Literature Review

Staffing issues continue to drive reduced admissions in SNFsMcKnight’s Senior LivingDecember 18, 2023Nursing home providers continue to struggle with staffing challenges as they aim to reboot admissions in the post-pandemic era, according to the newly released results of a recent Ziegler CFO Hotline survey. “The demand for our SNF services is rising at a rate significantly higher than our labor force allows,” said one respondent. ... Forty-six percent of the respondents to the November survey indicated that staffing issues have forced a reduction in SNF admissions. 

‘It’s Water Grinding Away The Stone’—Senior Care Providers Face Common Challenges In Continuum ExpansionsHome Health Care NewsDecember 15, 2023Home-based care providers are no longer content delivering a standard set of care services. Instead, leaders at in-home care organizations are working strategically to enhance services, creating a more integrated care delivery model—a continuum of care. At Intrepid USA, this means pairing the company’s home health and hospice services more closely together. ... Strategically, creating a continuum of services allows providers to maintain relationships with clients and patients longer—before their needs become acute, all the way through to end of life.Notable Mentions: Susan Ponder-Stansel, CEO of Alivia Care.

NAHC President Bill Dombi—History Repeating Itself on Hospice Program IntegrityHospice NewsDecember 14, 2023Issues of fraud in the hospice industry echo events that previously affected the home health space, and providers can learn from that prior experience. This is according to Bill Dombi, president of the National Association for Home Care and Hospice, who spoke Thursday in a Relias webinar. ... “What I’m seeing is history repeating itself. Back in the 1990s, the microscope ended up focusing on the Medicare Home Health Program. 

Boston VNA Nurses and Healthcare Professionals Cast a Unanimous Vote Authorizing a 14-day StrikePRNewswireDecember 13, 2023Boston, MA—In response to an increase in the complexity of care required for patients admitted for care at home, in conjunction with a lack of staff and resources to provide that level of care, the 60 registered nurses and healthcare professionals who work for the Visiting Nurses Association of Boston/VNA Care, cast a unanimous vote to authorize a 14-day strike in an effort to move their administration to provide the staffing and wage enhancements they need to provide the care their patients deserve. 

Plains hospital ends home health servicesClark Fork Valley Press (Plains, MT)December 13, 2023Plains, MT—Clark Fork Valley Hospital will close its Medicare certified home health agency at the end of the year. According to a press release from the hospital, hospice services will not be affected and will continue unchanged. Hospital officials cited ongoing labor shortages, financial losses and regulatory burdens of operating Home Health organizations as reasons for the closure. 

Memory Care Gap—GAO Report Shows Less than 2.5% of Medicare Beneficiaries with Alzheimer’s Receive Cognitive AssessmentSenior Housing NewsDecember 13, 2023Between 2018 and last year, use of cognitive assessment and care plan services tripled, but few Medicare beneficiaries who qualify received the service, according to a recent study by the Government Accountability Office. The GAO study found that, at most, 2.4% of Medicare beneficiaries with a diagnosis of Alzheimer’s disease or a related disorder received this service. 

Home Health Industry Leaders Scoff At ‘Distorted Picture of Reality’ Painted By MedPACHome Health Care NewsDecember 12, 2023The Medicare Payment Advisory Commission recommended that the Medicare base payment rate for home health care be reduced by 7% for CY 2025. The recommendation is another chapter in the contentious relationship between the commission and the home health industry. It also recommended that Congress eliminate any payment updates for hospice providers in 2025. 

Kroger Health boosts investment in senior primary careModern HealthcareDecember 11, 2023Kroger is testing a strategic shift for its in-store clinics and moving into primary care for seniors. This month, its Kroger Health unit transitioned eight of The Little Clinic sites in Atlanta to focus on seniors, in addition to their regular services. If the change proves successful, Kroger wants to expand it to other existing locations and potentially new markets, said Jim Kirby, Kroger Health’s chief commercial officer. “We want to make sure that we’ve got the model right, and that we’re seeing the outcomes from the patients that we expect,” he said. “We want them to have that relationship with us, [so] that we can go deep with them, and we can do the best job we can to quarterback their care.”

