of daily supportive care is needed. You may have to consider hiring a private duty care agency, or as a much more affordable alternative, hire your own caregiver using a service such as Well Beyond Care.

About Well Beyond Care
Well Beyond Care is the only company that teaches families and individuals how to find and manage affordable non-medical in-home care, while solving the chronic problems of caregiver truancy and turnover through the web application, WellBeyondCare.com.  The Company’s platform combines the power of the internet with the personal touch of nurses to offer families a pathway to transitional care, allowing our elderly parents to safely age-in-place. Their solution lowers stress in hiring a caregiver and saves families tens of thousands of dollars per year in care costs.

Private Duty Services for All!

Reprinted by permission from Elisabeth Hogue, Esq.; (877) 871-4062; ElizabethHogue@ElizabethHogue.net

In order to be appropriate for home care services of all types, patients must be able to care for themselves or have primary caregivers who can meet patients’ needs in between visits from professional staff from home care providers. This requirement is necessary in order to meet the eligibility of many payors, to avoid risk of legal liability and to help ensure quality of care.

Patients’ family members or others may be willing to serve as primary caregivers on a voluntary basis. If not, providers should offer patients and/or their family members the option to pay privately for primary caregivers. These services may be referred to as private duty or non-medical services.

The option to pay for private duty home care services should be offered to all patients who cannot care for themselves and who have no voluntary primary caregivers. Patients who can care for themselves or have voluntary primary caregivers may also wish to contract for additional assistance, so providers should offer this option to all patients who may benefit from these services.

Specifically, this means that:

  • Hospital discharge planners/case managers should offer private duty services to all patients who may benefit from them and assist patients to arrange for such services post-discharge as part of the discharge planning process.
  • Other types of institutional providers; such as skilled nursing facilities (SNFs), Long Term Acute Care Hospitals (LTACHs), and independent rehabilitation facilities (IRFs); should also offer patients who are being discharged the option to arrange for assistance from private duty agencies and should arrange for such services post-discharge.
  • Assisted living facilities (ALFs) should offer private duty services to all of their patients who may benefit from such services.
  • Home health agencies should offer patients the option to private pay for services if primary caregivers are no longer available to provide assistance and if patients no longer meet the eligibility requirements of payor sources.
  • Home health agencies, hospices and home medical equipment (HME) companies should educate patients about private duty services even though patients may have voluntary caregivers and help patients and their families arrange for these services.

Providers may be reluctant to offer these services to patients and their families because of their cost. They may also erroneously conclude that patients and their families cannot afford them. Providers should not jump to conclusions about who can afford these services. Instead, private duty home care services should be offered to all patients and their family members who may benefit from them.

A home health agency, for example, decided that a patient no longer met the eligibility requirements of the Medicare Program. The staff of the agency was reluctant to offer the patient the option to private pay for additional services prior to discharge because the patient lived in a “shack” and drove an old, beat-up truck. They did so anyway. To the staff’s surprise, upon receipt of the offer, the patient got out of bed, extracted a wad of cash from under the mattress and told the staff that there was plenty more money to pay for private duty services!

Private duty care has a very important role to play in the provision of home care services. This type of care should be offered to all patients whenever it seems that patients may benefit from it.

About Well Beyond Care
Well Beyond Care is the only company that teaches families and individuals how to find and manage affordable non-medical in-home care, while solving the chronic problems of caregiver truancy and turnover through the web application, WellBeyondCare.com.  The Company’s platform combines the power of the internet with the personal touch of nurses to offer families a pathway to transitional care, allowing our elderly parents to safely age-in-place. Their solution lowers stress in hiring a caregiver and saves families tens of thousands of dollars per year in care costs.

 

Sandwich Generation Woes

A funny thing has happened in the United State over the past 50 years, which on the surface is good, but for a growing segment of the population is adding an additional stress in their life. Due in a large part to vast improvements in medicines and treatment, the median life expectancy has been steadily increasing, adding about one half year of life expectancy to the population ever two years. So, in 1959 the median life expectancy was under 70, now, it is 83.  At the same time, Americans on average have been holding offer getting married and starting a family well into the late twenties or early thirties.  As a result, the generational gap between grandparents and grandkids has grown from 20 years to now 30.

