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The inclusion of Home Care services in Medicare Advantage plans has doubled from ’21 to ’22. This means that more seniors are receiving care at home, which is a positive trend for senior living communities and In-Home Care providers.
Join me in a LIVE conversation with Doug Robertson, Kerin Zuger, Right at Home.
A decentralized care model provides patients with the right care, at the right time, and in the right place. It’s a patient-centered approach to health and wellness that gives people access to high-quality services from trusted providers.
It also helps providers better coordinate care across settings, making it more efficient, effective, and affordable while improving patient outcomes. This is the future of healthcare – decentralized, integrated, and patient-centered.
Medicare Advantage Partnerships are a great way to diversify your revenue stream and increase profitability.
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Bio:
Doug Robertson, Government affairs professional providing regulatory compliance, licensing, and government reimbursement guidance in the senior care market. Learn more about Doug: https://www.linkedin.com/in/robertsondoug/
Kerin Zuger, Experienced and passionate Healthcare Executive with a demonstrated history of developing scalable business models, innovative solutions, and strategic partnerships across multiple industries; with the goal of finding synergistic ways to expand value proposition and diversify revenue streams. Learn more about Kerin:Â https://www.linkedin.com/in/kerin-zuger-51963517/
Transcript:
Hanh:
Hi. I’m Hanh Brown, the host of the Boomer Living Broadcast. On the show, industry leaders share information, inspiration and senior. Our experts discuss topics like senior health care, dementia, care giving in-home care technology for seniors and affordable senior living options. So thank you so much for participating in asking questions throughout the event. So today’s topic is hospital at home for seniors. Hospital at Home is an innovative care model for adoption by healthcare organizations that provides hospital level care in the patient’s home as a full substitute for acute hospital care. The inclusion of home care services in Medicare Advantage plans has doubled from 2021 to 2022. So this means that more seniors are receiving care at home, which is a positive trend for senior living communities in in-home care providers. With Medicare Advantage, you can integrate rehab, pharmacy and care management into the residents clinical care. So managing the beneficiary population and providing the right services at the right time is critical to controlling costs and maximizing outcomes in. Medicare Advantage in-home care providers should also benefit from this growth as they will have an opportunity to partner with senior living community. And offer their clients new options when it comes to receiving care. So today my guests are Doug Robertson and Kerin Zucker. They are from right at home, senior care, right at home. Senior care is a growing international network with over 650 offices servicing tens of thousands of clients needing in-home care. So there are located across the United States, Canada, United. Kingdom, Australia, China, Ireland, Japan, and the Netherlands. So right at home, senior care provides in-home assistance for seniors who want to live independently or need some help with their daily living activities. And they believe that everyone is entitled to the best possible quality of life we guard plus of their location or circumstances. So Doug and Kerin, welcome to the show.
Kerin:
Good morning. Thank you for having us. Great to be here.
Hanh:
Good morning. How are you?
Kerin:
Doing well we’re, we’re in Omaha, Nebraska, so it’s a little bit frigid over here, but other than that, we are doing very well.
Hanh:
Right. Well, Hey, welcome. Welcome. Thanks for your time to be here. So could you introduce yourself and your role in your company?
Kerin:
Absolutely. I’ll kick things off here. So Karen Zucker and I am chief of strategic girls for right at home. Um, and I’ve been with the organization now going on five years prior to that worked in a acute, the acute world of medical helicopters. Um, but similar, um, issues and problems across the industry. So really shifted into this role to help write. Really figure out where they fit within that post acute continuum and to help to build the health care partnerships and relationships necessary to do exactly what you stated very eloquently earlier, um, improve the quality of life for those that we serve and make sure that they’ve got the resources, tools, and services to stay home and independent and safe as long as possible.
Doug:
Doug Robertson. I have over 20 years of government relations experience the last six with right at home, helping our franchise locations across the country, understand government regulations, including how to get their licenses to open and provide the care. In those states that require that license, as well as getting contracts with the us department of veteran affairs, Medicare Advantage plans, through insurance carriers and understanding all of the different mandates and regulations that they’re experiencing at this very busy time in home care. It’s great to be on the show and to help folks understand the different opportunities in government contract.
Hanh:
Welcome. Well, first to bring everybody in the same page, give us the definition, distinction, home care model hospital at home model in the ed at home models. Can you bring this up to same page on that?
