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.”

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!

Well Beyond Care:

WellBeyondCare.com gives those who need care the tools to manage their in home care online. Careseekers, or family members looking for someone to help care for their parents or loved ones, can use the website to search for qualified nurses and caregivers, post jobs that outline their specific care needs, monitor their caregivers’ schedules, and make payment online and receive personal support, local support from their personal Nurse Care-Pair Manager. Caregivers can use the website to search for caregiving jobs, set their wages, post their weekly availability, receive weekly payment, and build their resume and portfolio with real experience. Join for free today at WellBeyondCare.com.

Home Health Aides hard to find in 2018

According to a new report conducted by CareerCast, jobs in the caregiving field, including in-home caregiving, and personal care aid, will be hard to fill in 2018. With the rapid growth in the demand for senior care with the Silver Tsunami approaching, there will be an ever-increasing demand for these types of “unskilled” jobs. According to the list provided by CareerCast, health care jobs in general will be five of the top ten most difficult job openings to fill in the coming year and years. Well Beyond Care understands this trend and has already taken steps to see that the need will be filled with qualified employees.

Looking at the list below, home health aides were ranked as the fourth toughest position to fill, with the median salary at only $10.55 per hour, and in parts of the country as low as $8.75 per hour. Personal care aides rang in at No. 8, with a median salary of $8.75 per hours.  Part of what makes WellBeyondCare.com different, is that Caregivers tend to make 25% to 40% more per hour when employed through our system.

Well Beyond Care realizes that over the next eight years the demand for home health aides are forecasted to grow 47%, while personal care aides are anticipated to go 39% over the same time period during to the fact that over 4 million baby boomers per year will be retiring over that same period. This forecast is based on data from trade and professional associations and the Bureau of Labor Statistics.

As a ranking, the 10 toughest jobs to fill in 2018 are:

  1. Application software developer
  2. Construction laborer
  3. Financial advisor
  4. Home health aide
  5. Information security analyst
  6. Medical services manager
  7. Nurse practitioner
  8. Personal care aide
  9. Physical therapist
  10. Truck driver

Due to a large part of how little private duty care companies pay their caregivers and how much they need to charge their clients to make a profit, it is little wonder that in-home care has been facing a labor shortage.  This will become exacerbated as companies like Well Beyond Care start to siphon off more of the higher quality caregivers and as a result, see a raise in hourly wages. Conversely, by using a company like Well Beyond Care a careseeker can actually end up playing a caregiver $3 to $5 more per hour, and still save between $10,000 to $30,000 per year in caregiving costs.

Well Beyond Care gives caregivers and those who need care the tools to manage their in-home care online. Caregivers, registered nurses, certified nurse assistants, and geriatric care managers can use the website to be best matched with Careseekers looking for care, set their wages, post their weekly availability, receive weekly payment, and build their resume and portfolio with real experience. Careseekers and family members looking for someone to give care for their parents or loved ones, can use the website to search for qualified nurses, CNAs and caregivers, are matched with a caregiver who can best can deliver care to specific care needs, monitor their caregivers’ schedules and payment online and receive personal support from the nurse that is assigned to them when they join. Join for free today at WellBeyondCare.com.

Hiring a Caregiver Tips

Hiring a caregiver for the elderly, especially for one or both of your parents, involves having to expend a great deal of effort and time, and commits you to major decision that affect not only your aging parents, but possibly your entire family. Hiring a caregiver for your parents requires a number of considerations in order to arrive at a well-informed decision regarding the kind of geriatric care that your elderly parents may require. In hiring a caregiver, the needs of your parents, as well as your capacity to financially provide for these needs, are just two among the many considerations you may have to keep to mind.

Determine what type of caregiver you need

While conducting your caregiver search, it is important to first determine what kind of care your parent requires. For instance, you should think about the types of skills your parent needs their caregiver to have, the amount of relevant experience your parent may require, the gender of the caregiver your parent prefers, as well as other non-quantifiable qualifications as well. Knowing the skills requirements that your elderly parent may call for in a caregiver should greatly help you narrow down your private duty care professional search.

Formulate a care plan

Along with the type of caregiver you need, you are going to have to take into consideration what types of care is going to be delivered and when. This is also known as a care plan, or a written plan that describes the services and care your loved one needs for their health condition. Sometimes, a care plan must be prepared or approved by your doctor.

