In the News

Census Bureau: ‘Aging-Ready Homes’ May be in Short Supply 

McKnight’s Home Care / By Adam Healy
As the older population of the United States continues to grow, the Census Bureau fears that the stock of what it calls “aging-ready homes” may be inadequate to keep up with demand.
Aging-ready homes are defined by three features: A step-free entryway, and a bedroom and bathroom on the entry level, according to the bureau in its new report. Informed by the 2019 American Housing Survey, estimates place the number of aging-ready homes in the U.S. at about 50 million households, or only 40% of all homes in the country.
Many older households — where at least one resident is 65 years or older — do not have the accessibility features to support aging in place. Around 4 million of these older households, or 11% of older households in the U.S., reported challenges related to living in their home. For households where a resident is 85 years or older, about 25% reported home-related living challenges.
The most frequently reported difficulty among older households was trouble entering the home. Though step-free entryways can help, this feature may not be available for many. Of the 124 million housing units included in the report, nearly half had steps leading to the entryway. This challenge can be more pronounced for residents of certain geographic areas. For example, only 1 in 5 houses in New England have step-free entryways, and many of these homes are multistory. Multistory homes are less likely to have both a bathroom and a bedroom on the entry level, according to the report.
Home accessibility challenges also disproportionately affect people of lower income levels. These individuals generally experienced more accessibility issues within their homes compared to those earning greater incomes.
Despite the importance of home accessibility features for aging in place, very few people reported plans to make modifications to support aging. Only about 6% of older households reported plans to make accessibility improvements to their homes. The Census Bureau report noted two possible reasons for this: First, home improvements are costly and may be unaffordable for low-income households; building an entry floor bathroom can cost anywhere between $6,000 and $90,000, according to the report. Second, people who rent rather than own their homes may have a lack of control over home modifications for accessibility.
Harvard study released in March found that older homeowners spent more than $84 billion in projects to facilitate aging in place. Some organizations, such as the U.S. Department of Housing and Urban Development or Habitat for Humanity, provide financial aid for older adults looking to make such accessibility modifications to their homes.


Celebrate National Physical Therapy Month

It's National Physical Therapy Month and I am pleased to share with you that APTA has worked with producers of the Viewpoint public television series to create a documentary-style feature and advertisement on the profession, organization, and ways physical therapy helps people stay healthy, active, and mobile.

The 60-second advertisement will air nationally tonight on Fox Business during primetime at 10:55pm ET (note that the airing could occur anytime within an hour of the scheduled time, depending on the news schedule). We encourage you to join us in watching for it tonight! The ad will air again on Oct. 8 on Fox Business, and then four times in each of the top 100 U.S markets, such as Boston, Houston, Chicago, Denver, and Phoenix for 400 airings throughout the month of October.

The documentary feature will air on public television as a part of the Viewpoint series throughout the month. You also can view APTA's full Viewpoint documentary anytime.

Lastly, we are running a ChoosePT consumer ad on a billboard in Times Square focusing on "The Economic Value of Physical Therapy in the United States" report throughout the month. View web cam footage of APTA's ad appearing in Times Square.

Thank you for your membership. We hope you have a wonderful National Physical Therapy Month, and we encourage you to share your celebrations with us! Use #PTmonth and #ChoosePT in your social media posts throughout October.


Aaron Bishop

APTA Vice President Public Affairs


'Boarding' Patients for Days, Weeks in Crowded ERs is Common Now

"I arrived at 2 p.m. and finally saw the obstetrics team at midnight," she recalled.

After an exam, doctors scheduled her for a procedure on the following day, but there wasn't a room available. "I ended up spending the night in a makeshift room in the lobby of the emergency room with a plastic sheet separating me from the rest of the people waiting for attention," Hannah said.

Unfortunately, this is not rare in U.S. emergency departments. Millions of people a day go to emergency rooms to seek care, but many, like Hannah, end up in a holding pattern due to overcrowding.

This is known as boarding, and experts say the problem is only getting worse.

"We are facing a national public health crisis," Dr. Aisha Terry, associate professor of emergency medicine at George Washington University School of Medicine and Health Sciences in Washington, D.C., and ACEP's president-elect, said Tuesday.

Speaking at an ACEP press briefing, Terry said that "emergency departments are overflowing, emergency physicians are overwhelmed, and patient care is at risk."

Research consistently shows that boarding leads to worse outcomes, medical errors, privacy issues and in some cases, death, she said.

Some people spend weeks, even months, waiting to get a room in the hospital or be transferred to an outside facility.

"It's jaw-dropping when you think about the length of time that people are waiting in the emergency department since there is no space to care for them," Terry said.

Boarding has been an issue for decades, but stresses owing to the COVID-19 pandemic such as staffing shortages and an uptick in mental health conditions have made it much worse.

In a new ACEP poll of 2,164 U.S. adults, 44% of respondents said they or a loved one experienced long waits in emergency departments, with 16% waiting 13 or more hours before being admitted or transferred. Almost half of adults surveyed said they would delay emergency care if they knew they could face boarding.

In all, 42% said hospitals should be primarily responsible for improving the situation, while 17% said Congress should pass legislation addressing boarding. Sixteen percent said insurers should ease cumbersome prior-authorization policies that can result in days-long waits for transfer to a skilled nursing facility.