Kerin:
Sure. Gosh, there’s so much, so the big war that’s up there, right? De-centralization of care. Right. And ultimately, what de-centralization of care means is we’re taking the care out of these brick and mortar institutions, hospitals, and delivering it at home when appropriate. So from this concept of decentralization of care, there’s been lots of different models that have popped up. So let’s start with home care a little bit, cause this is the one that’s sort of been in place for a really long time. And you’ve got home care and home health care and they’re two different services servicing. The same population within the home environment right at home is a in-home care provider. And so we provide all levels of care from companionship care, personal care and skilled care. But the majority of what we do is private pay. So the consumer really is our, um, payer of of choice and it’s up to them. What type of service they want, how long we’re there, or normally there before other providers get there while other providers are in place within the home and after other providers have left. So that’s home care, home health care. It’s a CMS organization, right? So they’re reimbursed by Medicare, Medicaid. They’re skilled care typically. And they’re there a lot of times for transactional care and they’ll come in after a hospitalization or if there’s a fall risk or some sort of medical need in place. So we work collectively in the home to provide care. From there we’ve built on from the decentralization, the hospital at home model, not to be confused with the hospital to home model, but hospital at home is exactly what you talked about earlier Hanh. So how did they, w they’re literally replicating. The one environment within the home, the reason that this happened, or one of the reasons that I would say expedited it’s been in place for a while, but the reason that this really grew within the home is because of COVID. Right? So we had a lot of sick people, really acute in the hospitals and they needed beds. So what were the, what were the opportunities? How could they free up some of the beds within the hospital? They’re in lie and born the true hospital at home model that is now reimbursed at the same level as a brick and mortar institution. However, to be reimbursed at the same levels, you have to mirror the level of care that’s happening within these brick and mortars. And in order to do that, you have to have a true interdisciplinary team to provide those services within the home. So just so that everybody’s super clear, because I know it gets a little bit confusing and muddy. Th a scenario would be something like this, a senior shows up or by the way, those living with a disability. So it’s not just seniors, um, that we would support, but a senior fellow shows up to the ER and they really are at a point where they should be admitted to the hospital for those hospitals participating in the program, they’ll say to the scene, Would you be prefer, be admitted to our medical unit or would you prefer be admitted home if the senior chooses to be admitted home, which nine times out of 10 they do right then the command center, the dispatch center is notified and that’s where everybody is sort of dispatched and notified that we’ve got a patient that’s going to be dispatched to the home environment. Everybody knows their role. There’s a lot of behind the scenes coordination that occurs to ensure that when that senior desert right home. Their home is literally set up like a hospital with the bed, the resources, the tools, and the machinery and the support that they’ll need as if they were inpatient. That also requires 247 oversight just as you would receive into a hospital. So that’s the hospital at home model. The other model that we’ll discuss today is the ed at home model. And this one works a little bit different. Um, but similar concept relative to delivering acute services within the home environment. This is a little bit what I would consider proactive in nature, as opposed to a hospital at home, which can be reactive in nature. Right. So if you’ve got a senior at home that, you know, maybe they’re having breathing issues or something’s going on, um, they may call one of the, the, the companies that are out there and say, Hey, I think I’m going to go to the ER, I need to go to the ER. A company, like the one that we partner with dispatch health we’ll S we’ll take them through a process and assessment to determine if it’s appropriate to deliver care in the home, or if they need to go directly to the ed, but they’ll live. They’re literally a mobile unit that provides the majority of ed or ER services. In out of their unit and they can be brought into the home. So the whole concept here is can we avoid unnecessary ed visits? Does it work for everybody? Absolutely not. Which is why that assessment, not escalation process is really, really critical on the front end to determine if a company like dispatch health makes sense for that client or that patient.
Hanh:
Great explanation. Okay. What are some common misconceptions about home care providers who focus on short-term respite, personal assistance or companionships services?
Kerin:
That’s a great question. So, you know, I’m going to call out the elephant in the room here and because we are 85% private pay and Doug will talk about some of the other options for reimbursement and pay. But because of that, a lot of people will assume that they just can’t. It just can’t afford it. And the reality is most of the time it’s not the client pain it’s family. Right. Um, or loved one saying my, my mom or dad really needs the service that I’m going to make sure that it’s taken care of. In addition to that, the phrase that we’ll use all the time is when somebody says, I’m not sure that I can afford it. The reality is, is sometimes you can’t afford not to. Right. So the cost of an ed or an unnecessary, um, hospitalization or being readmitted to the hospitals.. The role is much more costly than it would to use home care services in a more preventative manner, which is really sort of misconception. Number two in my mind is home care. Is there for people who, you know, have had a fall or were recently discharged from the hospital? You need a re a lot of help, you know, and, and reactive in nature. And of course, we’re there for those individuals. That’s a huge population of, of the individuals that we serve, but we’re also very preventative in nature. Right? So engaging with your right and home owner at the right time, as you mentioned earlier at the right time, really allows us to put the right plan of care in place that may or may not include home care, right. At that very that moment. Right at home, across the board. Our goal, our obligation is to ensure that our clients and their family members and caregivers have the resources. They need to keep that senior and individual home as long as possible, the longer you wait to reach out to a home care organization to figure out what your options are, the fewer options you have. Right? So early planning is really, really key to living that long quality of life in your home environment.
