Literature Review

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.

Here’s why you can’t die peacefully in Oklahoma.By Abby RemmingThe OklahomanDecember 6, 2023... Having Medicare or a Medicare Advantage plan would cover hospice, but many people have private insurance from work or state Medicaid plans. Private insurance and Medicaid Advantage plans at times can have a hospice benefit but limit which companies can be used. Applying for Medicare will ensure you are covered for hospice. ... I currently work as a hospital social worker and assist many people who need hospice. Many times, I have had to share with patients and their families that, while they may be ready to peacefully pass away, hospice coverage is not included in the patient’s current insurance plan. Providing end-of-life care is extremely difficult without the added burden of worrying whether insurance will cover the benefit. Those without the benefit and who need the service are then reliant upon the generosity of the companies to absorb the cost. If the Medicaid Advantage plan is picked, a person would need to decide if they wanted the benefit to either cover nursing home care or in-home hospice care. A Medicaid Advantage plan might not cover hospice even when the policyholder believes they have the benefit. 

South Hill hospital to cease in-home hospice, home health services Dec. 31News & Record (South Boston, VA)December 6, 2023South Hill, VA—VCU Health Community Memorial Hospital in South Hill will no longer provide in-home community health and hospice services starting Dec. 31, hospital officials announced Monday. ... Kristy Fowler, marketing and communications specialist for VCU Health CMH, said the hospital will continue to provide these services on “an inpatient and outpatient basis, [but] they will no longer be available in the home.” ...  Fowler explained that home health and hospice services declined throughout the pandemic and are no longer part of VCU Health CMH’s core business. 

CVS to start rebranding its healthcare services segment this yearMcKnight’s Home Care DailyDecember 6, 2023CVS disclosed Tuesday that it will begin to roll out its newly rebranded healthcare services segment this month. The new brand, called CVS Healthspire, includes CVS’ suite of care delivery businesses: Caremark, Cordavis, Oak Street Health, MinuteClinic and the company’s home care entity Signify Health.  ... Evidence of the rebrand will soon be visible, according to the company; the five businesses within Healthspire will soon incorporate “Part of CVS Healthspire” to their assets.

Care Advantage Acquires Nova Home Health Care, Delivers On 18th Acquisition Since 2018Home Health Care NewsDecember 6, 2023Care Advantage announced Tuesday that it has acquired Nova Home Health Care. The acquisition expands Care Advantage’s Northern Virginia footprint—a market that CEO Tim Hanold believes is an important one for current and future growth. ... Hanold told Home Health Care News, “... Northern Virginia is part of the Metropolitan D.C. area, and is a very diverse market. We want to make sure that we’re approaching that in a smart and culturally sensitive way.” Richmond, Virginia-based Care Advantage is a home-based care company that has more than 45 locations throughout Virginia, Maryland, Delaware, Washington, D.C., and North Carolina. The company offers both personal care and home health care services. On its end, Nova Home Health Care is a personal care company that serves the Medicaid population. The company has ties to a number of different communities that make up the diverse population in the area. “They have real deep market penetration with the Vietnamese community, as well as the Hispanic and African American communities,” Hanold said.

New Analysis Shows How Unaffordable Home Care Is Becoming For American SeniorsHome Health Care NewsDecember 4, 2023Most Americans will need some sort of in-home care support as they age. The issue is that many of them cannot afford it. ... Only 14% of American seniors can afford to do so [pay for personal care services], however, according to a new analysis conducted by the Joint Center for Housing Studies of Harvard University.

Dying Broke: The High Cost Of Help Desperate Families Search for Affordable Home CareNew York TimesDecember 2, 2023... Frank Lee’s search for trustworthy home health aides—an experience that millions of American families face—has often been exhausting and infuriating, but he has persisted. ... There is precious little assistance from the government for families who need a home health aide unless they are poor. The people working in these jobs are often woefully underpaid and unprepared to help a frail, elderly person with dementia to bathe and use the bathroom, or to defuse an angry outburst.[Editor’s Note: This article is part of The New York Times’ “Dying Broke” series examining how the immense financial costs of long-term care drain older Americans and their families. For additional coverage, see the accompanying article in this package, “What to Know About Home Care Services: Finding an aide to help an older person stay at home safely takes work. Here’s a guide.“]