Fix needed now—America’s long-term care financing system is brokenBy Katie Smith SloanThe HillDecember 11, 2023Nonprofit providers of aging services have been warning for decades that America’s system for financing long-term care is dangerously broken. The dedicated professionals serving older adults in nursing homes, home health agencies, hospice programs, and senior living communities have toiled side-by-side with families across the country to cobble together care and services for parents, friends, and neighbors—connecting the tattered pieces of our patchwork long-term care system in an effort to ensure dignity, comfort and independence as the needs of our loved ones change. The New York Times KFF Health News’ series “Dying Broke” aptly illustrates the impact of the United States’ insufficient approach to financing of long-term services and supports. It’s an important and unflinching look at how our country is failing us. ... We can do better. A comprehensive and equitable long-term care financing system would make all the difference. The longer lives that many Americans will enjoy offers enormous potential for our nation. We must seize this opportunity and ensure that potential isn’t squelched by an oppressive and unfair long-term care financing system. The solutions are complicated—but smart approaches abound. The variable is political will. ... I urge our leaders to listen to the voices of their constituents, and join us in creating solutions. All of our futures depend on it.

MedPAC draws fire with draft recommendations for massive home health cut, hospice rate freezeMcKnight’s Home Care DailyDecember 12, 2023The Medicare Payment Advisory Commission offered initial recommendations for Congress to cut home health reimbursement by 7% and pause hospice payment updates in 2025. “The 2022 [home health] margins remain above 20%, higher than the long-run average of 16.8% since 2001,” Evan Christman, senior analyst at MedPAC, said during last Friday’s public meeting, according to a transcript. “Overall, these margins indicate that Medicare fee-for-service continues to pay well in excess of cost.” Part of the reason home health agencies reportedly saw margins of 22.2%, on average, according to Christman, is a decline in the number of visits per 30-day period. Since the implementation of the Patient-Driven Groupings Model in 2020, these visits have declined more than 15%; between 2021 and 2022, visits per 30 days declined 3.5%. Home health advocates were quick to dispute MedPAC’s claims. “There are many shortfalls in MedPAC’s home health margins report—starting with the fact that MedPAC’s analysis only captures a declining fraction of the Medicare home health population, ignoring that overall margins are low,” Joanne Cunningham, chief executive officer of the Partnership for Quality Home Healthcare, said in a statement. ... The Partnership and National Association for Home Care & Hospice cited poor methodology and data in the recent home health final rule, which contained a Medicare cut related to PDGM. MedPAC also recommended that Congress eliminate any payment updates for hospice providers in 2025. 

Study—Black Patients Less Likely Receive A Home Health Referral Following A Hospital StintHome Health Care NewsDecember 8, 2023Home health services are a vital component of care continuity. But nurses are less likely to give Black patients, compared to white patients, home health referrals when being discharged from a hospital stay, a new University of Michigan study found. Specifically, researchers found that roughly 22% of Black patients were receiving home health referrals by discharge nurses, compared to 27% of white patients.

New Mexico’s Medicaid Rate Hike Bodes Well For Addus, Other Home-Based Care ProvidersHome Health Care NewsDecember 7, 2023New Mexico is increasing its reimbursement rates for providers that bill Medicaid in the state. Overall, providers are set to get an additional $409 million in reimbursement. The increases will start taking shape on claims made on or after July 1, 2023. Another rate hike is expected in the future for CY 2025. “Thanks to this substantial funding boost, Medicaid providers across New Mexico will now receive reimbursements at rates as high as 120% of Medicare,” Lorelei Kellogg, the acting director for the New Mexico Medicaid program, said in a press release. “By elevating rates, New Mexico Medicaid continues to work toward the goal of ensuring that all New Mexicans enrolled in the program have access to vital health care services.”

Nursing home palliative, hospice care provide CNAs new opportunitiesMcKnight’s Long Term Care NewsDecember 7, 2023A lack of end-of-life training may leave certified nurse assistants unprepared to work with patients receiving palliative or hospice care, but nursing homes must do more to cross-train and build their confidence. That was the message this week from Karl Steinberg, MD, CEO of Stone Mountain Medical Associates, and certified nurse aide Telisa Green, who addressed barriers to quality, end-of-life care during a webinar hosted by the National Association of Health Care Assistants. The speakers recognized that education in this care area can be hard to come by for CNAs, who are broadly trained in vitals and other care-taking tasks. “Almost all of the palliative care skills that CNAs learn are on-the-job training,” Steinberg acknowledged. “I absolutely will advocate for increasing the availability of palliative care training for nursing assistants.” ... Both presenters emphasized the importance of prioritizing a patient and their family’s comfort over too much devotion to a formalized care plan, as well as being an advocate for the patient’s well-being—especially in end-of-life and hospice settings.