When hospitals select preferred providers, they often rely on skilled nursing facilities or home health agencies that they’ve built relationships with and trust. Providers may be friends or long-time partners. Or, they might bring in lunch or treats for hospital staff. All too often the referral flow is based on doughnuts and not data. But in a value-based care environment, data matters.
It isn’t a secret that the post-acute care industry is changing. Over the last decade, there have been two significant structural changes in the market: Medicare’s movement away from a fee-for-service pricing model to a value-based care model, and the growth of Medicare Advantage. These shifts present multiple challenges for skilled nursing facilities (SNFs).
Private-duty home care providers across the country are celebrating the recent announcement that Medicare Advantage plans will cover non-skilled home care services starting next year. The change will be available to the 21 million seniors who have opted in to the Medicare Advantage plans and is an important step in helping the rapidly growing senior population age safely in their own homes.
Home care - unskilled personal care or private duty - is fast becoming one of the most needed long-term healthcare services in the US. Our elderly population is growing quickly and will likely double by 2060, putting seniors at close to a quarter of the population. While not a surprise, there will also likely be a reduced availability of family caregivers to help manage and provide care for their aging loved ones. More people are now dependent on professional caregiving to maintain a normal and healthy standard of living. To understand just how important this is, it’s necessary to know what home care entails and how it’s beneficial to the wellbeing of seniors.
A growing number of erroneous discharges of patients from skilled nursing facilities (SNFs) around the country is concerning. SNFs maintain that these usually arise as a result of mental or behavioral problems, patient distress, or payment issues. But regulators have taken notice of this worrying trend of improper, and even sometimes illegal, discharges and are concerned about the possible negative effects it could have on the safety and well-being of the affected patients/residents and their families. In a bid to combat it, the Centers for Medicare and Medicaid Services (CMS) announced that it was considering rolling out a new initiative.
The use of skilled nursing facilities as short and long term post-acute care settings has become very prevalent. At the moment, there are nearly 16,000 certified skilled nursing facilities in the U.S and the number keeps rising.
Over 5 million patients transition from hospitals to skilled nursing facilities each year. Millions of others transition from hospitals to their homes, rehabilitation centers and other care settings. Social workers are central to these transitions. They are tasked with discharge planning and coordinating post-acute care from the early stages of a patient’s hospitalization. Their responsibility often follows patients as they move among different caregiver settings.
It’s not news that an increasing portion of Americans are seniors, but to provide some perspective, since 2012, nearly 10,000 Americans turn 65 daily and by 2030, 20% of the population will be over 65 years old. In response to this trend, the healthcare industry continues to rely more and more heavily on two increasingly important avenues of post-acute care: home care and home health. Considering the complexity of the in-home care delivery ecosystem, it is vital that patients, caregivers, and providers understand the differences between each aspect of care to ensure all involved approach each conversation and decision from an informed standpoint. To help drive some clarity, here is a brief overview of home care (non-medical) and home health care (medical) and the advantages of both in meeting the needs of an aging population.