Hanh:
Very true. Very true. So now do you find that home care and hospital models work together or compete with each other?
Kerin:
Oh, my gosh, definitely no competition. There should never be any competition, frankly, as far as I’m concerned, there shouldn’t be any competition between any post-acute providers, even home care and home care companies, because there’s plenty of people that need support. Right. So that’s what I’ll say first and foremost. Second, regard to the hospitals, you know, we are more and more becoming ingrained in the hospital processes, particularly as clients get ready to be, or patients get ready to be discharged. Right. We even have some locations across the country. We’ll, we’ll go to the hospital and be bed side. With the client or the patient and talk to them about their options, work with the discharge nurses, help them with logistics and coordination and transportation and making sure everybody gets home safely. And they’ve got safe environments and access to fresh food and water. So there’s lots of ways that we can collaborate together. Um, but there still is frankly, and transparently a lot of education that, that needs to occur, you know, across all of the different providers. But collaboration through that full post-acute continuum is, is critical. And I would never use the word competition in any area.
Hanh:
Great. Great. So what do you think, which should patients opt for when it comes to care?
Kerin:
I would love to answer that question, but I can’t. And the reason that I can’t is because every situation is very, very, very different. Um, and it, a lot to what I have been talking about, you know, throughout here is as we age and we go through that journey, I mean, and listen, we’ve tried, we at one point we were like, okay, we’re going to create this profiles, right. These personas have from 40 to 50, this is what you need. These are the services. These are the technologies, 50 to 60, 60 to 70, and tried to build out this whole sort of map of what the aging process and the journey looks like so that we can plug in and support products and services. No, it failed. It doesn’t work. And the reason being is I can be 65 alongside somebody else at 65 and have very different circumstances and not just clinical, right? This is not just about comorbidities or other things going on. It’s about how close are my loved ones to me. You know, what type of living environment do I have? How comfortable am I with technology? How comfortable am I with people coming into my home? How engaged are my family members and friends. There are so many different elements that we have to really look at and assess to make sure that we put a very unique and customized care plan in place. And again, I’m just going to continue to plug the sooner that you can do that. The better off you are because your options, there’s a ton of options out there from where you live to the resources and products that you need to the types of services and providers that you want to bring into your home. Or if you’re not comfortable with that, I mean, let’s be honest. Some people would prefer not have people come into their home provider.
Doug:
I’m going to jump in there too. And I think it’s important for a senior and their family to have that conversation with the agency managers. Who has had that conversation many times, if not hundreds of times before with other families and seniors, you know, seniors, when, when they approach that age or that edge of their capabilities in the home. They’re approaching that for the first time, they don’t really know what to ask. What products are out there, how to handle that situation. Our agency managers and our owners out in the field they’ve had the experience may, may times, and they can have that conversation and bring to bear a lot of experience, years of experience and understanding not just from themselves, but also from our entire nationwide network to help that family and help that senior, navigate that situation and understand. What it is that they should expect what it is they should ask for and what might be advantageous for them. So I think it’s really important to lean on that home care agency, its management and its supervisory staff that know the caregivers as well as the client and can bring the two together and provide that supervisory over sight.
Hanh:
Great. Great information. Yeah. So, it sounds like there are many, many moving components, to come up with a standardized care plan, but although that’s what we all aim for, but it’s very specific. It’s very person-centered care.
Kerin:
Absolutely.
Hanh:
And then the other thing is, well, as we are all aging, everything that folks are navigating myself included, for my parents. It’s the first time. And typically people don’t want to learn because it’s always, well, you know, aging that comes later. My parents are aging, but you know, that’s not going to happen to them, right. So, I think the sooner that we get informed, surround ourselves with the care team, the more options we have, right. And when we don’t, the fewer options and they’re not the best options at the tail end.
Kerin:
You got it.
Hanh:
Yeah. So now, how do family members fit into this picture while trying to figure out what they want? I mean, I know you described that, but what are, what are the, the care team and where does a family member fit in? Where is the patient fit in? Can you do a deep dive on that?
