After three calls yesterday from folks who are planning on starting a home care company, I am feeling really scared about the level of care that our nation’s older folks are going to get when they need it. In each case, the person had no health care or aging care experience, no business experience, and no idea of what a caring for the elderly business actually means. This inquiry from start-ups is not new, but it seems that lately the quality of those callers has degenerated. And, it certainly seems that they are coming with more frequency.
I know there have previously been concerns voiced over the franchising of elder care, but, the established franchises have checks and balances in place, and train and educate so the new owners have some guidelines to follow, and help on issues when they arise. However, there are now almost 90 franchises that serve the home care industry, and some of them new to the game are as bad as these independents of which I am now writing. No experience, no standards, no quality measures….only $$ is their eyes.
The independent individual who is just starting out and only reads that elder care is a good business for the future, really has no idea how hard it is to care for people. Plus, the caregiver shortage is everywhere. And, if you look at the demographics, that should be no surprise. We do sell a manual, a start-up manual, about how to start a good elder care business, and the items that are necessary to know prior to start-up, but these folks are not interested in spending any money to know what to do, they are only interested in making money without knowing what it is they are doing.
I like to cite my entering 1st grade as a great example of a nation unprepared for the boomers. It should have been no surprise that the children entering the first grade were going to overwhelm the system in 1953. After all, we were born in 1947 and, 6 years later we would be entering first grade. You cannot tell me that the hospital maternity wards were not bursting at the seams in 1946 and 1947. Logically, without a plague, we would all grow, age and be ready to start school.
The same is now happening with caring for our aging society. Back in the 90’s Ron Crouch (noted demographer) and I used to do workshops on envisioning the future out to 2020. We presented at the American Society on Aging, and around the Kentucky regions where we were both active. The information on the numbers who are aging has been no surprise, as well as the information on the decreasing numbers of those younger who could provide care.
And, what if we had chosen home schooling for our boomers? Instead of double shifts for 1st grade, we would have been in a no school zone. There simply would not have been enough teachers to go one on one. What makes us think that caring for people at home (one on one) as the population is bursting at the seams is going to be any different? In private duty, there are oftentimes more than one on one care needed. When I had my ElderCare Solutions business, we even had clients who needed two caregivers at once, 24/7/365. So, it took at least 5 caregivers to maintain that one person at home. Unusual, but not unheard of. More likely today it is one or two caregivers for each elderly person needing care.
So, home centered care is the model for the future, and, I think it is a good model, but it has to be done with some sense of reality and thought. The Future of Home Care Project that the AHHQI is undertaking is a great first step. Also, technology will have to play a great part in this care. We are just at the beginning if looking at ways to meet the care needs that are impending.
What scares me today is the people who are now starting these in-home care businesses and buying untested franchises, and running those businesses, with no idea of what they are doing, the nuances of care needs, and what is in the best interest of the client. Join Sam Smith from AXXESS and me at the American Society on Aging conference in March as we explore some of these issues in depth and look at the future of home care in America and what we (as a nation) are doing about it.
In the words of Bob Dylan, “the times they are a changin’.” By 2030, there will be about 72.1 million older adults, more than twice their number in 2000, according to the Administration on Aging. It’s time for aging industry leadership to shift thinking from the status quo to thinking about how we’re going to solve the influx of aging issues before us.
Thankfully, the 2015 Aging in America Conference is about a month away, and it’s the only summit that is totally focused on issues that an aging population will face, and what’s being done to create fail-safe systems to handle the extraordinary numbers that will cause unprecedented usage of our care systems. This year, I’m proud to be among the presenters—co-presenting with Sam Smith, Chief Culture Officer and Vice President of AXXESS—at the annual conference of the American Society on Aging.
