Home Healthcare for Elderly Sees Largest Price Increase Ever

The Hill - Changing America / By Alejandra O’Connell-Domenech

Costs for home healthcare for the elderly and bed-ridden have gone up by 14.2 percent over the past year, according to new Consumer Price Index data released Wednesday.  
 
That represents the largest percent increase in home healthcare costs during a 12-month period since the Bureau of Labor Statistics began collecting data on such costs in 2005.  

The United States has an aging population, and the need for care among the nation’s roughly 73 million Baby Boomers is driving up the cost of nursing homes, assisted living facilities and home healthcare.  
 
About 70 percent of American adults aged 65 and older will need some form of long-term care in the future, according to the Administration for Community Living.
 
There are two main types of in-home care providers for the elderly or bed-bound: home health aides who help with personal care and homemaker aides who assist with household chores.  
 
The prices for these aides’ services vary by need and location, but in 2023 the median cost for a home health aide was $33 an hour and that for a homemaker aide was $30 an hour, according to insurance company Genworth.  
 
The reason behind the striking increase in in-home care costs stems from shortages in the country’s home health workforce coupled with rising wages for these workers, according to Marc Cohen, co-director for the Leading Age Long Term Services and Supports Center at the University of Massachusetts-Boston.  
 
In 2022, there were about 4.8 million direct care workers, a category that include home health aides, according to an analysis from KFF. These workers helped 9.8 million people at home, 1.2 million in residential care facilities and 1.2 million in nursing homes.
 
The direct care sector is expected to add over 1 million new jobs by 2031, according to that same analysis. But those additional jobs will not be enough to meet the country’s rising eldercare needs.  

How Home Health Providers Can Avoid Payment Denials

Home Health Care News / By Joyce Famakinwa

Payment denials can be costly and time consuming for home health providers, and they’re often self-inflicted. 
 
In order to avoid this all together, home health leaders should educate themselves on the common reasons behind denials, and also adopt documentation techniques that will help their organizations stay compliant with Medicare’s coverage criteria.
 
That was the main takeaway of a recent webinar hosted by WellSky, an Overland Park, Kansas-based company that utilizes software and analytics to help providers across the continuum achieve better outcomes at lower costs.
 
One of the most prevalent claims errors is not including the signature of a certifying physician. Documentation not meeting medical necessity is another top claims error that providers make. 
 
Other common claims errors include encounter notes that don’t support all elements of eligibility, and missing or incomplete certifications or recertification documents.
 
“If you get a SMRC, or a supplemental Medical Review contractor, request for additional information, and you don’t comply … they will notify your Medicare Administrative Contractor. That can initiate claim adjustments and/or overpayment recoupment actions through their standard recovery process,” Beth Noyce, of Noyce Consulting, said during the webinar presentation. 
 
Providers are able to appeal, but this can be a lengthy and cumbersome process.
Noyce noted that providers looking to find the home health coverage and documentation requirements, in order to stay on the right side of compliance rules, should be aware that all of the information is available to the public.
 
“All of the things are published, everything’s available to you without having to spend a dime of extra money, and it’s all in the public domain,” she said. 

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One-Minute Speech Test Could Help Assess Dementia Risk

Medscape / By Sara Freeman

BUDAPEST — Analyzing temporal changes in people's speech could be a simple way of detecting mild cognitive impairment to see whether there is a risk of developing dementia in the future, suggests research.

János Kálmán, MD, PhD, and colleagues at the University of Szeged in Hungary have developed an automated speech analysis approach called the Speech-Gap Test (S-GAP Test) that is unique because it focuses on the temporal changes made when someone talks. This means it does not overcomplicate matters by also assessing the phonetics and semantics of speech, Kálmán told Medscape Medical News. 

Kálmán presented his findings at the 32nd European Congress of Psychiatry. 

Temporal Speech Parameters

The test analyzes parameters such as how quickly someone speaks, whether they hesitate when they talk, how long the hesitation lasts, and how many silent pauses they make. This can be done with a mere 60-second sample of speech, Kálmán said, noting that other automated speech and language tools currently in development need much longer audio samples. 

"We tried different approaches and we finally ended up with the temporal speech parameters because these are not culture-dependent, not education-dependent, and could be more reliable than the semantic parts of [speech] analysis," he explained.

The analysis of temporal speech parameters is also not language-dependent. Although the S-GAP Test was developed using audio samples from native Hungarian speakers, Kálmán and his collaborators have shown that it works just as well with samples from native English and German speakers. They now plan to validate the test further using samples from native Spanish speakers. 

For Screening, Not Diagnosis

Currently, "the only purpose of this tool would be initial screening," Kálmán said at the congress. It is not for diagnosis, and there is no intention to get it registered as a medical device. 

A national survey of primary care physicians conducted by Kálmán and collaborators showed that there was little time for performing standard cognitive tests during the average consultation. Thus, the original idea was that the S-GAP Test would be an aid to help primary care physicians quickly flag whether a patient might have cognitive problems that needed further assessment at a memory clinic or by more specialist neurology services. 

The goalposts have since been moved, from developing a pure telemedicine solution to a more widespread application that perhaps anyone could buy and download from the internet or using a smartphone. 

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Lack of Retroactive Coverage for HCBS Pushes Seniors into Institutional Care: MACPAC

McKnight’s Home Care / By Adam Healy
 
Determining a beneficiary’s eligibility for Medicaid home- and community-based services can be a lengthy ordeal. And while states have options to streamline the process, most lack options for retroactive coverage, which can allow for the quickest access to HCBS, experts at the Medicaid and CHIP Payment and Access Commission discussed during a meeting Thursday.
 
“Timely access to HCBS is essential to ensure individuals receive care in the setting of their choice,” Asmaa Albaroudi, a senior analyst at MACPAC, said during the meeting. “States have several options to streamline Medicaid enrollment for people who need HCBS.”
 
Eligibility offerings
 
The most common way states streamline Medicaid eligibility processes is through presumptive eligibility. This system allows beneficiaries to begin receiving HCBS immediately as their eligibility is determined over a two-month period. Nine states use presumptive eligibility. 
 
Four states use expedited eligibility when making Medicaid HCBS determinations. While there is no uniform definition for expedited eligibility, it typically involves fast-tracking beneficiaries’ applications for HCBS so that they may begin receiving services sooner.
Only one state, Connecticut, offers retroactive coverage for Medicaid HCBS. This method allows people who are eligible for services, but not yet enrolled, to get coverage for care received up to three months prior to the start of their enrollment. This type of coverage is commonplace for nursing home care, but not for Medicaid HCBS, in other states, according to Patti Killingsworth, senior vice president of long term services and supports strategy at CareBridge and MACPAC commissioner.
 
Institutional bias 
 
As a result, nursing home care is often more financially viable for older adults as they can be reimbursed for care received before they enrolled in Medicaid. On the other hand, if one chose to receive Medicaid home care, they are fully responsible for the bill until they become enrolled.
 
“That is the reason why so many people end up in nursing homes that don’t need to,” Killingsworth said. “And I think it is a fundamental institutional bias — one of many in the federal regulations — that results in people being institutionalized when they don’t want to be and need to be.”
 
And while other tools including presumptive eligibility can still help beneficiaries receive HCBS, without retroactive coverage, many are still forced to rely on institutional care.
“I appreciate the fact that presumptive eligibility is available to states,” Killingsworth said. “I do not appreciate the fact that retroactive coverage of nursing facility benefits is available to people, while home- and community-based services are not.”