Final Rule Strengthens Social Needs Programs for Seniors Aging in Place
McKnight’s Home Care | By Adam Healy
The Administration for Community Living on Tuesday released a final rule affecting the Older Americans Act (OAA) — the first significant change to the act in more than 35 years.
Among various updates, ACL’s rule specifies what people are eligible for assistance under the OAA, clarifies how federal funds can be used to provide supportive services, and spells out requirements for state and local programs helping older adults aging in place. There have been small modifications to the act in recent years, but this week’s final rule marks the first major changes to the OAA since 1988, according to the ACL.
“Updates are needed to align regulations to the current statute and reflect the needs of today’s older adults,” ACL wrote in a Notice of Proposed Rulemaking in June 2023. “[The rule] aims to better support the national aging network that delivers OAA services and improve program implementation, with the ultimate goal of better serving older adults.”
Also since 1988, the population of older adults in the United States has nearly doubled, seniors on average are living longer and expectations for aging have changed, according to ACL. The provisions finalized in the rule aim to reflect these changing standards and provide more comprehensive care for aging adults. Its ultimate goal, ACL noted, is helping seniors receive services and support to live at home and in their communities as they age.
“The overwhelming majority of Americans want to live in their own homes as they age … For many, this is possible because of the programs and services provided through the Older Americans Act,” Alison Barkoff, ACL administrator and the assistant secretary for aging, said in a statement. “The updated regulations strengthen the stability and sustainability of these programs.”
Some services provided by OAA programs include rides to medical appointments, nutritious meals, in-home care and support to family caregivers, according to Barkoff.
The final rule also solidifies flexibilities put in place during the COVID-19 pandemic that promoted aging in place. For example, the rule now allows some meal programs to offer carry-out meals for seniors.
In 2022, USAging, the national association that supports area agencies on aging called for OAA expansion. Meanwhile, workforce-challenged aging service providers — including home care agencies — struggle with a lack of resources to serve the growing number of older adults in need.
The rule has been filed in the Federal Register and is scheduled for publication on Feb. 14. |
10% of People with Dementia May Actually Have Different Disease, Research Suggests
Becker’s Clinical Leadership | By Ashleigh Hollowell
Certain cases of dementia — potentially up to 10% — could instead be undiagnosed liver disease and related neurological issues, according to a study published Jan. 31 in JAMA.
Additionally, researchers believe that the 10% of undiagnosed liver disease and brain dysfunction could possibly be resolved with treatment.
For the study, researchers analyzed a decade of data — spanning 2009 to 2019 — from 177,422 veterans who had a diagnosis of dementia, and looked for a high Fibrosis-4 score, which is a sign of advanced liver fibrosis that can lead to cirrhosis.
Across the dataset, around 10.3% of patients who did not previously have a cirrhosis diagnosis showed high Fibrosis-4 scores and signs of hepatic encephalopathy (HE), a neurological disorder that is often challenging to distinguish from dementia.
But, a reversal of symptoms is possible through treatment for metabolic encephalopathies like HE, and researchers suggest clinicians pay particular attention to "the determinants of undiagnosed cirrhosis among veterans with dementia" and use that information to help properly "identify those eligible for screening and subsequent HE therapy." |
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For Home Care Providers Still Invested In Medicare Advantage Business, Patience Is Wearing Thin
Home Health Care News | By Andrew Donlan
Around 2019, Medicare Advantage (MA) was all the rave among home care providers.
That’s because, in 2018 and 2019, two pathways opened for MA plans to provide more benefits to beneficiaries: the primarily health-related benefit pathway and the Special Supplemental Benefits for the Chronically Ill (SSBCI) pathway.
Included in those were plenty of areas of opportunity for personal home care providers to step in and become more involved with the Medicare dollar. In-home support services (IHSS), namely, were a popular benefit that providers theoretically stood to benefit from.
But, since 2019, that optimism around MA has waned for most. The return on the investment has largely not been there.
For one, providers that generally dealt with private-pay clients were met with less favorable rates in MA, plus less reliable scheduling for their caregivers. Then, particularly recently, the growth in plans’ adoption of SSBCI and primarily-health related benefits has slowed.
This year, for instance, 867 plans are offering IHSS as a supplemental benefit, according to the research and advisory firm ATI Advisory. That’s a significant drop off from 2023, when 1,308 plans were offering the benefit.
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New Legislation Would Expand Access to Occupational Therapy
NAHC Report
In a promising bipartisan effort, the Medicare Home Health Accessibility Act, H.R. 7148, has been introduced by a coalition of legislators including Reps. Lloyd Smucker (R-PA-11), Dr. John Joyce (R-PA-13), Paul Tonko (D-NY-20), and Lloyd Doggett (D-TX-37). This crucial bill aims to revolutionize home health care by allowing occupational therapy (OT) to be ordered as a stand-alone service for Medicare beneficiaries.
Currently, OT services are excluded from qualifying beneficiaries for Medicare’s Part A home health benefit. This limitation means that OT services can only be provided in a beneficiary’s home if other therapy services, such as nursing, physical therapy, or speech and language pathology, are simultaneously ordered at the start of care.
Congressman Lloyd Smucker (PA-11) expressed his enthusiasm for the bill, stating, “The Medicare Home Health Accessibility Act will ensure beneficiaries can receive the care they need in a setting that more and more prefer—at home. Our commonsense measure will tailor home health orders to each patient, maximizing their ability to thrive at home and avoid costly rehospitalizations.”
Congressman John Joyce, M.D. (PA-13), emphasized the bipartisan nature of the bill, calling it a “game changer for patients who wish to heal and recover in the comfort of their homes.” He stressed the importance of in-home occupational therapy, especially in rural communities.
The proposed legislation received widespread support from Congressman Lloyd Doggett (D-TX-37), who highlighted the critical role home- and community-based care play in the healthcare system. Removing unnecessary barriers to receiving health care at home, he said, would provide more patient choices and access, particularly benefiting seniors.
Congressman Paul Tonko (D-NY-20) pointed out that passage of the bill would better target home health services to meet specific patient needs, particularly in preventing falls and accidents, ultimately enabling Medicare beneficiaries to remain independently at home.
The National Association for Home Care and Hospice (NAHC) supports this new legislation and applauds the sponsors for their leadership. With the bill’s introduction NAHC President Bill Dombi said, “It is time that Congress rectify a long-standing weakness in the home health benefit by making occupational therapy a qualifying skilled service. OT is an essential service not only for patients, it also is a proven means to saving Medicare expenditures.” |
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