Elder care services are becoming an ever-increasing need as baby boomers continue to retire at an alarming rate. Combining the fact that the elderly are living longer, and individuals are holding off having children until they are older, a new dilemma has developed for individuals between 38 and 55. Many of these adults are becoming part of the what is referred to the “sandwich” generation. This is where an adult has to not only take care of their children, but one, two, three or even four parents dispersed across the country which they are also taking care of.

Accounting to a 2013 Pew Research report, nearly half (47%) of adults in their 40s and 50s have a parent age 65 or older and are either raising a young child or financially supporting a grown child (age 18 or older). And about one-in-seven middle-aged adults (15%) are providing financial support to both an aging parent and a child.  Combine the fact that most adults in America do not live within 100 miles of their aging parents, it becomes obvious that this trend is adding stress to when elderly parents get ill or need care.

As a fallout of this growing trend, when the parents of a working adult become ill or need assistance, presently that working adult child will need to leave and take extended time away from work to deal with the situation.  The average time away is one week, and sometimes stretches into three weeks! In most cases, these individuals will likely have to continue to visit their aging parents for extended periods of time for the next 5 to 15 years.

The reason why individuals have to take time off, is that up until now, there was no “on-line” way to get reliable geriatric care. As stated earlier, most adult children do not reside close to their aging parents, and as such, have to schedule time to travel in order to arraign for care from a private duty agency, which includes interviewing the agencies, developing a care plan, and signing contracts.

Not only is there an impact on work, there is also a financial impact on these adults. According to a recent AARP study, 30 percent of family caregivers dip into their personal savings to cover long-term care costs, 16 percent reduce contributions to their retirement accounts, and about half cut back on leisure spending in order to help take care of their parents.

The tough reality is that many families are not rich enough to afford the staggering cost of private duty long-term care. Yet at the same time, they do not qualify for Medicaid, a health care program for low-income and disabled adults. So, it is nice to have a lower cost alternative to the high priced private duty agencies, that also delivers a superior service like Well Beyond Care.

About Well Beyond Care
Well Beyond Care is the only company that teaches families and individuals how to find and manage affordable non-medical in-home care, while solving the chronic problems of caregiver truancy and turnover through the web application, WellBeyondCare.com.  The Company’s platform combines the power of the internet with the personal touch of nurses to offer families a pathway to transitional care, allowing our elderly parents to safely age-in-place. Their solution lowers stress in hiring a caregiver and saves families tens of thousands of dollars per year in care costs.

 

Well Beyond Care invited to attend Johns Hopkins MedHacks 2018

For Immediate Release
Contact:
Lauren Tarrant, RN
COO/CNO
Well Beyond Care, Inc.
(512) 809-4057
lauren@wellbeyondcare.com

Well Beyond Care invited to attend Johns Hopkins MedHacks 2018
Company choose to present at Health Financial Management Association’s Annual Event

Austin, TX, Sept 19, 2018 – Well Beyond Care recently attended the 3rd Annual MedHacks held at Johns Hopkins University’s School of Medicine from September 7th through the 9th in Baltimore, Maryland. The company’s CEO & President, Jeffrey Fry, joined over 750 of the best and brightest students from around the world participated in the world’s biggest medical hackathon. This year’s participants came from over 25 countries and studying a range of topics from Aerospace Engineering to Zoology.

The Johns Hopkins MedHacks (medhacks.org) is known as a Snow Day. Teams work 36 hours to develop a hack in one of three tracks. The three tracks were Medication Adherence sponsored by CVS Health (cvshealth.com), Patient Safety & Quality lead by Hopkins Medicine (hopkinsmedicine.org), and Access to Care with Blue Cross Blue Shield (bcbs.com).

In addition to exposing the Company to a plethora of great ideas, Mr. Fry attended as a mentor and judge. Needless to say, one of the groups he mentored, won first prize for their Hack. In addition, Mr. Fry made his “Silver Tsunami” presentation, which outlines the growing concern of the aging of America to much of the healthcare community. Quotes Mr. Fry, “what a fascinating event hosted by Johns Hopkins. To see so much raw talent, pour out some many ideas in such a short period of time is exhilarating. We will definitely be back next year.”

In closing a special thank you to Dean Patricia Davidson, PhD, RN and Assistant Dean Kenneth Dion, PhD, RN from the Johns Hopkins School of Nursing for their gracious invitation and hospitality during our stay.