Nine in 10 respondents consider emergency medical services (EMS) essential, roughly the same percentage who said additional or supplemental government funding for essential services should be a priority.

The poll has a margin of error of plus or minus two percentage points.

One health care worker quoted in the ACEP's presentation to journalists said, "Last week our 22-bed emergency department had 35 boarders and an additional 20 patients in the waiting room. Longest boarding time this month was over 200 hours with averages around 70 hours per patient. In addition, we have patients who unfortunately have died in our waiting room while awaiting treatment. These deaths were entirely due to boarding."

Terry told reporters that resource and staff shortages can't be accepted as the new normal.

"We need action now to preserve the safety net for the lives we work every day to save," she said.

ACEP has suggested creating a regional dashboard of available beds that emergency departments can use when needing to place someone. In addition, reimbursement incentives for hospitals that transfer people to avoid extreme boarding could also make a difference, the group suggests.

Terry added that tuition reimbursement, stress relief programs and suicide prevention services need to be available for health care workers to help address the staff shortages. Laura Wooster, senior vice president of advocacy and external affairs at ACEP, agreed.

She added that some groups such as kids in mental health crises are disproportionately affected by staffing shortages and emergency room boarding situations.

Addressing the crisis starts with efforts to increase the number of beds available for these kids in the community, Wooster said. Mental health mobile crisis teams can also help reach these kids where they are, she added.


Report: CMMI has Raised Federal Spending, Not Lowered it

Fierce Healthcare / By Noah Tong
The Center for Medicare and Medicaid Innovation (CMMI), once expected to save money and deliver healthcare at a lower cost, is increasing federal spending after all.
report from the Congressional Budget Office (CBO) shows that the office increased direct spending by $5.4 billion between 2011 and 2020. CMMI spent $7.9 billion to operate models, but those models only reduced healthcare benefits spending by $2.6 billion.
The new figures reflect a stark contrast from CBO’s projections when the Affordable Care Act (and CMMI) was first enacted. CBO believed at the time that CMMI would reduce spending by $2.8 billion and lower spending on benefits by $10.3 billion, offsetting the $7.5 billion needed to operate CMMI’s models.
CBO now anticipates spending will increase an additional $1.3 billion from 2021 to 2030, though the office notes that the “budgetary effects of CMMI’s activities over the first decade and its updated projects are subject to considerable uncertainty.” For example, the report did not capture savings that were gained by accountable care organizations (ACOs) through the Medicare Shared Savings Program.
The agency believes that its incorrect projections can be attributed to several factors.
One, CBO thought that CMMI would continue to find models that reduced spending, but after the first two models were certified, the rate of certification declined over time. Second, CMMI models are largely voluntary, meaning providers can choose models that have positive financial outcomes and drop models that have the opposite effect. CMMI has discussed implementing mandatory participation for this reason. Third, CBO said it did not realize CMMI models would contradict within health systems, creating conflicts for providers, as well as payment policy changes.
Several days before the CBO report was released, Senate Budget Committee members briefly praised the CMMI for working to lower spending, prematurely praising CMMI during a hearing on Medicare solvency when it did not actually lower spending.
Blair Childs, president and CEO of healthcare communications company Childs and Associates and a senior executive advisor for Premier Inc., said the CBO report is “missing the forest for the trees.”
“We are undergoing a tectonic shift in the incentives in healthcare payment,” he said in a LinkedIn post. “This is due to a bipartisan movement to shift payment from fee-for-service to accountable, value-based care. CMMI is a key player in making that change a reality under traditional Medicare and Medicaid. While Washington skeptics don’t want to stick their heads out and attribute this spending decline to the movement to value-based care, I submit that, based on strong evidence, it is the dominant cause of this change.”


Diabetes Multiplies Hospital Admission Risk for Home Health Patients, Study Finds

McKnight’s / By Adam Healy
Home health patients with diabetes are three times more likely to be hospitalized than those without, according to a new study published in Nursing Outlook
Almost half of home health patients suffer from diabetes. According to the study, it is one of the most common chronic conditions among people in this population. Among 5,300 community-dwelling home health patients with diabetes, the study recorded a hospital admission rate of 29.5%, affected by risk factors such as past hospitalizations, decreased performance in activities 
of daily living, depression or unhealed acute injuries.
The researchers compared this to people with diabetes in assisted living. These people may struggle more with activities of daily living or have greater cognitive impairments, the study noted, but they had a lower rate of hospital readmission due to access to round-the-clock assistance, meaning they were able to receive more timely preventive care 
For home health patients, one of the best predictors of hospital readmission was whether a person had been hospitalized in the past six months. Home health patients who had been recently hospitalized were more than twice as likely to be readmitted. Another strong predictor was someone’s function completing activities of daily living. The participants who struggled to manage their daily activities were more likely to be hospitalized. 
Conditions such as depression, decreased cognitive function and unhealed acute injuries like ulcers were all found to impact people’s ability to manage activities of daily living. While assisted living patients had greater access to support for these conditions, home health patients who lack access faced a higher risk of hospitalization, according to the study. Therapy services and other health interventions can help manage these conditions and help prevent rehospitalization, the researchers noted. 
Other research has found that staffing problems in the home care industry may lead to discontinuity of care, which can increase a patient’s risk of hospital readmission.

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