Decide on a schedule

Depending on the needs spelled out in the care plan of your elderly parent, the duration of the care required may vary greatly. For instance, you can call for a personal care assistant to work days or nights, or for overnight stays. You may only need to hire a part-time nurse for when your parent only needs a few hours of skilled medical care a day. You should also determine how many hours per week and how many days a month the caregiver may need to be of service to your elderly parent. In the case where your parent calls for round-the-clock care, you should consider hiring three or more caregivers to keep overall costs down, especially when considering overtime and duties performed.

Determine a budget

Determining a budget for your parent’s geriatric care is a decision that may require agreement from a number of your family members. Since this concerns the financial matters affecting your family, it would be wise to involve everyone involved in the process of looking for a caregiver for your parent. At this phase it is also important to determine who among the family members can contribute financially and to what the extent the contribution will be given. It is important to note when you hire a caregiver, financial considerations are one of the most important factors.

Start searching for a caregiver in your area

In your caregiver search, it is best to look for someone who resides within your immediate area. The closer the better. You can try looking for caregivers in local health care agencies, local advertisements, or employment publications. As a more convenient method, it may be better to look for healthcare professionals online by using trusted sites like WellBeyondCare.com that usually have a large listing of caregivers of various skills sets, training, experience, locations and pay ranges.

Conduct an interview and hire them

After searching for a caregiver, select a number of qualified prospects who match your skills requirements, temperament and “rightness of fit” for an interview. Interviews allow you to verify the qualifications of your prospective home care professional. On a site such as WellBeyondCare.com, conducting personal interviews may be easier as this website allows you to get in touch with your prospective caregiver right away and offers you tips on what you should look for in and what questions you should ask a prospective caregiver. As soon as you have interviewed a few caregivers and are satisfied with the caregiver that you have chosen, then it is time to make a hiring decision and start your parent’s in-home care.  One of the first things you should do prior to hiring any caregiver is do a background check that can detect any criminal history and a reference check. It is best if you leave this to 3rd party suppliers.

Well Beyond Care provides the tools that help you plan care and allow your loved ones to safely age in place. It 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. Our 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. This solution lowers stress in hiring a caregiver and saves families tens of thousands of dollars per year in care costs. Its online system combines the best in Caregiver matching (searching, screening, ratings & hiring) with all the back-office functions (time worked, payroll, scheduling, and notifications) to ensure safe, reliable, dependable, affordable care is obtained. It is the only company that gives each Careseeker access to their own local, personal nurse to help guide them through the hiring process. The Careseeker’s nurse provides advice on healthcare options and aids with transitional care.

Common Diseases Seniors Face and Challenges in Providing Healthcare Solutions

Due to aging, diet, and living styles, seniors are more prone to degenerative diseases. As people age they become more susceptible to diseases and conditions that make even simple tasks difficult. Routine activities like grocery shopping, preparing meals and running errands become harder as we get older and adopt a sedentary lifestyle, which is why many elderly people seek assistance from caregivers. Though aging is a reality of life, it is important to know which specific diseases are most common among seniors in order to decide a course of action of prevention, and barring that, then which type of care or assistance is best for your needs.

According to a recent article in the New York Times, the most common diseases among seniors in the U.S. are Alzheimer’s or any other form of dementia, high blood pressure, heart disease, depression, diabetes, and chronic obstructive pulmonary disease (COPD). Each of these illnesses can have dramatic effects on the quality of life of seniors and their families. Caring for an aging parent with dementia or depression can be especially trying. And while there are some precautions one can take to avoid such diseases, like leading a healthy lifestyle, the inevitable deterioration associated with old age is the leading factor that make seniors vulnerable (Medicinenet, 2013).

Though these conditions may manifest alone as a single disease, the problem gets worse as these conditions overlap. According to recent studies, having one of these diseases may make an elderly patient more susceptible to contracting others. Dr. P. Murali Doraiswamy, a psychiatry professor at Duke University, suggests that there is a link between dementia and vascular diseases. Studies aimed at establishing these connections are currently under way. As these ailments and conditions coexist, seniors suffer more and start to need more care. These overlapping health conditions also call for more specialized care for the senior; they need a caregiver or nurse who has experience working with patients suffering from similar comorbidities.

To date, more than 733,000 Americans live in assisted living facilities (ALFs) (New York Times, 2013). These popular living arraignments for seniors and people with disabilities offer an easy solution for their families if they can afford it. Depending on the preferred facility, level of care required, and professionals called for to provide care, yearly rates may vary, but the cost of living in a nursing home or assisted living facility has increased consistently for the past five years and typically costs about $80,000 annually. With such high costs, many families are looking for more affordable alternatives without sacrificing the quality of care and stability for their loved ones.