About Johns Hopkins University School of Medicine
The Johns Hopkins University School of Medicine (JHUSOM), located in Baltimore, Maryland, was founded in 1893 and is the academic medical teaching and research arm of Johns Hopkins University, which was founded in 1876. Johns Hopkins has consistently ranked among the nation’s top medical schools in the number of research grants awarded by the National Institutes of Health. Its main teaching hospital, the Johns Hopkins Hospital, was ranked the #1 hospital in the United States for 22 years by U.S. News & World Report.

About Well Beyond Care
Well Beyond Care is the only company that teaches families and individuals how to find and manage affordable non-medical in-home care, while solving the chronic problems of caregiver truancy and turnover through the web application, WellBeyondCare.com. The Company’s platform combines the power of the internet with the personal touch of nurses to offer families a pathway to transitional care, allowing our elderly parents to safely age-in-place. Their solution lowers stress in hiring a caregiver and saves families tens of thousands of dollars per year in care costs.

Well Beyond Care Selected as Innovation Hub Finalist

For Immediate Release

Contact:
Lauren Tarrant, RN
COO/CNO
Well Beyond Care, Inc.
(512) 809-4057
lauren@wellbeyondcare.com

Well Beyond Care selected as HFMA Innovation Hub Finalist

Well Beyond Care has been chosen to present at Health Financial Management Association’s Annual Event as part of the Innovation Hub Pitch Event

Austin, TX, Jun 12, 2018 – Well Beyond Care has been selected by the Healthcare Financial Management Association (hfma.org) as one of the top 12 startups that can most influence the healthcare industry out a pool of over 100 candidate companies that submitted their ideas to a nationwide contest.  As a finalist, the Company has been invited to attend the annual HFMA meeting (annual.hfma.org) as a spotlight company in this year’s Innovation Hub and take part in the Virtual Pitch Competition.  The annual meeting is taking place in Las Vegas, Nevada, from June 24th through June 27th.   Well Beyond Care was selected due in part to the way the Company can impact 4 out of the 8 most critical content areas (see graphic below) outline in this year’s mission, including Reducing Total Cost of Care, Creating a Consumer Centric Healthcare Delivery System, improvement to Payment Trends and Models, and leveraging and capturing Trends and Innovation.

Part of the criteria of being selected was how well a company would affect at least one of the following outcomes.

  • Reducing Cost of Care Delivery: Product, service or technology that quantifiably reduces the cost of care delivery through its implementation or utilization.
  • Enhancing the Healthcare Consumer Experience: Product, service, or technology focused on specifically improving the healthcare consumer experience in facets such as patient satisfaction, care coordination, price transparency, communication, etc.
  • Improving Population Health Management through Analytics: Product, service or technology providing analytics that lead to better health and outcomes of patients. Areas and products in the realm of wearables, mobile or telehealth, monitoring, or other digital tools.

As the Company’s CEO, Jeffrey Fry goes on to say, “Part of what makes this a great selection for our company, is being recognized for how we can save families and hospital systems money by reducing readmissions, how we combine high tech with high touch using our nurse navigators, and ultimately we will allow people to age safely in their homes and prevent a large number of emergent events. It is always nice to be recognized for your efforts, but more so by the individuals who are responsible for cost containment while maintaining quality control.”

Presently, Well Beyond Care is operating in 44 States and territories and has clients in over 350 cities. The company did its “hard-launch” in the first quarter of 2018 and is looking to hire upwards of 500 nurses this year as it continues to expand its footprint across the United Stares.  The company is also starting to partner with not-for-profit and public hospitals in order to reduce readmissions and improve outcomes.

About HFMA

With more than 38,000 members, the Healthcare Financial Management Association (HFMA) is the nation’s premier membership organization for healthcare finance leaders. HFMA builds and supports coalitions with other healthcare associations and industry groups to achieve consensus on solutions for the challenges the U.S. healthcare system faces today. Working with a broad cross-section of stakeholders, HFMA identifies gaps throughout the healthcare delivery system and bridges them through the establishment and sharing of knowledge and best practices. We help healthcare stakeholders achieve optimal results by creating and providing education, analysis, and practical tools and solutions. Our mission is to lead the financial management of health care.

