In The News

Dignity: A Story for Home Care & Hospice Month

By NAHC Director of Membership Lisa Rackstraw

My father was diagnosed with kidney cancer when he was 42 years old.

One day Dad seemed fine, the next day surgeons were rushing him into surgery in Denver, Colorado to remove a kidney that contained a grapefruit-sized tumor. As I rushed to get a flight to Denver, I knew my father would not like all the fuss.

Dad was born and raised in Halifax, England. He left school when he was 16 and had no formal education, but what he did have was determination and lived by a “pull yourself up by your bootstraps and get on with it” mentality. Facing cancer only cemented his determination to get through the illness and no complaints ever left his mouth.

My father started his career as a coal miner in the mines in Cornwall, England.  That’s where I was born; a beautiful part of England lined with breathtaking coastal cliffs, beaches and tiny fishing villages.  He was an avid reader all his life.  He basically read himself up from coal miner to a senior engineer.  He worked for an international corporation out of Germany.  This career led us to move often, both internationally and domestically.

He approached his battle with cancer the same way as he approached any subject matter that he was not well-versed in.  He read every book and study on kidney cancer.  He participated in numerous experimental treatments at the National Institutes of Health.  He battled faithfully for two years.  All along with determination and no complaints – and with dignity.

Dignity was a big presence in my father’s life.  He was a proud man.  Proud of his career and proud of his family.  I can remember the car service coming to the family house for him to take him into the city to give a deposition in a lawsuit his employer had brought against one of their clients.  My Dad was very ill, the doctors had given him six to eight weeks, but his determination and dignity carried him that day to fulfill his obligation to his career.  The lawyers deposed him for hours and he held strong.

We knew my father had planned with his doctors and his lawyer to pass on at home.  He’d had his fill of hospitals over the past two years.  His dignity was served best at home.  His master bedroom became care central.  His Hospice Caregiver Michael entered our lives, touched our souls and left an endless impression.  In fact, I don’t think any of us talk about my father’s death without mentioning Michael.

I was 22 years old.  I had been volunteering for some years by now at a local nursing home back in Washington, DC.  I recognized the empathy, understanding and endless gift of caring within him as he went about the business of caring for my father.  But it didn’t feel like a job to him, it was an extension of who he was.  I’ve always believed caregivers either have it or they don’t.  Like teachers, one cannot fake it.  It takes a very special person.

Michael was in the family home everyday for the next two months.  He allowed my father to spend the remainder of his life as comfortable as possible, in as little pain as possible, in the sanctuary of his home, surrounded by his family, surrounded by familiarity — with dignity.

Michael allowed us, the family, to come to terms with my father’s inevitable passing on without the added stress of trying to care for his daily needs.  He allowed his children to not have to face what could have been embarrassing and heartbreaking moments between father and child had he not been there to bathe my father, dress him, feed him and assist him to the bathroom.  Alleviating that stress and giving us the peace of mind that our father’s daily needs and comforts were being taken care of brought us comfort during one of the most heartbreaking times in our lives.

My father moved on with no complaints and with dignity.  Thank you, Michael.

 

Home Health Industry Unscathed In Latest CMS Improper Payments Report

Home Health Care News | By Andrew Donlan
 
The Centers for Medicare & Medicaid Services (CMS) released its improper payment report last week. It was another win for the home health industry, which has become less of a culprit in the reports over the years.
 
Overall, the Medicare fee-for-service (FFS) estimated improper payment was 7.38%, or $31.2 million. That was the seventh consecutive year it has been below the 10% threshold established by improper payment statutory requirements, according to the agency.
 
In 2022, the improper payment rate was 7.46%.
 
“While CMS’ improper payments reporting programs are designed to protect the integrity of CMS programs, not all improper payments are fraud or abuse. It is important to understand that improper payments are payments that do not meet CMS program requirements,” CMS wrote in a corresponding fact sheet on improper payments. “They can be overpayments or, underpayments, or payments where insufficient information was provided to determine whether a payment was proper.
 
From 2016 to 2020, home health improper payments decreased by $5.9 billion. Then, in 2020, the industry had a 9.3% improper payment rate. In 2021, it had a 10.24% estimated improper payment rate.
 