Kerin:
Yeah. You know, I think, um, we actually are in the middle of a research project right now. So this is a great question. And we have done several focus groups with family members, you know, um, just to talk through what are their needs, right. Because it’s challenging for the senior. Also very challenging for the family members that are trying to navigate this with their loved one. Right? So the reality is the family member. We encourage them to be involved and engaged, but again, it depends, family dynamics are different across it’s like snowflakes, right? That’s what a gal that I work with mentioned yesterday. She’s like, I’m a snowflake. I’m like, that’s right. It’s so unique to every single scenario. You have to determine what the comfort level is of that family. We’ve got scenarios and we serve as seniors, thousands and thousands of them across the country. And to Doug’s point, we’ve been there, done that, and we recognize that you’ve got to go in with a completely open mind and recognize that sometimes the family is real. They’ve got busy lives. There’s stuff going on, whatever those dynamics are. They don’t want to be engaged in the process as much as maybe we would encourage. And that’s okay. There’s no judgment here. And then you’ve got families that want to know everything along the way and make sure that they’re heavily involved within the care team approach. And there’s a variety of different ways that you can make that happen. Right? Sometimes family lives close, but most of the time they lived, you know, many miles away from the client. So engaging virtually through platforms and technology and phone calls is a great way to keep them involved. But again, at the very beginning, when you’re setting the stage for what are the needs that the senior, the client, their family, their environment, is when we all get on the same page together and work together to collaborate on what is the plan. And it’s not just about the care plan. What’s the communication plan, you know, where are we going to communicate and continue to stay on the same page as we do that, it becomes more and more important to also ensure that we’re staying on the same page with the other providers that may be engaged in that care plan. And then that process. And again, there’s varying levels of how integrated and how, um, how much you collaborate on that. But we encourage as much collaboration as people are comfortable with. And sometimes. The client doesn’t want their family involved. You know, they are the client, they’re the receiver. So it is their decision on how much they want a son and daughter involved in the decisions and the discussions of their care through the raging process.
Hanh:
Very true. And you mentioned communication plan. That’s huge. Right. And thank goodness. There’s a lot of innovation technology to support that because like you say, the the senior may or may, may or may not choose their love ones. Protect, you know, you just don’t know what that dynamic is. So, by having that communication plan and the technology to support that, you can really put some boundaries.
Kerin:
Yeah, it was interesting. Even in, in some of the focus groups, it was, you know, we, we sorta, as we debriefed after there were there, there’s a lot of challenges sometimes on the front end, too, just around. Who’s responsible for what? So it’s not just communication. It’s, what’s my role and purpose throughout this process. And those can be difficult conversations or just conversations that you don’t really think about, but they’re really important conversations again, as you move through the process to go. Yep. That’s my responsibility. That’s sort of the area that I’m focused on, whether. Taken mom to medical appointments or making sure that we’re engaged with the pharmacy and medication reconciliation, or just stopping by for socialization, because let’s not forget the mental component of growing old and the importance of a healthy mental state and socialization and engagement from that perspective. So I think, again, everybody plays a role. Communication is key, but also defining roles and responsibilities and expectations. So that there’s no secrets and, and there’s no, um, miscommunication that can very easily occur as you go through this.
Hanh:
Very true. So living at home can help patients feel more safe and secure during their recovery. So give me your thoughts on what are the advantages of living at home for hospitalized patients over staying in a hospital bed?
Kerin:
Right. Well, I mean, I think there’s a lot. So first of all, I’m just going to talk about the mental component, because this has been highlighted so much during, during COVID and it’s very sad, you know, we’ve got outside of just a huge population of folks that, you know, have some cognitive decline issues and Alzheimers or dementia, those sorts of things. We’ll sort of bucket over here. Just general depression, loneliness. These are things that can quickly deteriorate your physical health. So making sure that you’re able to engage with your family and stay close to your loved ones when you’re in a hospital environment, particularly during this crazy feeling like never ending pandemic. You’re elated. You’re way more isolated from the areas that your comforter comfortable with and the people that you’re comfortable with. So that would be number one. Second is hospitals are for sick people, right? So trying to stay out of the environments where that may, um, um, cause some issues, um, relative to picking up different diseases and that sort of thing, just for me, From a, um, exposure standpoint, staying at home can be a safer environment for those that are more prone to those types of things. Right? So that would be number two and number three, it’s the comfort level, right? It’s the pure comfort of being in my own home, receive receiving the own services. Being able to know my surroundings, have that continuity of surroundings, which can be really, really important again. To the physical health and the healing and the impact of those individuals. And we’re seeing more and more studies showing that outcomes are so much better in some cases where appropriate to deliver hospital services within the home environment.
Hanh:
Very true. So how do you think we can shift the world to be more health focused? I mean, I think that’s more of a proactive approach. What’s your thought?