About Well Beyond Care

Well Beyond Care is the only company that teaches families and individuals how to find and manage affordable non-medical in-home care, while solving the chronic problems of caregiver truancy and turnover through the web application, WellBeyondCare.com.  The Company’s platform combines the power of the internet with the personal touch of nurses to offer families a pathway to transitional care, allowing our elderly parents to safely age-in-place. Their solution lowers stress in hiring a caregiver and saves families tens of thousands of dollars per year in care costs.

The difference between a Registered Nurse (RN) and a Licensed Vocational Nurse (LVN)

Although registered nurses (RNs) and licensed vocational nurses (LVNs) both practice in the health care industry, there are a number of distinctions that set one apart from the other. While these medical professionals may have some similarities, their differences in terms of education and training, skills, responsibilities, and expected salaries draw clear lines between the two.

To start with, being a Registered Nurse requires having a diploma after successfully completing a nursing program, receiving an Associate’s degree, or a Bachelor’s of Science degree in nursing.  A nursing program diploma under an Associate’s degree program usually only takes two years, while a Bachelor’s degree program requires a four-year commitment.

After formal education, a nursing graduate must pass the National Council Licensure Examination and other statutory requirements as mandated by State law to become an RN. On the other hand, being a Licensed Vocational Nurse requires only the completion of a certificate program at a community college or career center. This education takes only a year, covering the subjects of nursing, pharmacology, and biology.   Both RN and LVN programs include supervised clinical experience in hospital departments such as pediatrics, psychiatry, maternity, and surgery. Bachelor degree programs usually include more training in the physical and social sciences, communication, leadership, and critical thinking, which is becoming more important as nursing practice becomes more complex.

LVNs possess the necessary skills to provide care and assistance to patients in a wide variety of clinical settings. They may be employed in different environments such as medical clinics, schools, and even as home care providers. They offer assistance ranging from the administration of oral medicine, dressing wounds, to personal hygienic routines. Depending on their relevant other skills, training, and experience; LVNs may pursue voluntary certification in additional skills such as in gerontology, foot care, or IV therapy. While LVNs possess general knowledge and skills to provide care and assistance to patients, RNs have more specialized skills and knowledge in the same areas of practice. RNs may perform diagnostic tests and analysis, and educate patients and their families on managing illnesses as well as operating medical equipment.

Responsibilities of an LVN may be considered more intricate, though less demanding and delicate than those of the RNs. LVNs are expected to provide bedside care, including bathing and dressing, and assistance with other daily tasks as required. RNs, on the other hand, may assist in the administration of anesthetics, IV medications, and other more specialized health care needs.

Think you will never be a Caregiver? Ask your parents

Our aging parents sometimes have unmet expectations of their children, like wanting them to become doctors, or visiting and corresponding more, and in an ever growing situations, taking care of them in old age.

But when the need for our aging parents to get care and their adult children are not around, this can be disastrous for all parties, both emotionally and financially.  Many times, adult children are still taking care of their own kids, and their parents are left with no one to help them around the house or bring them to doctors. This “sandwich generation” is when adult children are taking care of both their children and their parents. In more and more cases, adult children are saving less for their futures as they help pay for their parents’ care and, in a few scenarios, may cut back on work hours or leave a job altogether.  In the worse case scenario,  discussions about what to do with mom or dad when they need care now or in the future go  undiscussed until it is too late.  Way too often, aging parents just assume that their adult children will take care of them and their needs, often thinking that one will move in with then in their twilight years.

According to a survey conducted by Bay Alarm Medical, more than 55% of parents anticipate their children will be the ones caring for them, either physically or financially, as they age. Unfortunately, most adult children do not agreed with that notion, or know that this is what their parents are thinking. In some areas, like the Midwest, only 36% of people felt children were obligated to care for their aging parents. Participants in other regions of the U.S. were much more likely to say they felt an obligation to caring for their parents in their old age. Parents are three and a half times more likely to lean on their daughters (and expect that of them) than their sons.  According to a 2006 study on mothers’ expectations of caregiving by their children,  and usually rely on the children they feel are closest emotionally.  To counter that finding, at Well Beyond Care, we have found that 80% of the adult children using our service as the care administrator and paying for the service, are male.

Unfortunately, most families do not discuss caregiving needs, nor most money topics in genreal, because they are so uncomfortable, personal or private. Not only do our aging parents keep their finances hidden, but they sometimes forget or avoid, or just don’t know how, to tell their children what they expect in their old age. The consequences could be a disappointed parent, or one without the proper plan to fund their care, or even worse, a parent who needs care and can not get it.

