Expanded Long-Term Services are a Must, Study Authors Say

McKnight’s Long Term Care / By Kristen Fischer
 
Infrastructure to support long-term care services and aging-in-place for people living at home is sorely needed, according to a recent study. The report identified gaps to meet the needs of aging adults in the United States and help them maintain independence, the authors say.

By 2034, the number of Americans who are aged 65 and up will exceed the number of children under 18 for the first time ever. This will drive up  demand for Medicaid long-term services and supports (LTSS) in home and community settings, the authors wrote. 

Current home- and community-based LTSS offerings are not adequate to meet the needs of aging adults, and there are disparities in who can access the services. Though more people are shifting from nursing home care to home-based care when possible, the infrastructure for aging-in-place is still underfunded and fragmented, the researchers pointed out.

The report identified two main obstacles that will make it hard for many to get the Medicaid services at home: a lack of affordable services and lack of qualified healthcare personnel. 

Recruiting and retaining healthcare workers, especially those in geriatrics, remains a top challenge in terms of long-term care and aging-in-place. In many cases, inadequate pay levels, difficult work environments and a lack of training make it hard to recruit and maintain workers, the investigators wrote.

Technology such as remote monitoring and telehealth can improve long-term care and aging-in-place, but it must be available in all areas, especially in rural regions. Additionally, the tools need to be distributed equally among all. 

Additionally, though most adults over 65 receive Medicare, it doesn’t cover long-term maintenance services. This can force families to pitch in, resulting in more financial strain. 

Although over 40 states have programs such as paid family leave and the Caregiver Advise, Record, Enable (CARE) Act to improve communication between healthcare providers and family caregivers, the policies aren’t used everywhere and don’t have enough funding. Authors of the report called out the need for policies to support caregivers and highlighted the potential benefits of integrating caregivers more fully into care teams.  

The team promoted care models that can be scaled to meet growing demand such as the Program of All-Inclusive Care for the Elderly (PACE) and hospital-at-home initiatives.

“An integrated public health delivery system with full support for aging-in-place, such as increasing opportunities for home-based care, improving access to affordable housing, and providing solutions to satisfy older adults’ transportation and social participation needs will be critical to meet care needs of the aging population,”  Katherine E.M. Miller, PhD, an assistant professor at Johns Hopkins Bloomberg School of Public Health, who led the team, said in a statement.

Student Focus: APTA Home Health

APTA interviews Philip Goldsmith, PT, MSPT, EMT, DScPT, president of APTA Home Health.

'Flexibility With a Sense of Humor'

As a physical therapy student, it can be overwhelming to familiarize yourself with all the specialties and practice settings in the profession. To provide a primer on the various career paths for PT and PTA students, APTA Magazine reached out to those in leadership roles in APTA's different academies and sections. At the APTA Combined Sections Meeting in February 2024, we got a chance to ask questions and get advice from section leaders.

In the coming issues, we will cover each section. In this month's edition, Leah Fogarty, APTA Magazine editor, interviewed Philip Goldsmith, PT, MSPT, EMT, DScPT, president of APTA Home Health and owner and founder of Goldsmith Therapy Solutions in Hanover, Pennsylvania.

APTA: Tell me about the advanced skills or knowledge that specialists in the home health arena have.

Philip: We are nonspecialist specialists. We see the entire gamut of physical therapy and medical diagnosis — musculoskeletal, neurologic, cardiopulmonary, integumentary — we get it all, sometimes all in the same client. I compare it more with acute care in that we are typically now seeing clients who are still acutely ill and have been hospitalized, sometimes for long periods of time. So you need to be very confident with a skill set for managing medically complex clients. The big thing is you need to be confident in your skills because you're it. There's no backup, there's no code team, there's none of that. If something goes sideways, it's you and your telephone to call 911.

APTA: What does a typical day look like?

Philip: You could go into your day with one plan with one set of clients, and by the end of the day you've done something completely different. There is a unique challenge to going into clients' homes; it is their environment. They may tell you they don't feel good, the power is out, or the plumber is coming because the water heater blew up overnight. You've got to roll with it...

Read Full Interview

National Alliance for Care at Home Lays Out 2024, 2025 Priorities

HomeCare

WASHINGTON—As 2024 starts to wind down and a new administration and Congress begins to take over in Washington, home health advocates are focused on two primary priorities: reversing planned reimbursement cuts for home health and reforming plans that target underperforming hospices. 

As Americans gather for Thanksgiving, “these are major family issues and also major national public policy issues of the highest level of strategic importance for our country,” said Dr. Steve Landers, CEO of the National Alliance for Care at Home, the organization formed by the recent merger of the National Association for Homecare and Hospice and the National Hospice and Palliative Care Organization. 

“We’re not done with 2024 yet,” Landers said Thursday, Nov. 21. “We’ve got a lot that we want to accomplish right now, this year—and we’re looking to the future.” 

