Category Archives: Retirement

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.”

More Baby Boomers Caring for Parents in Their Homes

Due in part to the fact that Americans are living longer, there are now over 70 million baby boomers who are now dealing with the reality of having to care for their aging parents or grandparents. Supplying geriatric care needs can affect these individuals on many different levels. Impediments such as arthritis, high blood pressure or increased blood sugar levels are just a few of the concerns that may require the attention of someone taking care of an elderly person. In addition to these medical conditions, incontinence and immobility may be additional burdening concerns, as well as comorbidities such as COPD (Chronic Obstructive Pulmonary Disease, CHF (Congestive Heart Failure, and Dementia.  With this in mind, aging adults may need the assistance of geriatric care professionals, in conjunction with skilled caregivers, in order to afford a safe, healthy, stress free environment for their loved ones.

Today, a number of geriatric care options exist for concerned baby boomers to choose from. There are nursing homes, assisted living facilities (ALF), independent living facilities, and in-home care service providers. Depending on the extent of service and assistance necessary, any of these geriatric care options could be a viable solution. While nursing homes and assisted living facilities may be more convenient for the responsible family member, these sorts of geriatric care options may also be cost prohibitive. 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). Assisted living facilities usually charge less, while in-home care is the least expensive option with flexible payment rates that can vary depending on the skill set and time required for the patient’s care.

Aside from these usual geriatric care options, there are those who choose to offer care for their elderly parents or grandparents personally. They are classified as “informal caregivers”, and provide in-home care for their loved ones without formal training or education in geriatric care. While this setup may be motivated by very noble causes, the physical, emotional, and psychological pressures associated with this kind of arrangement could become a very large burden for someone to assume. In addition to the pressure of caring for an elderly person, there may also be some legal implications if you cannot provide the level of appropriate geriatric care needed for your elderly relatives.

Just recently, prosecutors from the State of Pennsylvania charged an “informal caregiver” with allegedly committing “assisted suicide” to his chronically ill and aged father, in spite of the personal requests to end his life due to the fact the father felt an undue burden was being placed on his child. It is important to note that taking care of the elderly requires tremendous amounts of dedication, care, and caution on a daily and ongoing basis.

Retirement Age: Caring for Baby Boomers

200258139-001To date, over 75 million baby boomers are dealing with the reality of having to care for their aging parents or grandparents. Supplying geriatric care needs can affect these individuals on many different levels. Impediments such as arthritis, high blood pressure or increased blood sugar levels are just a few of the concerns that may require the attention of someone taking care of an elderly person. In addition to these medical conditions, incontinence and immobility may be another burdening concern, as well as comorbidities such as COPD (Chronic Obstructive Pulmonary Disease, CHF (Congestive Heart Failure, and Dementia. With this in mind, aging adults may need the assistance of geriatric care professionals, in conjunction with skilled caregivers, in order to afford a safe, healthy, stress free environment for loved ones.

Today, a number of geriatric care options exist for concerned baby boomers to choose from. There are nursing homes, assisted living facilities (ALF), independent living facilities, and in-home care service providers. Depending on the extent of service and assistance necessary, any of these geriatric care options could be a viable solution. While nursing homes and assisted living facilities may be more convenient for the responsible family member, these sorts of geriatric care options may also be cost prohibitive. According to the Genworth Cost of Care study, nursing homes can cost up to $6,390 per month. Assisted living facilities usually charge less, while in-home care is the least expensive option with flexible payment rates that can vary depending on the skill set and time required for the patient’s care.

Aside from these usual geriatric care options, there are those who choose to offer care for their elderly parents or grandparents personally. They are called “informal caregivers”, as they provide in-home care for their parents or grandparents without formal training or education in geriatric care. While this setup may be motivated by very noble causes, the physical, emotional, and psychological pressures associated with this kind of arrangement could become a very large burden for someone to assume. In addition to the pressure of caring for an elderly person, there may also be some legal implications if you cannot provide the level of appropriate geriatric care needed for your elderly relatives.

Just recently, prosecutors from the State of Pennsylvania charged an “informal caregiver” with allegedly committing “assisted suicide” to his chronically ill and aged father, in spite of the personal requests to end his life due to the fact the father felt an undue burden was being placed on his child. It is important to note that taking care of the elderly requires tremendous amounts of dedication, care, and caution on a daily and ongoing basis.

Considering the challenges and dilemmas baby boomers face regularly while fulfilling their obligations to provide geriatric care for their elderly parents or grandparents, they may still require the assistance of a geriatric care professional and a private duty caregiver, in one form or another.

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.