Many healthcare professionals, including Registered Nurses (RNs) and Licensed Vocational Nurses (LVNs), are moving away from the old model of finding jobs in an established geriatric living facility. Uncertainty about the future of the healthcare industry has driven many qualified medical professionals to operate independently, working for private pay and visiting the patients in their homes. This limits the cost of care and allows aging loved ones to remain in their own homes.

The number of seniors who need personal care is ever increasing in the US. These individuals and their families have enough stress in their lives dealing with illnesses and deteriorating health, that the addition of navigating the waters of elderly care is simply too difficult to take on alone. Fortunately there are many resources available today that can help seniors and their loved ones find the care they need at a cost they can afford.

Well Beyond Care gives caregivers and those who need care the tools to manage their in-home care online. Caregivers, registered nurses, certified nurse assistants, and geriatric care managers can use the website to be best matched with Careseekers looking for care, set their wages, post their weekly availability, receive weekly payment, and build their resume and portfolio with real experience. Careseekers and family members looking for someone to give care for their parents or loved ones, can use the website to search for qualified nurses, CNAs and caregivers, are matched with a caregiver who can best can deliver care to specific care needs, monitor their caregivers’ schedules and payment online and receive personal support from the nurse that is assigned to them when they join. Join for free today at WellBeyondCare.com.

Well Beyond Care on Golden Years

Lauren Tarrant & Jeffrey Fry were on “Dr. Mara Karpel & Your Golden Years” program today. Hear more about Well Beyond Care’s progress  on this podcast (start at 9:35 and end at 40:45).

They go over the company’s progress to date and our mission on helping families find affordable, reliable, quality care. Great interview and very informative.

Study Shows, Wearables Do Not Improve Outcomes

While we are a big believer that technology is a great boon to health care and in improving outcomes, and healthcare in general, we have always had our doubts on the efficacy on wearables in truly improving outcomes, or caregiving in any measurable way. Now a new study conducted by Cedars-Sinai investigators published in Nature Partner Journal, NPJ Digital Medicine indicates that these very expensive wearables have essentially no effect on improving medical outcomes.

As outlined in Health Management Technology’s article, “Analysis shows lack of evidence that wearable biosensors improve patient outcome,” over the past ten years, there has been no significant improvement in patient outcomes with or without wearable. Well Beyond Care has always believed that while technology is wonderful, but without a competent and dedicated caregiver, that any improvement in tech is pretty much useless. The trick is in integrating technology to improve excellent and dedicated caregiving.

Fear of Falling? Here is an Alternative

As people age, their ability to fall diminishes and as a result, may falls end in hospital stays, or even worse, fatality. Here is an innovated approach used by the Dutch in this New York Times’ Article.

Just as in the Netherlands, there has been an increase in the number of elderly in the US, so too is there an increase in the number of deaths caused by falls.  Experts indicate that this increase is due in part to people living longer, the types of medications uses, and a general lack of activity.   This would be a great program to be imported to the United States as well.

In-Home Care: The Practical Choice

Many American adults today are facing the reality of caring or having to care for their aging parents who are no longer capable of living an independent life. Many are worried about what they can do to ensure that their parents may receive the kind of care they need at this point of their life, but few know what to do about getting care. So, if you are in this situation, it may be comforting to know that you are not the only one facing this challenge. According to recent statistics, “the oldest-old population (those age 85 and over) grew from just over 100,000 in 1900 to 5.5 million in 2010” (AgingStats.gov). There are millions of others like you thinking about how to get the best care for their aging parents and wondering how to do so at an affordable cost.

Without a doubt, the costs of healthcare these days can be crippling. And sadly, the hope of having these costs adjust favorably may be bleak. In spite of health care reforms, there is no guarantee as to whether or not they will work out well for American citizens or not – and this leaves you with the only option of working on your parents’ healthcare requirements using your own resources.

The Difficulties of Healthcare for Elderly Parents

The difficulties that your parents are experiencing as they feel the pangs of aging may be as overwhelming to you as them. The added stress you are feeling about having to provide them the best help they can get makes the situation even worse. Their health issues, along with the inconveniences of possible incontinence and inability to perform their daily tasks, like dressing, bathing, and cooking, call for your immediate attention.  Adding this urgent need to your own scheduling requirements to look after them as they progressively need more care, adds significant angst to you and your family.  What options do you have?

The Common Response

The most common response in this kind of situation would either to admit your parents to a full-time nursing home, or an assisted care facility if you can afford it. Though these options may be plausible, they may not be the most practical choice if you are considering your long term financial future.