The number one priority, he said, is for Congress to intervene and stop home health payment cuts as outlined in a final rule from the Centers for Medicare and Medicaid Services (CMS). He said that the cuts would impact patient outcomes, reduce visits and hurt providers—and that they were implemented based on a Congressional mandate saying CMS should support home health.

“Instead, what CMS did was decimate the program,” Landers said. “It’s inconsistent with what Congress asked. There’s no public constituency for this. … It needs to be reversed, and it’s fixable."

The Alliance is also focused on protecting hospice, which Landers called “a national treasure,” by limiting the effects of CMS’ hospice special focus program. The Alliance is urging the agency not to release a list that purports to include the 10% lowest performing hospices in the country, saying that the list is built on incomplete data. Katie Smith Sloan, president and CEO of LeadingAge, has also called the special focus program well-intentioned, but flawed in its current design.

“It’s likely to harm beneficiaries if it’s released, because it’s going to steer them away from quality providers. At the same time, it misses some poor performing hospices that should be flagged," Landers said. 

Reps. Beth Van Duyne and Jimmy Panetta recently introduced the Enhancing Hospice Oversight and Transparency Act, which would increase the transparency of CMS’ data and selection processes, reduce payment for non-compliance and boost public awareness of data reporting failures.

At the same time, Landers said, The Alliance is looking forward to working with new Congressional and administration leadership to improve the outlook for homecare. He included Robert F. Kennedy Jr., the president-elect’s choice to lead the Department of Health and Human Services, and Dr. Mehmet Oz, the president-elect's nominee to head CMS. Landers congratulated both nominees and said he likes the idea of having a physician in the CMS administrator role. 

“We want to see opportunities to grow and expand care at home as families and as many advocates hope to see,” Landers said. “As we get to engage with new officials … we will be a very visible, a very vocal partner and collaborator.”

BREAKING: CMS Proposes More Medicare Advantage ‘Guardrails’

McKnights | By Kimberly Marselas
 
The Centers for Medicare & Medicaid Services announced [Last] Tuesday it is pursuing further limits on Medicare Advantage plans’ use of prior authorization and artificial intelligence as “barriers to care.”
 
Officials billed the Contract Year 2026 MA and Part D proposed rule as a response to mounting calls from consumers, providers and members of Congress to institute reforms related to coverage decisions. Insurers often defend the extensive use of prior authorization and artificial intelligence tools as “utilization management,” or an effort to contain costs. 
 
But CMS noted that data submitted by MA plans indicate that, on average, MA plans overturn 80% of their decisions to deny claims —when those are appealed. Less than 4% of denied claims are appealed, meaning many more denials could be overturned by the plans if they were challenged.
 
“We continue to hear from people enrolled in Medicare Advantage who are having difficulty accessing the care they need and are entitled to, and CMS remains focused on removing these barriers,” said CMS Deputy Administrator Meena Seshamani, MD, PhD. “Whether it’s difficulty navigating options, being able to afford the lifesaving medications you are prescribed by your doctor, or receiving the inpatient or rehabilitation care you need to get well, no senior or person with disabilities on Medicare should be having these challenges.”
 
Skilled nursing providers have been sounding the alarm for years on Medicare Advantage coverage access, especially when informed by AI and other algorithms. Sector leaders have frequently noted that these methods can deny or prematurely end coverage for patients who need it to afford necessary long-term care. 
 
MA plans’ methods of prior authorizations and denials of coverage are a threat to both residents’ access to coverage and providers’ access to vital Medicare funding, sector experts say. 
 
“Skilled nursing providers have struggled, and continue to struggle, with Medicare Advantage coverage decisions that are based solely on AI algorithms,” Nisha Hammel, vice president of reimbursement policy and population health at the American Health Care Association told McKnight’s Long-Term Care News in June after a group of lawmakers urged greater oversight of MA plans. 
 
The rule proposed Tuesday also lifts limits on anti-obesity medications, “in recognition of the prevailing medical consensus that obesity is a disease.” If the rule is finalized, CMS would no longer exclude anti-obesity medications for the treatment of obesity from coverage under Medicare Part D and would require Medicaid programs to cover these medications.
 
In addition, the rule would increase guardrails on the use of artificial intelligence to protect access to health services. Other proposed policies will promote competition on the things that matter to people enrolled in MA and Part D plans, further addressing misleading marketing practices, and enhancing consumer tools on Medicare.gov.
 
“HHS is proposing to improve transparency, accountability, and consumer protections in Medicare Advantage and Part D plans so that everyone receives high-quality care,” said HHS Secretary Xavier Becerra. “To achieve that, we want to remove barriers that delay care or deny people services and medications they need to be healthy. In addition, we continue to promote competition for pharmacies and other health care businesses.”