In The News

Medicare Home Care Eligibility Standards Unfairly Burden Family Caregivers, Think Tank Argues

McKnight’s Home Care |  By Adam Healy
 
Researchers called on the Centers for Medicare & Medicaid Services to act now to integrate more kinds of home care benefits for Medicare beneficiaries to help patients and their caregivers grappling with strict eligibility criteria and inadequate support systems.
 
“Millions of unpaid family caregivers are providing a broad range of assistance to beneficiaries as they recover from illness, move through rehabilitation or deal with chronic health challenges,” experts from the non-profit research group Aspen Institute wrote in a recent report. “Without more medical and social support from a reconfigured Medicare system, the overwhelming burden on family caregivers will only grow heavier.”
 
Medicare’s criteria for a beneficiary to be eligible for home care is too high, they argued, and unpaid family caregivers bear the greatest responsibilities caring for those that do not make the cut. Oftentimes these caregivers are forced to “spend down” to become eligible for Medicaid, whereby long-term services and supports, including home- and community-based services, are more easily accessible. 
 
By expanding Medicare’s eligibility pool and offering home care services to a greater share of the Medicare population, beneficiaries can enjoy better health outcomes, the researchers said.
“Current criteria for receiving home health Medicare services, especially the requirement that a recipient be homebound, greatly shrinks the eligible population,” they wrote. “A number of alternative eligibility guardrails, such as functional status or level of risk for potentially avoidable nursing home care, could be considered if the homebound requirement were eliminated.”
 
New systems to coordinate care between healthcare and nonmedical personal care providers should be considered by CMS, they added. Things like reimbursement for navigation services, better training opportunities for caregivers, and effective use of new technology are especially important and can make it easier for providers and caregivers to help older adults in need of home care.
 
While a one-size-fits-all solution may not be possible, current support for Medicare-funded home care is simply not enough, Aspen Institute wrote.
 
“Medicare needs to change. An aging population and the opportunities introduced by technology add to the sense of urgency,” they said. “Coupling immediate steps with longer-term strategies to respond to the needs of a changing healthcare environment can strengthen family caregiving and allow Medicare beneficiaries to remain in the safe and familiar environment of home.”
 

Hospice Experts Advocate for Early Admission to Hospice

The Herald-Mail (Story from Hospice of Washington County)

“Former President Jimmy Carter’s months-long time in hospice has helped tens of millions of Americans realize that hospice isn’t a brink-of-death service, that it helps patients and families focus on quality of life and not just length of life,” observed Hospice of Washington County CEO Sara McKay.

With a physician, nurse practitioner, nurse, certified nursing assistant, social worker, chaplain, bereavement specialist and hospice-trained volunteers, “the hospice team is structured to manage the patient’s physical, emotional and spiritual needs and support the patient’s loved ones while helping them care for their loved one,” McKay added.

According to Lee-Anne West, MD, physician executive and chief consultant for Hospice of Washington County, one of the biggest hurdles to overcoming resistance to a timely hospice admission is the misnomer that signing up for hospice means that a patient is giving up and that care stops with a hospice admission. “Nothing could be further from the reality of what hospice care entails,” West explained. A major difference, she noted, “is that before a patient enters hospice, the focus isn’t on the patient but rather is on fighting the disease—even when those treatments aren’t helping. After a patient enters hospice, the focus is solely on the patient’s comfort and dignity, managing pain and other symptoms, thus allowing the patient to enjoy being at home, in a comfortable setting, surrounded by family and friends.”

Instead of endless trips to a hospital emergency room for a patient with a limited time left to live, “the care comes to the patient in hospice,” she explained.

Having worked in hospice and palliative care for more than 18 years, West has seen numerous studies over the years that have demonstrated that patients who enroll in hospice live longer than patients with a similar diagnosis and similar demographics who continue aggressive curative treatments up until they are near death. “For many patients who come on hospice earlier, life expectancy can increase by as much as one to three months,” West stated. “When you step back from doing everything to treat the disease, the patient is allowed to live in the moment. The psychological pressure often melts. Hospice patients tend to live longer when they elect the hospice benefit earlier.”…

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One Year of President Carter Lighting the Way

NHPCO Hospice Action Network

One year ago, former President Jimmy Carter made history by making the courageous choice to share that he was entering hospice care. The Carter family is proving what many of us already know to be true: hospice provides value at any length of stay . By sharing President Carter's end-of-life journey, conversations are being sparked across the nation about palliative and hospice care. To commemorate President Carter's one year in hospice care, we wanted to share the following facts and resources:

President Carter's Hospice Journey Facts:

• President Carter is the first former US president known to utilize hospice care.
• The Carter administration tested hospice care as a model, which led to the Medicare Hospice Benefit we know today.
• The average Length of Stay for Medicare hospice patients in 2021 was 92 days, and the median was 17.
• President Carter is receiving the same hospice care that is available to all Americans under the Medicare Hospice Benefit.

