In The News

AARP: Paid Caregivers are Key to Relieving Family Caregiver Burden

McKnight’s Home Care | By Diane Eastabrook
AARP said Wednesday state and federal lawmakers must solve the home care worker crisis in order to take pressure off of an estimated 38 million family caregivers.
“We have to address that issue because it means family caregivers have no choice,” Susan Reinhard, director of the AARP Public Policy Institute said during a roundtable on family caregiving. “If there are no paid [caregivers], even more unpaid caregiving has to be done.”
Reinhard made the comments as AARP released Valuing the Invaluable 2023 Update: Strengthening Supports for Family Caregivers. The report estimated that unpaid family caregivers are providing an estimated 36 billion hours of care annually, worth approximately $600 billion. That is an increase of $60 billion from 2019 when AARP released its last family caregiver report. 
Attracting up to 6 million direct caregivers into the workforce by the end of the decade will require increasing caregiver wages, according to Nancy Leamond, AARP chief advocacy and engagement officer and executive vice president. She also suggested that finding ways for Medicare and private insurers to pay for home care might incentivize more workers to join the industry.
The family caregiver study painted a grim picture of stressed-out family members working what are essentially unpaid part-time jobs dressing wounds, managing medications, cooking, cleaning, bathing and providing other activities of daily living for loved ones. Many family caregivers are doing that work in addition to carrying on full-time jobs and taking care of children. 
AARP is advocating policy initiatives in Washington and state legislatures that would provide more resources, including training for family caregivers; tax credits and reimbursements to help families pay for direct care workers; workforce policies that provide flexible schedules and paid leave for family caregivers; and well-being programs that promote respite care. 
About a dozen states enacted paid family leave and sick leave that help family members care for ailing loved ones. Forty-five states now have Coronavirus Aid, Relief, and Economic Security (CARES) Act laws in place that support family caregivers when their relatives are hospitalized or return home.
Arizona, Colorado and New Hampshire now have laws in place that provide training for family caregivers.


Home Health Leads Senior Care Sector in Worker Demand, Report Finds

McKnight’s Home Care | By Diane Eastabrook 

The home health workforce is projected to grow a whopping 46% by 2040, representing the largest increase in the senior care sector. That’s according to a new report released Wednesday by Argentum, a trade association representing senior living facilities.
“The baby boomers are aging and will put a strain on our nation’s ability to provide senior care, supports and service,” Argentum researchers wrote in the report. “And, while our senior population grows, the American workforce is not keeping pace. We are facing a significant worker shortage across the economy generally but within senior care, in particular.”
The report said employment in the home health industry will reach 2.2 million by 2040, adding approximately 692,000 new jobs to the 1.5 million home health workers in 2021. Argentum also estimated home health will need to fill an additional 4.3 million positions as workers exit the industry or move to other occupations over the next two decades.
The report said demand will be strongest for home health and personal care aides, with 3.4 million workers needed for those jobs by 2040. Nursing assistants and registered nurses will also be in high demand filling 330,200 and 310,200 positions, respectively. The states that will see the strongest demand for home health workers by the end of this decade include Texas (415,800), New York (391,000) and California (156,000). 
The report reflects the changing demographics of an aging nation where 10,000 people are turning 65 each day. It also reflects the trend of seniors opting to age at home, rather than in a facility. Employment in senior living facilities is expected to grow just under 33% by 2040, while employment in skilled nursing is expected to decrease by 6.5%. 
Some of the states facing the most critical shortage of direct care workers are taking action. In January, New York took its first step in developing a master plan for aging which includes proposals for public-private partnerships to address long-term care initiatives. California, Texas, Colorado, Massachusetts and Minnesota have adopted similar plans.


DEA Issues Proposed Rule for Telemedicine Prescribing of Controlled Substances

proposed rule was published in the Federal Register on March 1, 2023 focused on telemedicine prescribing of controlled substances when the practitioner and the patient have not had a prior in-person medical evaluation. This proposed rule applies only in limited circumstances when the prescribing practitioner wishes to prescribe controlled medications via the practice of telemedicine and has not otherwise conducted an in-person medical evaluation prior to the issuance of the prescription. With that in mind, NHPCO is working with legal counsel to determine the circumstances under which this proposed rule could apply to hospice or palliative care providers and will also provide talking points for those who want to submit a comment letter directly to the DEA. The DEA has posted two helpful resources for providers and prescribers.