When it comes to the industry, we need to be prepared, we need to become future thinkers and planners to be equipped to meet the demands of the what’s to come. Our workshop entitled Home Centered Care is the Model for the Future of Home Health: Chronic and Value Added will cover what home health agencies need to know and do today to prepare them to survive and thrive in the future. Sam and I have been attending the Alliance for Home Health Quality and Innovation workshop and symposium held recently in Washington, DC. The AHHQI workshop was held at the Institute of Medicine with the National Research Council, and the topic was The Future of Home Health. A follow up symposium covered the salient topics in more depth. Sam and I are continuing that dialog as to what the future of home health will look like, and how the industry needs to change to meet the demands of the future.
So for decades, I have worked in the aging care business, but there is nothing like growing older to really shed light on the aging process. There are things that sneak up on you. There are things that no one tells you about aging. There are things that we should know about, and combat if possible. Today, I’ll cover one scourge of getting older, shingles.
As it turns out, anyone can who has had chicken pox can get shingles—that means 95 percent of adults are at risk, according to the Centers for Disease Control and Prevention (CDC). Unfortunately, as we age, the risk of getting shingles rises. In fact, half of people living to age 85 have had or will get shingles. And among those who get it, more than one-third will develop serious complications, such as severe nerve pain, blindness or pneumonia.
Research puts shingles on a par with congestive heart failure, diabetes and depression for disrupting a person’s quality of life. It can have a major impact on morbidity, lost work productivity and quality of life in older adults—and most people don’t even realize it’s a cause for concern. Shingles affects about 1 million Americans each year — almost half of those cases are among people age 60 or older.
So what is shingles? It occurs when the varicella-zoster virus (VZV) — the same virus that causes chickenpox — is reactivated in the body. For many years, chickenpox remains dormant in the nerve roots, and then as you get older and your immunity declines, they reemerge.
It starts as a painful rash that typically blisters in a band on one side of the body, often on the face or torso. Be on the look out for early warning signs, such as pain, itching or tingling before a blistering rash appears several days later. It can also appear above an eye or on the side of the face or neck. In addition to the rash, more than one-third who get shingles go on to develop severe nerve pain that can last for months or even years. Mine appeared IN my eye, about 15 years ago and it still gives me fits.
What you can do? The CDC recommends that everyone age 60 and older should get a one-time shingles vaccination called Zostavax. Even if you’ve already had shingles, you still need the vaccination because reoccurring cases are possible. Check out zostavax.com for more information or to locate a vaccine provider in your area.
No matter the condition, whether you’re an older adult who is frail, or on multiple medications, you should still talk to your doctor about getting the vaccination. The main concern is if you’re on immunosuppressant agents, like high-dose prednisone or cancer chemotherapy—then you should not be getting the shingles vaccine.
More insider-aging scoop soon. For now, be sure you treat shingles seriously, and look into getting the vaccine. You’ll never know what hit you, if you wait until the shingles appear.
Payment, Reimbursement and Quality Lead the Home Care Trends Illuminated at the Northeast Home Health Leadership Summit
Each year, for the past 13 years, home health agency leaders gather in Boston for three days at the Northeast Home Health Leadership Summit. Aren’t we glad this summit was last week and not this week as Boston braces for the blizzard of 2015?
Traditionally at this leadership conference, speakers share their insight on the industry and home care executives, administrators, and nurses fill the seats seeking understanding of the latest trends—all with the same goal of gaining some insight into how to allocate time and resources for best practices. This year more than ever, there is a need for increased creativity and adaptability in the agency, the workplace and the industry.
The changes that are pending in providing Medicare in-home care as a post-acute service have just been escalated with the latest announcement on January 26th by the Obama administration. By the end of 2016 they want 30% of payments for traditional Medicare benefits to be tied to alternative payment models such as accountable care organizations, bundling, value based reporting, the Independence at Home model or medical homes, with a goal of hitting 50% by the end of 2018.
This is not a surprise, but, it is happening quicker than most predictions.
Sparking the leadership light was the focus of this conference, and after a few days of taking it all in, here are a few standout speakers who helped to spark my leadership light.
Dana Sheer, ACNP and director of clinical programs for Partners HealthCare at Home, in eastern Massachusetts, spoke about the importance of homecare pre- and post-hospital discharge.