President Carter's Hospice Journey Resources:

• Video commemorating President Carter's courageous choice

• New York Times story on President Carter's one year in hospice. Ben Marcantonio, NHPCO's COO and Interim CEO, quoted.

• Axios article on how President Carter's story is making the public more aware of the truths of hospice care. Logan Hoover, Executive Director of HAN, quoted.

Thank you, President Carter for lighting the way for all of us.
 

Research Overwhelmingly Points to Benefits of Smart Home Health Technology

McKnight’s Home Care | By Adam Healy

A growing body of research has indicated that smart home health technology provides a wealth of benefits for home care patients and older adults aging in place.
 
In a literature review published by BMC Geriatrics, researchers analyzed 163 studies conducted between 2000 and 2021 concerning the use of smart home health technologies. These technologies included tools to monitor patients’ physiological well-being or functional status, safety and security technology; tools that facilitate social interaction; and other instruments like home reminder systems or medication management devices.
 
The most common benefit associated with smart home health technology was that they effectively helped clinicians and caregivers continuously monitor patients, which “makes caregiving simpler, more efficient, holistic or of higher quality,” according to the study published Wednesday. And at the same time, patients using these tools tended to feel greater confidence and peace of mind as a result of being monitored.
 
Smart home health technology was also effective at reducing seniors’ loneliness, which has been shown to lead to worse health outcomes. Such tools, the researchers said, promote self-care and adherence to clinically-prescribed medication, exercise or diets. Furthermore, many studies indicated smart home health technology’s ability to prevent emergencies such as falls, as well as enable earlier responses when emergencies do occur...

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Despite these benefits, barriers limited many older adults from using these technologies most effectively. Of the 163 studies analyzed, 110 found that smart home health technology was not intuitive or hard to use. Some older adults were hesitant to use robotic devices in the home, and technical issues such as battery life, internet connectivity, password systems and incompatibilities with existing home medical devices prevented many from being used successfully.
 

SBA Announces PPP Loan Forgiveness 

NAHC Report

Earlier this month, the Small Business Administration (SBA) announced an important deadline extension for certain Paycheck Protection Program (PPP) borrowers that could impact many entrepreneurs and small business owners.

Specifically, the SBA has set a new March 3, 2024 deadline for defaulted (PPP) borrowers with loans under $100,000 to apply for forgiveness. The new application deadline reflects a 60-day goodwill exception period dating back to January 1 to allow borrowers more time to get in good standing with the SBA. After this period, borrowers may incur non-forgivable fines, fees and be subject to other collection measures. 

NAHC has been contacted by the SBA to communicate the latest developments regarding these COVID relief programs. The SBA urges home health, home care and hospice providers to apply for PPP loan forgiveness or verify that their loans have already been forgiven through SBA before the March 3rd deadline. The SBAhas seen especially high rates of outstanding defaulted loans among home health care and hospice borrowers.   

If you are not sure about the status of your PPP loan, check here. 

The goal for the SBA is to help small businesses restore their good standing, improve credit scores, and remain eligible for future financial assistance.

Borrowers with defaulted PPP loans who have not applied for forgiveness by March 3rd, 2024 may accrue non-forgivable interest and fees or face other collection efforts. 

  • Apply for Forgiveness Today: The SBA urges PPP borrowers to apply for loan forgiveness without delay.  
    • Qualified borrowers with loans $150,000 and below can apply for forgiveness directly with our Direct Forgiveness portal, which takes most borrowers less than 15 minutes. Others should work with their lenders or contact SBA directly. 
    • Borrowers who need additional assistance can contact SBA at our dedicated forgiveness call center: 877-552-2692. The call center is open Monday through Friday from 8:00 a.m. – 8:00 p.m. ET. 
  • Additional costs for delinquent borrowers: Any borrowers who have not applied to have their PPP loan forgiven by March 4th may face additional non-forgivable fines, fees and other collection efforts.  
 
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