Kerin:
Absolutely. I mean, I think, and this is another great discussion that we’ve had even just over the last couple of weeks, particularly around these focus groups is how do we get in front of the audience, right? How do we get in the home a little bit sooner so that we can help support a healthy aging safe aging process? And I think you’ve got to use a lot of different avenues. One of the things that I think people are very dependent on is their clinical advisors. And most of the time that’s going to be your primary care physician. So engaging with physicians from a home care perspective, making sure that they understand the services that we can offer, how we can collaborate, make sure the patient has the resources they need. Help to ensure that they’re taking medications, being reminded of medications, again, all different levels of things that we can do to help from a healthy and wellness standpoint, working through those physicians and educating those physicians. Another great avenue, frankly, is through employers, making sure that employers are aware. We had this discussion last week where I said, shoot, you know, the only time I really think about my benefits. You know, when it’s time to enroll for insurance, how can we better engage with employers to help employers educate their people that are taking care of mom and dad? Right? Things have switched. It’s, you know, you’re having less babies. And the idea of saying, well, my employer pay for daycare has sort of moved away and now it’s just my employer pay for home care, right. Um, and there’s a lot of big organizations, Amazon, Nike Starbucks that are, are making that move towards saying, we recognize that your loved ones, your parents are going to need some help. And that, that really helps too. So working through employers, working through physicians and any other medical providers that would be trusted advisors for the sons and the daughters and the loved ones, looking for answers, I think is going to be really, really critical. And also understanding that when we think about. Sort of a holistic approach. There’s just many different legs to that from mental, spiritual, emotional, physical, all of these things have to, it’s not, and I know we say this and we talk about it a lot. It’s a matter of just making it happen and recognizing that all of these cylinders really have to be hit on for us to achieve this level of wellness and help people living that we’re talking about today.
Hanh:
Very true. Very true. You know, um, the proactive approach. To get people in the mindset and the attitude and the commitment to healthy living starts much, much, much sooner than 65 or when they approach senior living and so forth, right. It’s it’s now it’s you and I, and it’s not, it’s not a diet. It’s, it’s not, it’s none of that. It’s a lifestyle that you take on. So I encourage that.
Kerin:
Yeah.
Hanh:
The earlier the better. You know, because we all want to live longer, right. Increase longevity, but we want to also increase quality. So net quality takes place in the proactive mode. So I echo what you’re saying. Thank you now. Coming questions will pertain a Medicare Advantage. So maybe Doug, you can chime in. All right. So Medicare Advantage Partnership for home care and also possible partnership home care with senior living. Now, what are the, I guess, advantages of Medicare advantage partnership for home care? Can you elaborate on that?
Doug:
Sure. Well, I think one Of the advantages is that a home care agency. By and large don’t participate in Medicare fee for service because Medicare fee for services not have a in-home care benefit available to it in a lot of seniors think, they’re going to be able to age in home and have some come into their home and provide a lot of services like assistance with ambulation or cleaning or meal prep assistance with dressing reminders of medication. Regimens, they think they’re going to get that with Medicare and Medicare does not pay for that. Medicare has a very limited home health, a benefit that only comes into play when there’s been another acute event that requires some skilled care or therapy to come into the home. And then that home health aid benefit provides a very limited amount of services that surround that acute event. For example, What I like to say for an example is, you know, if there’s linens that need bed linens, that need to be changed and laundered as a result of wound care, you know, the home health benefit will cover that type of service, but Medicare is not going to pay for ongoing laundry assistance. You know, if there’s stairs going down to the basement, to the laundry machine in the scene, could possibly fall down those stairs and then end up past wise because of broken hip which we know can be lethal. They’re not going to get assistance from Medicare to pay for that. Medicare advantage offers the part a, the part B benefit, and often times some supplemental benefits as of 2019, in some carriers are choosing to include an in-home care benefits, called in-home support and it provides a few hours a week of in-home care and a home care agency does not need to participate in Medicare in order to provide those services. And so there are some plans across the US. That would allow a senior to have in-home care paid for by their Medicare Advantage plan. So there, the advantage for the agency is that they’re able to participate in some Medicare plans. Now, the advantage for the seniors, That they Can get some of these services paid for by their Medicare Advantage plan. But the, the number of hours, the amount of the benefit is still limited. The centers for Medicare and Medicaid services have rules that prohibit carriers from having a large amount of funds available to have a large amount of supplemental benefits. And in the supplemental benefit bucket you include not just home care, but also dental. Vision hearing which are significant benefits that seniors depend upon. And so carriers are not certain. They want to divert a lot of dollars away from those three key benefits for in home support at this time. But I think over time, we’re going to see the interest by the carriers grow because seniors are going to become more aware that they can get some in-home care through their Medicare band. Advantage plan.
