Grabbing Our Advantage

In April the Centers for Medicare & Medicaid Services (CMS) announced it would allow non-skilled in-home supports to be added as a supplemental benefit for Medicare Advantage (MA) plans in 2019. As might be expected, corporations, such as major insurance carriers (Humana) and Home Health Care Agencies immediately began plans to capitalize on this new funding stream. One such player is Honor, a California-based home care company. They describe themselves this way: “Honor is the founder of the Honor Care Network, a pioneering national network of home care providers. Honor is the first company ever to bring scalable workforce management and technology expertise together with the high-touch, personalized care of local homegrown care agencies. Founded in 2015, Honor is now one of the fastest-growing, non-medical home care companies in the U.S., currently providing care to families in California, Texas, and New Mexico.

Sounds promising, and Honor’s CEO, Nita Sommers, sounds sincere in interviews where I’ve heard her say she’s thinking about her parents and her own future as she positions the company to “provide personalized home care for people who want to continue to live in the homes they love—safely and happily—as they age.” However, I believe we, who will ultimately be the care-recipients, need to keep our eyes & ears open, our analytical skills working and make sure our voices are heard as these trends evolve.

Technology, Personal Care Assistance and Managed Medical Practices is a complex combination with many loose ends and competing goals. It’s great to see CMS allowing Medicare Advantage plans to add tailored, flexible benefits to address the social determinants of health, such as food insecurity, home adaptation and avoiding isolation. However, I’m not so overjoyed if the idea is to limit these services to MA plans thus incentivizing people to move away from original Medicare.

Medicare Advantage plans have a very different payment system traditional Medicare with Supplemental Insurance. They don’t have a homebound requirement in many cases. (That means you don’t have to be homebound to receive PT for example. A good thing.) Insurers will pay for home support services if that means avoiding expensive future or repeated hospitalizations because they have an amount they are provided with to care for a patient. They will do whatever they need to make sure that patient doesn’t cost them more money than necessary. Again, it sounds good, but the devil is in the details. If the ultimate goal is to keep costs down by pushing more and more of us into the Health Management Organization/Medicare Advantage model that limits our right to choose providers, we need to be prepared to raise our objections.

In terms of who will be providing home health and personal care assistance, the Bureau of Labor Statistics forecasts more than half of new jobs in the health care industry, or 1.6 million, will come from personal care aides, home health aides and some types of nurses. The number of people requiring these services is expected to increase with more vigor than the workforce can handle. This gap will likely be compounded by the typically low pay for workers in those positions.

Again, according to the Bureau of Labor Statistics, “The national average hourly rate for nursing assistants, home health aides and personal aides has stagnated at $10.11, a few cents lower than a decade ago, making recruitment more difficult,” And low pay increases turnover. Competition for these workers? Consider the average wage of a fast food worker can be $7.26 – $10.09, with no certificate training, and fewer on the job physical and reporting demands.

Will technology fill the gap? Not really – there are many tools already available to help with safety, communication, prescription management, etc. But robots won’t replace someone rolling you over in bed to avoid bedsores or help you get in and out of the shower safely. I’d say that the lack of pay, respect, and training that is contributing to this looming gap in the continuum of post acute health care is a major concern.

Lions and tigers and bears, oh my! Managing costs, assuring access to quality non-medical support services and retaining our right to direct our personal situations as long as possible – It is to our advantage to accept that (sometimes sudden) change is a part of aging. Providing care is a business driven by profit-seeking individuals, government programs are too big, too slow and too focused on those “dual-eligible” (poor as well as disabled) to be of much use to us in the middle class. We changed the meaning of youth, invented the teen age phase, introduced new ways of parenting, reduced gender bias in many aspects of our culture. Now it’s time to collectively forge a new old age. We can make a difference for ourselves and all who follow us if we speak up and sing in one voice!

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