To the consternation of  adult children, they end up bearing the brunt financially if they become their parents’ caregiver without planning. The children may not pursue the careers they want because they have to move back home, or they forego putting more money into a retirement account because they think they willl need liquidity for when their parents fall ill.

Communication is vital between the generations in terms of caregiving, estate planning and myriad other reasons and goes a long way to help both generations plan and live without regrets.  Begin by getting the entire family together (or at least those most important to planning) and come up with a list of questions or concerns, such as who will provide physical care, do household chores or pay bills. Because this is such an emotionally charged subject (people don’t normally like talking about their declining physical or mental state), children have to be especially patient and empathetic toward their parents, and give them room to get angry when they bring up difficult observations, such as impaired driving abilities. If parents keep resisting the conversation, be persistent and bring it up as many times as necessary.

The good news is this that most adult children tend to step up to the plate, even if it is a stressful situation. Of all the 2,000 adult children surveyed in a Merrill Lynch and Age Wave report, 100% said they support their loved ones emotionally and socially, followed by 92% said they provide household support, 84% who said medical support and 64% who said physical care. Another 92% said they provide financial assistance, such as paying the bills, handling insurance claims and cutting back on their own expenses or dipping into their own savings accounts. What is beneficial, is that if a family is unable to move back home, Well Beyond Care can supply a service that saves on average $10,000 to $30,000 over private duty care, and allows management of the care plan from anywhere in the world.

About Well Beyond Care
Well Beyond Care is the only company that teaches families and individuals how to find and manage affordable non-medical in-home care, while solving the chronic problems of caregiver truancy and turnover through the web application, WellBeyondCare.com.  The Company’s platform combines the power of the internet with the personal touch of nurses to offer families a pathway to transitional care, allowing our elderly parents to safely age-in-place. Their solution lowers stress in hiring a caregiver and saves families tens of thousands of dollars per year in care costs.

 

CMS Adds Non-Skilled In-Home Care to Medicare Advantage Benefit

Beginning in 2019, non-skilled in-home care services will be allowed as a supplemental benefit for Medicare Advantage (MA) plans the Centers for Medicare & Medicaid Services (CMS) announced in a final rule issued Monday, April 8th. This ruling, originally proposed in February, was met with enthusiasm from both the home health and private duty home care industries.

This marks the first time CMS has allowed supplemental benefits that include daily maintenance in Medicare Advantage. “CMS is expanding the definition of ‘primarily health related,’”the agency stated in its announcement. “Under the new definition, the agency will allow supplemental benefits if they compensate for physical impairments, diminish the impact of injuries or health conditions, and/or reduce avoidable emergency room utilization.”

In 2015, 35% of Medicare beneficiaries were participants in MA, according to CMS data. And that figure is expected to grow quickly over the next several years. Home care providers are not the only ones welcoming this change, as many also believe MA payors are ready and willing to pay for non-skilled in-home care services but as of yet did not have a mechanism to do so.

“The Medicare Advantage plans have a very different payment environment [than fee-for-service],” Tracy Moorehead, CEO of industry group ElevatingHome, told Home Health Care News at the association’s National Leadership Conference in March. “They have greater flexibility than the fee-for-service providers do. They do not have a home bound requirement in many cases. So they are tasked with full capitation, where they have an amount they are provided [with] to care for a patient and they will do whatever they need to make sure that patient doesn’t cost them more money than necessary. And if that [includes] private duty services, then I’m sure a plan is more than ready to pay for that.”

In fact, insurers and payors have been positioning themselves to better align with post-acute care services for years. As the focus also shifts toward the high-cost, high-needs dual-eligible patient populations of people who qualify for both Medicare and Medicaid, that has provided additional incentive to cover personal care services as well.

“What Humana, UnitedHealthcare, and Aetna have been saying for several years is that we’ve have a great relationship for skilled home health and hospice for quite a while,” Keith Myers, CEO of LHC Group (Nasdaq: LHCG), told HHCN. “In the last few years, they’re starting to focus more on dual-eligible population and have needed us to have a bigger commitment in personal services.”