Hanh:
For folks that are watching or listening. If you have any questions. Message in the comment and we’ll be happy to answer it, or perhaps we’ll bring you on stage as well. So, Doug, what do you anticipate changes in the Medicare. Advantage Coverage in 2022?
Doug:
Well, we are seeing a lot more plans include the in-home support benefit. Again, it is in a smaller, a small amount of hours to think greatest amount of hours that I’ve seen as 120 hours in a year. And when you think about, you know, there being 24 hours in a day and someone that needs in-home care quite often needs care throughout the day. So maybe eight hours in a day, 120 hours gets used up pretty quickly. So I think we need to see an expansion of the number of hours of care in these plans. That’s going to require CMS makes some rule changes that allow the carriers to be more generous with that benefit. But we do see in 2022, there are more plans getting into the in-home support space. And I think carriers again, more familiar with ancillary providers like home care providers that they haven’t normally partnered with. And they’re expanding their experience in that, in that universe.
Hanh:
I know you mentioned the benefits that’s included in the home care plans, but I guess give us like the top three top four benefits included in the home care plan that come with a Medicare Advantage program. You want to deep dive on that a little bit more?
Doug:
Sure. Yeah. The in-home support benefit is all inclusive of personal care services. A home care aid would come into the home. They would assess with dressing with bathing, with ambulation or moving around the home assistance in and out of the vehicle, with meal prep reminding to take medications assisting with any kind of post discharge hospital plan given to them by their PCP. So it’s, it’s a very helpful benefit. If there is a meaningful number of hours that’s provided so that the caregiver can be in the home long enough to really make an impact on the health of the, of the client, of the beneficiary.
Hanh:
So what role do you think home care plays in aging?
Doug:
Well? Well, I think home care is vital to assist seniors to stay at home around their familiar environments, around the familiar relationships with family, with friends that they’re used to, you know, they think of their home as the place to live. There may be other places that they would go to in an advanced age where they’re not thinking about living for that much longer, but they are interested in living when they’re at home. And so, I think home care enables a lot of the existing relationships, experiences, and perceptions to continue. And I think there’s enough changes going on in the life of a senior without introducing more changes in terms of the facility that they live in. And so that. Probably one of the big advantages of home care to help with that senior living experience.
Hanh:
Absolutely. So what kind of partnerships can we create to make sure that our resources are put to good news?
Doug:
Well, I think that there’s a lot of folks looking at that question right now right at home participates in the moving health home coalition, which is a group of influencers in Washington, DC. that includes home health. That includes home care and other provider groups that they’re seeking changes to the Medicare benefit package to allow for more hospital at home care to allow for more care in the home. Hospitals, as we know, as we’re seeing right now, even today are burdened with staffing shortages with a great deal of complexities and regulations. And if we can provide more care to people at home who qualify for care at home safely, I think that’s a tremendous opportunity. There are other groups as well, the Washington they’re looking to try to make some changes, to provide more care at home. We’re seeing states also participate in that discussion. For example, Washington state has reasonably passed the bill that created a law. Provides an employee and employer payroll tax to provide care in the home. And that currently is being implemented. There are some court decisions that are still coming down on around that law by things. States are also thinking of what can we do to provide a funding stream, to allow more care in the home that doesn’t depend on Medicaid and also fills that gap between those that are on Medicaid and those that don’t qualify. Cause there’s a lot of folks that don’t qualify for Medicaid, but they really need some help to provide resources through the aging process and stay at home.
Hanh:
Absolutely more so than we know, or even acknowledged. Right. And we don’t talk about them enough. So I’m going to ask you advantages and disadvantages, and I kind of know where we’re heading, but I’m still going to ask you. So what do you think Medicare advantage partners for home care? The positive would be a positive integration or a negative pressure on our resources and why?
Doug:
Well, I think the positive innovation is that it allows another source of care that folks currently don’t have through their Medicare fee for service plan. As the Medicare Advantage plan gets them an additional resource. I think that’s good for home care agencies that are looking to expand their relationships with insurance carriers who maybe they haven’t worked with that much in the past. As far as negative pressures often times the Medicare. Advantage in home support benefits are a small number of hours. As I said, which also means that the shifts are shorter and caregivers are usually interested in having a longer amount of time in the home to develop a relationship with their client, who they care about. They’re also looking to have more hours in a home so that they don’t have a lot of transportation throughout the day between different sites of care. So we would like to see some larger chunks of hours for that in-home support benefit, because it is a negative pressure. If a agency or a caregiver has to have multiple site visits during the day to provide care.
