Living with HD: In-Home Care Options

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1 Living with HD: In-Home Care Options Presented by: Teresa Lee, JD, MPH Executive Director Alliance for Home Health Quality & Innovation

2 The information provided by speakers in workshops, forums, sharing/networking sessions and any other educational presentation made as part of the 2014 HDSA Convention program is for informational use only. HDSA encourages all attendees to consult with their primary care provider, neurologist or other healthcare provider about any advice, exercise, medication, treatment, nutritional supplement or regimen that may have been mentioned as part of any presentation.

3 Presenter Disclosures Teresa Lee The following personal financial relationships with commercial interests relevant to this presentation existed during the past 12 months: No relationships to disclose or list 3

4 Overview Background Key elements for independence Definitions Services and benefits: payers and eligibility Resources 4

5 Background: Alliance for Home Health Quality & Innovation 501(c)(3) non-profit research and education foundation Mission: To lead and support research and education on the value home health care can offer to patients and the U.S. health care system. Working with researchers, key experts and thought leaders, and providers across the spectrum of care, we strive to foster solutions that will improve health care in America. 5

6 Key Elements for Independence Skilled care Personal Assistance Services Transportation Medical Care Independence/Community Living Housing 6

7 Definitions Home care or In-home care is a broad term that includes wide range of health and social services. The following are the most common types of home care: Skilled home health care Personal Assistance Services Hospice services (end-of-life care) Many other services can also be provided in the home (e.g., infusion therapy, physician house calls). 7

8 Definitions Home Health Care is one type of in-home care: Primarily skilled nursing and/or therapy services Home health aide services also included, but patient must need skilled nursing or therapy services Usually Medicare, but Medicaid also pays for skilled home health Medicare benefit/eligibility is narrowly defined 8

9 Who qualifies for Medicare Home Health Care? To qualify, the Medicare beneficiary: Is homebound Needs intermittent skilled nursing and/or therapy Is under the care of a physician and needs reasonable and necessary home health services that have been certified by a physician, and subject to plan of care established by a physician and established in a 60-day plan of care 9

10 Demographics of Home Health Users Demographics of Home Health Users Table 2.6: Selected Characteristics of Medicare Home Health Users and All Medicare Beneficiaries, 2011 All Medicare Home Health Users All Medicare Beneficiaries Over age % 12.5% Live alone 35.6% 29.4% Have 3 or more chronic conditions 83.2% 60.5% Have 2 or more ADL limitations * 28.7% 10.6% Report fair or poor health 45.8% 26.6% Are in somewhat or much worse health than last year 41.3% 23.0% Have incomes under 200% of the Federal Poverty 64.5% 48.9% Level (FPL) ** Have incomes under 100% of the Federal Poverty 34.8% 22.0% Level (FPL) ** Source: Avalere analysis of the Medicare Current Beneficiary Survey, Access to Care file *ADL = Activities of daily living, such as eating, dressing, and bathing. Limitations with at least 2 ADLs is is considered a measure of moderate to severe disability and is often the eligibility threshold for a nursing home level of care. **In 2011, FPL for a household of 1 was $10,890, a household of 2 was $14,710, a household of 3 was $18,530, and household of 4 was $22,350. Page 14 10

11 Personal Assistance Services Also known as: Personal Care Services Personal Attendant Services Attendant Care Services Personal Care Assistance Includes people that assist a person with a physical, sensory, mental, or cognitive disability with tasks that the person would perform him or herself if he or she did not have a disability. 11

12 Personal Assistance Services (PAS) For people of all ages to help with activities of daily living (ADLs) or instrumental ADLs (IADLs) ADLs: needed for fundamental functioning and include eating, bathing, dressing, grooming, ambulating, and toileting. IADLs: not needed for fundamental functioning, but enable independent living in community e.g., shopping, housekeeping, accounting, food preparation/meds, telephone, and transportation. Informal or Formal 12

13 Who are the people/workers providing personal assistance services? Caregiver Respite care worker Personal care attendant or aide Personal assistant Attendant care worker Home care worker or aide Homemaker Direct support professional (specifically for people with certain disabilities) Habilitation technician Direct care worker Home Health Aide Nursing Aide or Assistant (CNA) Paraprofessional 13

14 Home Health Care Services Industry Workforce Chart 4.1: Total Number of Home Health Aides Employed in the Home Health Care Services Industry, , , , , , , ,000 50, Source: Bureau of Labor Statistics, U.S. Department of Commerce Page 34 14

15 Home Health Care Services Industry Workforce Chart 4.2: Number of Home Health Aides Employed in the Home Health Care Services Industry, 2010 and 2020 (projected) 700, , , , , , , , , Home Health Aides Source: Bureau of Labor Statistics Employment Projections program, U.S. Department of Commerce Page 35 15

16 Home Health Care Services Industry Workforce Chart 4.3: Breakdown of Persons Employed in Home Health Care Services by Sex, 2012 Home Health Care Workers by Sex Male 12.4% Female 87.6% Source: Bureau of Labor Statistics, Labor Force Statistics from the Current Population Survey Page 36 16

17 Hospice What is Hospice? Program of care and support for people who are terminally ill (not just cancer) Focus is on comfort, not on curing an illness Specially trained team of professionals and caregivers provide care for the whole person, including his or her physical, emotional, social, and spiritual needs Services may include physical care, counseling, drugs, equipment, and supplies for the terminal illness and related condition(s) Family caregivers can get support (respite care) 17

18 Who is eligible for Medicare Hospice? You can get Medicare hospice benefits when you meet all of these conditions: Eligible for Medicare Part A (Hospital Insurance) Your doctor and the hospice medical director certify that you re terminally ill and have 6 months or less to live if your illness runs its normal course You sign a statement choosing hospice care instead of other Medicare-covered benefits to treat your terminal illness (Medicare will still pay for covered benefits for any health problems that aren t related to your terminal illness.) You get care from a Medicare-approved hospice 18

19 Payment/Benefits and Eligibility Individuals pay out-of-pocket Private insurance: long-term care insurance policies (subject to individual policy limits); private health insurance usually covers home health care Medicaid: Eligibility: disability, income level (varies state-bystate) Long term services and supports diverse array of programs, varying state-by-state Considerable state-by-state variation 19

20 Payment/Benefits and Eligibility Medicare: For 65 or older and people with disabilities (2 year waiting period) Skilled nursing and/or therapy is focus, but PAS provided with home health aide supervised by nurse or therapist Hospice Veterans Administration: Home-Based Primary Care Medical Foster Homes 20

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22 Resources for accessing services/benefits Home Health Compare ml Center for Personal Assistance Services: Go to For PAS Users and then Help in my State Centers for Independent Living Find your local CIL: 22

23 Resources (cont d) Hospice: American Hospice Foundation: e (Resources, Find a care provider ) Veterans Administration Resources: Long term care cost calculator: 23

24 Questions/Discussion Thank you!

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