Well Beyond Care at SXSW

South by Southwest, or South By, or SXSW is an annual Austin, Texas event that highlights music, technology, film, and more and more healthcare. This year’s event happened between March 8th and the 17th. Well Beyond Care shared a booth as part of SXSW’s Health + MedTech Pavilion from March 10th – 13th in Austin Convention Center with 24HourPhysicians, and got a lot of traffic. Also, our CEO, Jeffrey Fry, was interviewed by Erik Liekam of KLBJ out of Austin, TX. You can listen to each below, they are only 37 seconds long.

Here are some of the pictures of the craziness that is SX.

Hospital Discharge Planners and Recommendations of Post-Acute Providers

Reprinted by permission from Elisabeth Hogue, Esq.; (877) 871-4062; ElizabethHogue@ElizabethHogue.net

MedPAC advises Congress about Medicare. The Remington Report in the October 4, 2017, edition of FutureFocus reported that a MedPAC staff member stated as follows at MedPAC’s September, 2017, meeting:

“The Balanced Budget Act (BBA) requires hospitals to provide beneficiaries with a list of nearby SNFs and home health agencies but the list is not required to have quality information….Medicare statute provides beneficiaries with the freedom to choose their PAC provider, the law states that hospitals may not recommend providers (emphasis added).”

Then in the March 7, 2018, edition of FutureForcus, a link was provided to a power point presentation presented by MedPAC on March 1, 2018. A slide entitled “Discharge planning is a hospital responsibility” that was included in the presentation states as follows:

“…Hospital discharge planners may not recommend specific providers-beneficiaries have freedom to choose PAC providers.”

Is it true that hospital discharge planners are prohibited from recommending post-acute providers to patients based on applicable federal requirements? The answer is a resounding NO!

The basis for the remarks of members of the staff at MedPAC seems to be Conditions of Participation (CoPs) of the Medicare Program that establish requirements for hospital discharge planning. Specifically, 42 CFR 482.43(7) says that hospitals must not specify or otherwise limit the qualified providers that are available to patients.

But making recommendations to patients about post-acute providers while emphasizing patients’ right to choose providers does not necessarily entail “specifying” or “otherwise limiting” the providers available to patients. In fact, such discussions seem to be required by applicable national standards of care the Case Management Society of America and sanctioned by the Centers for Medicare and Medicaid Services (CMS). Prohibiting these types of discussions also has practical implications for patients and their families.

Specifically, the Case Management Society of America (CMSA) first published Standards governing the practice of case management, including hospital discharge planners/case managers, in 1995. The Standards were revised in 2002, 2010 and 2016. Among other requirements, these standards require case managers to advocate on behalf of patients, including provision of assistance with making decisions about their care.

In addition, CMS sanctioned making recommendations to patients through the use of preferred providers. In final regulations of the Comprehensive Care for Joint Replacement Payment Model for Acute Care Hospitals Furnishing Lower Extremity Joint Replacement Services at 80 Fed. Reg. 73274 (November 24, 2015), CMS says on Page 73518: “We agree that hospitals should be allowed to identify preferred providers and suppliers…”

CMS goes on to say on Page 73520 that:

“…hospitals, if desired, may recommend “preferred providers,” that is, high quality PAC providers/suppliers with whom they have relationships (either financial and/or clinical) for the purposes of improving quality, efficiency, or continuity of care.”

Finally, anecdotally, hospital discharge planners/case managers often report that patients are unable to choose post-acute providers when lists are presented to them. In light of MedPAC’s comments above, it sounds like discharge planners/case managers are unable to provide assistance to patients except perhaps to hand them the equivalent of a copy of the yellow pages! From a practical point of view, this dog will not hunt! In fact, the “heart” of the discharge planning process includes recommendations from discharge planners/case managers about the best choices for patients. Patients are, of course, free to reject these recommendations.

Case management/discharge planning activities are at the heart of our healthcare delivery system. These crucial activities are finally receiving the recognition and “due” that they deserve. They should not be mischaracterized!

About Well Beyond Care
Well Beyond Care is the only company that teaches families and individuals how to find and manage affordable non-medical in-home care, while solving the chronic problems of caregiver truancy and turnover through the web application, WellBeyondCare.com.  The Company’s platform combines the power of the internet with the personal touch of nurses to offer families a pathway to transitional care, allowing our elderly parents to safely age-in-place. Their solution lowers stress in hiring a caregiver and saves families tens of thousands of dollars per year in care costs.