Hanh:
Very true. So now how can we help an individual or care provider was questions about. Medicare Advantage partnerships when it comes to home care? What’s your thoughts?
Doug:
Well, I think calling right at home, for example, you know, our Network has a lot of experience and understanding and the new answers between the home health, a benefit and the in-home support benefit in Medicare Advantage plans would be a good place to start. The Medicare advocacies, the Center for Medicare Advocacy recently conducted a poll of a, or a survey of home health agencies, as well as CMS staff and and found that there was really very little understanding of the home health, a benefit and the in-home support benefit amongst CMS staff members. And they also found that home health agencies. Really we’re unable to provide the full home health, a benefit because of the rules around that benefit the CMS has in place. And so I think if they would call a provider like a ride at home, they could get an understanding of the difference between the home health benefit, the in-home support benefit and whether or not their plan actually includes the benefit that they can use.
Hanh:
Medicare Advantage home health care. So who are the best partners for home care?
Doug:
Well, I think in, and we would certainly consider ourselves a leading provider with expertise in the home care space and with over 350 locations across the country right on can certainly provide some care to a lot of folks with a great deal of quality and compassion. I think there are also some coalitions and some associations like the home care association of America that has a great deal of expertise and understanding. And, HCOA members provide great care throughout this country, there are over 3000 providers that belong to the association and it can help a lot of seniors across the nation.
Hanh:
All right. So pros and cons to home health care services.
Doug:
Y think some pros are that folks can say in their home, if they have, some in-home support and and they can enjoy the quality of life that they’ve become accustomed to their family knows that someone’s there to remind them to take medication. To help them in and out of bed to help them with bathing and with dressing and continue the relationships with getting to the places that they’re used to getting to. And I think that improves their quality of life. Some cons, I think, you know, over the course of time, it may be a conversation BI with the, with the client. If they, if they need some kind of higher acuity of care they may need to start thinking about a skill facility or perhaps even some hospitalization. Kerin might have some thoughts on that as well.
Kerin:
I was wondering how you’re going to answer that question. Cause I don’t think there are any cons. But I am, maybe I’m biased. But I, you know, I, I think it’s, I think you’re right, Doug. I think it’s just challenging in general. It depends on the dynamics, but staying in communication, um, you know, when you’re in facilities, there’s more clinical staff, right. As opposed to when you’re in the home. So once your, your, your level. Reach higher acuity where they can’t be monitored on a 24, 7 basis is where home care you’re going to probably need a little bit more than home care. Right. And I think we’re, we, we know that it takes a village. We know where we’re good and what our swim lane is, if you will, and, and where we strive with clients and their family and the engagement components. We also know when it’s necessary to take the next level of steps, um, and reach out to others that have services beyond our capability or capacity. So again, it’s all about planning and being ready for those steps and knowing when to jump in and when to make tough decisions along that journey.
Hanh:
So, what do you think will happen to your company, as we continue to depend on virtual healthcare services?
Kerin:
Yeah, I’ll jump in. I, you know, The human element of home care is never going to go away. Right? Obviously the thing that we haven’t talked about today, which is a huge hurdle relative to anybody providing care within the home, or frankly, lots of other industries outside of healthcare is labor, right? The labor shortage issue is a problem. So when you think about the labor shortage issue and how it’s going to affect our organization, many others, you do have to get a little bit more innovative in the way that you’re approaching things. We continue to figure out ways to professionalize the caregiver role, create flexibility, put resources in place, where they feel that they have, um, a more agile schedule. And they, they, you know, again, the whole flexibility component, higher wages, you know, these are all really important things. Um, relative to supporting the population of caregivers going beyond your typical demographic of caregiver, who else can support seniors within the home. So that’s one sort of bubble that will effect, you know, where we go as an institution, as we look at the caregiver shortage or the labor shortage in general, you don’t have a lot of options, right? It’s it’s you recruit more, you retain more. You got to figure out different ways to support the client when the caregiver can not be there. And that is when technology comes into play. We, excuse me, we are not a tech shop. We will never be a tech shop. Um, however, and you know, going back to, from a technology standpoint, there is a massive amount of technology out there from, you know, wearables and purrs units to sensors and monitors. Screen, you know tablets and iPhones and you know, everything else in between medication dispense. I mean, there’s just a gazillion different types and approaches with technology. Our goal is to really be as neutral as possible. And that’s because all the things that we’ve talked about today, everybody has different needs and comfort levels. Certainly COVID swung the door open to people being more comfortable with technology because they had to, they were isolated. They had to figure out Face Time or zoom, you know, it’s like weird. You don’t even get on a phone call anymore without zoom. So I, you know, those types of things have become the new normal. And I think those will be integrated into our care models as we move forward. Um, but I think the human element of what we do and what we provide will always be there. It will always be calm, strong. We will always. Be focused on the client and the resources that they need and their family and their family struggles and their family needs. We’re never going to let go of that because that’s who we are as an organization.