To begin with, long-term outlay costs may be burdensome for you and your family; you may have other fiscal obligations, such as having to provide for your spouse and children, and your own daily living expenses. On the other hand, nursing homes and assisted care facilities may also be equally as expensive, with the costs estimated at up to $80,000 annually (CNN Money, 2013).

In-Home Care Options

Hiring your own In-home caregiver, on the other hand, may be a more practical choice. Unlike the other more common options, having this kind of care for your aging parents may mean not having to spend as much money while getting the same or better assistance they require and deserve.

These non-medical, private pay or personal care professionals, or caregivers, can do anything from preparation of meals, to bathing and grooming, to even administering intravenous medications. Depending on their specific qualifications, they may also offer other services as that your parents may need now or in the future.  The cost savings of hiring an individual caregiver can be substantial, sometimes less than half the expected cost of a nursing home facility.  The advantages of having a caregiver for your parents may be the best choice you make for them; and for yourself as well.

When hiring your own caregiver, you should look at companies like Well Beyond Care. Well Beyond Care offers an online caregiving matching application and more. While most in-home care is provided by private duty agencies, Well Beyond Care teaches and guides a Careseeker (a senior or their children) on hiring their own caregiver. Compared to traditional Private Duty Agencies, families can save $10K to $30K per year, and caregivers make an additional $3 to $4 per hour extra using our on-line service.  The Well Beyond Care system, combines the best in caregiver hiring (matching, screening, ratings & background checks) with all the back-office functions (verified time worked, payroll, scheduling, and documentation) to insure safe, reliable, dependable, affordable care is obtained.  Each careseeking member has access to their own local, personal nurse navigator to help guide them and give advice on healthcare options.  An user friendly, free service, the  Well Beyond Care system wants to make sure that there is a rightness of fit in the Care-Pair by empowering caregivers and those looking for care.

Tips for Finding Care for Elderly Individuals

As we grow older, we go through many changes both physically and mentally. Some elderly individuals will have trouble performing every day tasks, like preparing their own meals or dressing themselves, while others will retain more independence. There are cases where aging loved ones who are still mobile and alert may need occasional assistance and care. The type of care that an individual receives will depend on their specific care needs and their family’s budget.

The cost of healthcare in the US, and more specifically in Texas, California, and Florida has been steadily increasing over the years. More and more families are struggling to afford nursing home care or assisted living facility care for their aging relatives.

According to Genworth’s 2016 Cost of Care Survey, the average cost of private nursing home care in the US is now $92,345 per year (or $235 per day). Just eight years ago that average was $67,527 per year. Though some geriatric patients may prefer the live-in nursing home option, the prohibitively high cost makes it impossible for many families to afford this option. Hence, many families are now opting to hire a private, qualified in-home caregiver or nurse to take care of their parents or loved ones in the comfort of their own home.

Some individuals worry that the lower price of an in-home caregiver means inferior quality care, but this is not necessarily the case. Many caregivers and nurses choose to work independently in order to maximize their income and to be able to control their schedule. While many caregivers are very capable and trustworthy, to be sure you are hiring a quality caregiver any person looking for in home care should follow these steps:

  • Use a trusted resource to find your caregiver or nurse. If you are hiring a caregiver for a parent or friend there are many online resources available that make this process easier than what was capable in the past.
  • Look for caregivers with recommendations or reviews from other patients. This will give you an idea of how well they got on with other geriatric individuals.
  • Only interview caregivers whose qualifications meet your or your parents’ needs. If your parent suffers from respiratory problems, look for a caregiver who is also a respiratory therapist.
  • Be thorough in your interview. This caregiver is someone you want to build a meaningful and positive relationship with, so make sure you get to know them and feel comfortable with them.
  • Get a certified background check and verify their references. This is an essential step in ensuring your parents’ safety and reducing your own stress.

There are a number of caregivers and skilled nurses available to provide in-home elderly care for you or your loved ones. If you are looking for a trusted resource to help you find professional caregivers and nurses, check out websites such as WellBeyondCare.com to find elderly care professionals in your area.

Well Beyond Care provides the tools that help you plan care and allow your loved ones to safely age in place. It 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. Our 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. This solution lowers stress in hiring a caregiver and saves families tens of thousands of dollars per year in care costs. Its online system combines the best in Caregiver matching (searching, screening, ratings & hiring) with all the back-office functions (time worked, payroll, scheduling, and notifications) to ensure safe, reliable, dependable, affordable care is obtained. It is the only company that gives each Careseeker access to their own local, personal nurse to help guide them through the hiring process. The Careseeker’s nurse provides advice on healthcare options and aids with transitional care.