She offered some interesting solutions on how to capitalize on post-acute opportunities through technologies, chronic care management, development of a mobile observation unit and integration with medical homes. She had a great report and case study on the Emergency Room diversion program that they have implemented that is sort of an urgent care clinic that goes to the patient’s home. This is a service that works for those with a mix of clinical complexity, who are frail with possibly some home safety concerns. Her enthusiasm and the ideas that are coming out of a need to change how home health works in tandem with the hospital show that we can solve some of our problems, and are creating ways to do just that.
Dr. Steven Landers, MD, and president of Visiting Nurse Association Health Group, Inc. stressed that home health agencies should promote value instead of volume in achieving person?centered care. He has coined the moniker “home centered care” to describe how he foresees the future of care for our aging population, and, he is always full of insights and ideas. Listen to him if you really want to see what the vision for care in America should be. He brings a physician’s perspective but also a home centered care perspective to the discussion.
Mark Graban, author and healthcare consultant, opened up those linear management minds with thoughts on organizational improvements (meaning happier employees and better patient care) through Kaizen, a Japanese concept that means “change for the better.” Although this management concept has been around a long time, starting in manufacturing, it was artfully applied to the home care setting, and it bears repeating.
In terms of change, he said, start small. “Moving from the mindset of a judge to a coach is critical,” Graban says. “You have to be careful how you react to a bad idea and treat each idea as a gift.” In light of the recent announcement moving the dates for payment change closer to the present, it is only through thoughtful processes focused on change that agencies will make the deadline and change how they operate.
Kaizen requires a baseline of trust, he notes that if there is fear and lack of trust people will not participate. It also requires that leaders want to improve and that they believe that the team is capable of doing more. Leaders also should remember that it’s ok if they don’t have all of the answers. An open line of communication is the better approach, and reminding oneself that there’s no need to cover up any problems.
Robert E. Mechanic, M.B.A, Brandeis University and Executive Director of the Health Industry Forum addressed the important data surrounding expenses for Medicare and examined new approaches to manage, coordinate and utilize post-acute services, including home care and implications for patients, providers and policy.
The numbers are staggering: Medicare spending on post?acute care now exceeds $62 billion annually. We are incurring a $500 billion annual deficit and that is on top of the $13 trillion overall deficit. His pronouncement? “Payment models are going to change!” )And boy was HRE right on the money!)
Since we have already been seeing and participating in some changes, it is worthy to note that 15% of Fee For Service Medicare beneficiaries (5.7 mil) are already participating in ACOs. Currently there are 17.7 million participating in Medicare Advantage, but their reimbursement has to decrease 15% in the near future, so that program will change as well. Bundled payments are happening throughout the healthcare settings. Value based payments are a hot topic of discussion, and the industry is struggling to find common grounds to measure quality.
We now have some data from the effects of the ACA: 8 million people signed up for health exchange, and guess what? They picked lower cost plans! This is forcing insurance companies to lower prices and find ways to keep costs down.
With the establishment of new payment models, strong incentives have been created for coordination of post?acute care. Health systems, ACOs and Medicare Advantage plans are beginning to establish preferred networks of providers to deliver care more effectively and reduce hospital re?admissions. Again, this movement will only escalate as home care agencies become more of a provider of choice for those who are leaving hospitals and want to recuperate faster, have a better quality to their life, and feel safer at home.
After a few days with some of the leaders in home health, that spark has been lit inside of many. There’s a need to think of the person behind the care, the person who is part of the care team, and the influx of people to come. There’s a flame calling to burst with creativity and a readiness for change. And that flame will only grow. Together we can make a difference, and we can provide better care to our citizens.
Thanks again to AXXESS for sponsoring my travels and industry involvement. Their software provides efficiencies at an affordable price, and they are on target with measuring quality that makes reporting easier, and revenue cycle management that will assist agencies in figuring out how to price services so they are participating in the changes in reimbursement as they are implemented.