Hanh:
Very true. Very true. So what are some ways to make sure that seniors know they have options for staying at home after their major illness or surgery and not returning to the hospital to soon?
Kerin:
Yeah. Well, I think you, again, have to leverage your trusted advisors and a lot of times that just is environmentally driven, right? So discharge nurses a lot when you’re in a hospital and you’re getting ready to be discharged are gonna look at your care plan and ask questions. You know, I think that that’s really, really important. Don’t assume anything. Um, don’t feel stupid for not asking questions, ask the questions. And one of those questions just might be after I get home, who should I call if I do have questions, right? What is the best resource to reach out to? Is that a right at home at area agency on aging? Is it AARP? Is it my doc? Is it, you know, what is it? You know, and I think again, um, people are seeking answers all over the place. Um, but you got to find somebody that you trust and that you can depend on and rely on to help you sort of navigate that process and that journey. So specifically from a hospital, I would say your discharge planner, your nurse is going to be really critical to that social worker, ask them questions, know what your options are. So when they say, we think you might need help, well, what does that mean? Who are my options? Who are, you know, what should I do? How many hours, what does that include? Um, to Doug’s point, people get very, very confused with benefits and what it includes and what it doesn’t include. So educating yourself, I think sometimes you do have to take responsibility for educating yourself, um, and bringing in family members, bringing in loved ones. Cause if you’re not comfortable asking those questions, that’s where roles and responsibilities come into place. And you can say. Can you, can you work with the doctor and make sure we have all the answers to these questions that I’ve written down? You know, that I, that I’m wondering about as we continue down this care road,
Doug:
I’ll add two other resources to call your insurance carrier. They often times have a nurse that’s a care manager or a case manager that understands the specific insurance plan that that senior has and the benefits that in it. And the providers that can be accessed through those benefits, you know, frankly, let’s be honest, you know, while those decisions are cost driven and, and the carrier is providing that plan to pay for a number of benefits. And by and large a lot of beneficiaries are unfamiliar with the package of benefits that they have particularly at discharge. The post acute benefits are a little bit muddy sometimes. And so talk to that case manager and also call right at home. You know, even if there isn’t an in-home support benefit in that, in that plan. The right at home agency owner in that area has a lot of experience with community providers and can give some advisement and direction to the senior as to what providers might be suitable for them at that time.
Hanh:
Great. Great. Well, thank you so much. Shed some light and wisdom in carrying the most important generation, our seniors. So I thank you so much for your time. Are there any other takeaways, any more points that you would like to share?
Kerin:
You know, again, I’m just going to echo some of the sentiments that we talked about, which is early planning, prevention, proactive, get, you know, we all are going to get old. We’re all going to face this one day, as much as we maybe you don’t want to believe it. It’s going to happen to all of us. So, you know, grab the bull by the horns and, and, and. Early planning, um, is so much better. And as we’ve echoed a, you know, a thousand times gives you so many different options to consider. So think about things early in the process, even if you don’t think you or a loved one needs home care, I’m going to echo Doug’s point as well. Reach out to right at home. They do have the resources we’ve been in business for over 25 years, 600 locations across the globe. We, we do, we have experience and we’ve been there, done that. Right? So leverage those with the experience. This is a first for you. It’s not a first for us. So reach out to your trusted advisors and resources.
Doug:
Yeah, absolutely. You know, use the resources that you have available to you and talk to your carrier, talk to right at home. And that will help the senior tremendously. There’s a lot of information out there on aging, and an insurance plans. I would not trust a whole lot of some of the advertising that you see on TV and what comes up in a social media thread. Talk to somebody that actually has experience in that field.
Hanh:
Very good. Well, as you can see, there’s been a significant increase in the number of seniors who are able to receive care at home. Thanks. So Medicare Advantage plans, and this is good news again for senior living communities and in-home care provider. It’s more people will be working with them rather than entering nursing homes or assisted living facilities. So it’s good news for beneficiaries themselves because it allows them to access rehab services alongside their other clinical needs. So this is good for senior living communities and in-home care providers who want the residents to be as independent as possible. And also managing the beneficiary population and providing the right services at the right time is critical to controlling costs and maximizing outcomes in Medicare Advantage. And if you want to learn more about these changes, what that means to you and how they might affect your business, reach out. We love to hear from you and explore ways that we can work together. And thank you so much and have a great day.
Kerin:
Thanks, Hanh. Appreciate it.