Proposed Rules Summary

Proposed Rules Highlights for Medical Practitioners

To provide feedback for the NHPCO comment letter, email [email protected].


How Do You Tell Someone Something They Don’t Want to Hear?

By Barbara Kares

How do you tell someone something they don’t want to hear? Very carefully and with compassion in your words.

In thinking about the answer to the above question I have two different answers. Those answers depend on who is delivering the information.

Physicians: Nobody wants to hear they can’t be fixed, treatment is no longer working. BUT, it is your responsibility, as a physician, to tell a person whatever “bad” news you have determined. “I am having a difficult time fixing you. The medicines, the plan of treatment is not doing what we had hoped.”

A part of a physician’s responsibility is to tell the truth as they know it. That truth may not be what the patient and family want to hear BUT consider that knowledge a gift . It is giving the opportunity to address life issues, to do and say what needs to be done and said. That knowledge is a life opportunity, even though nobody wants to hear or acknowledge the message.

Tell that truth in a manner that the patient/family can understand. No medical words, look the person in the eye, sit rather than stand by the patient, speak slowly, gently, sincerely. It’s okay to say “I don’t know.” When addressing end of life issues do not put an exact number on a prognosis. Use months, but not “six“months. Dying is too personalized to be accurate with a number. 

Make recommendations for further care. That can be a referral to palliative care or hospice. Don’t just leave a person and family with no resources after you have told them they can’t be cured.

Palliative care and hospice nurses, social workers and end of life doulas: So often I’ve been told by families “Don’t tell mom the doctors can’t fix her. Don’t tell mom she is going to die sooner rather than later. Don’t tell her she is on hospice” 

It is our job, our responsibility as end of life workers to be honest with our patients. In a “don’t tell mom” situation I first assess where everyone is, who believes what. Then, I address the family’s concern. I tell them I don’t lie or play games, and let them know they can talk to me about anything. I am here to guide and support them and their family through this challenging experience. 

As part of my “don’t tell mom” support, if they would be more comfortable, I won’t address the subject of illness and decline directly. However, if asked, I will answer honestly in a supportive manner. I will be gentle, use my conversation and people skills. I will do my job of supporting a person where they are in this life altering situation.

As difficult as it is to tell someone “we can’t fix you”, to say those words nobody wants to hear, it is our job as health care workers to do so. A person has the right and physicians have the obligation, to tell a person ONCE that they can’t be fixed. What they do with that knowledge is for the person to decide.

They can take the opportunity to address life issues, put their affairs and relationships in order —- or not. BUT the physician has to tell them first. The physician has to have an honest, direct and gentle conversation. The physician has to give the gift before it can be officially acknowledged by the rest of us healthcare workers.


HCAOA, Polsinelli, & NAHC Team Up for Home Care Industry Update on March 16

HCAOA has teamed up with Polsinelli and NAHC for a Home Care Industry Update webinar on Thursday, March 16, from 12:00 - 2:00 p.m., EST.

Tune in for a legal update tailored for the Home-Based Care Industry (home health, home care, and hospice providers). This presentation will cover recent government action extending the statute of limitations for investigating and prosecuting certain providers who participated in specific COVID related aid packages and the impact on the home care industry. Aid packages include the Paycheck Protection Program (“PPP”), COVID-19 Economic Injury Disaster Loan Program (“EIDL”), Provider Relief Funds Program (“PRF”) and the Employee Retention Credit Program (“ERC”).  We will provide best practices for preparing for government investigations aimed at providers that leveraged COVID-related aid during the pandemic. 

Also hear an overview of the latest federal legislative and regulatory developments impacting our industry, including the latest developments regarding the Federal Trade Commission’s proposed ban on non-competes, the status of the NLRB’s proposed rule modifying the joint employment standard under the NLRA, and an overview of the DOL’s recent activity, including the status of the proposed change to the independent contractor standard and recent enforcement activity. Biden’s statements in his most recent state of the union address will also be discussed.

Register now. This meeting is free, but registration is required.

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