In the latest report, home health was not included as one of the sectors contributing most to overall improper payments.
 
Those sectors were skilled nursing facilities, outpatient hospitals, inpatient rehabilitation facilities and hospice.
 
Review Choice Demonstration (RCD) could be helping the home health industry improve on payments, at least in Illinois, Ohio, North Carolina, Florida and Texas.
 
CMS did mention RCD’s expansion within the report.
 
“HHS announced expansion to the Review Choice Demonstration for Home Health Services to Oklahoma, starting December 1, 2023,” the agency wrote. “This demonstration is also ongoing in Illinois, Ohio, North Carolina, Florida, and Texas. It offers Jurisdiction M providers three initial options: pre-claim review, post-payment review, or minimal post-payment review with a 25% payment reduction for all home health services. A provider’s compliance with Medicare billing, coding, and coverage requirements determines their subsequent steps in the demonstration.”

 

The United States Department Of Labor Issues Template Home Care Worker Employment Agreements

Polsinielli | By William C. Vail and Clayton Nedza

The U.S. Department of Labor recently issued a template home care worker employment agreement to increase visibility of employee rights and employer responsibilities. This document comes as a result of an April 2023 Executive Order titled Increasing Access to High-Quality Care and Supporting Caregivers.

The Executive Order called on the Department of Labor to develop “compliance assistance and best practices” for, among others, home care workers. The DOL explained that the informal and non-binding sample agreement is not required by law. Rather, it is better viewed as “tools” that may help household employers and workers develop their own employment agreements together, “thereby reducing potential future misunderstanding or conflict and strengthening the employment relationship and trust.”

The DOL further states that the agreement reflects topics that employers and employees may voluntarily choose to address. For example, the template agreement provides for an explanation of benefits like health insurance, paid leave, pay if the employer cancels a shift on short notice, and on-call pay – none of which are required by federal law. The DOL is also careful to note that the sample agreement does not constitute legal advice, an official statement of position by the DOL or reflect the full range of laws that may apply in every situation, such as local and state laws. It also notes that the use of an employment agreement cannot waive the rights or protections of an employee under applicable federal, state, or local law.

Any questions may be directed to your Polsinelli attorney, the Authors of this article, or any attorney in our Labor & Employment Department.

 

Why Long-Term Care Insurance Falls Short for So Many

New York Times | By Jordan Rau and JoNel Aleccia
 
The private insurance market has proved wildly inadequate in providing financial security for millions of older Americans, in part by underestimating how many policyholders would use their coverage.
 
This article is part of the Dying Broke series examining how the immense financial costs of long-term care drain older Americans and their families.
 
For 35 years, Angela Jemmott and her five brothers paid premiums on a long-term care insurance policy for their 91-year-old mother. But the policy does not cover home health aides whose assistance allows her to stay in her Sacramento bungalow, near the friends and neighbors she loves. Her family pays $4,000 a month for that.
 
“We want her to stay in her house,” Ms. Jemmott said. “That’s what’s probably keeping her alive, because she’s in her element, not in a strange place.”
 
The private insurance market has proved wildly inadequate in providing financial security for most of the millions of older Americans who might need home health aides, assisted living or other types of assistance with daily living.
 
For decades, the industry severely underestimated how many policyholders would use their coverage, how long they would live and how much their care would cost.
And as Ms. Jemmott belatedly discovered, the older generation of plans — those from the 1980s — often covered only nursing homes.
 
Only 3 to 4 percent of Americans 50 and older pay for a long-term care policy, according to LIMRA, an insurance marketing and research association. That stands in stark contrast to federal estimates that 70 percent of people 65 and older will need critical services before they die.
 
Repeated government efforts to create a functioning market for long-term care insurance — or to provide public alternatives — have never taken hold. Today, most insurers have stopped selling stand-alone long-term care policies: The ones that still exist are too expensive for most people. And they have become less affordable each year, with insurers raising premiums higher and higher. Many policyholders face painful choices to pay more, pare benefits or drop coverage altogether.
 
“It’s a giant bait and switch,” said Laura Lunceford, 69, of Sandy, Utah, whose annual premium with her husband leaped to more than $5,700 in 2019 from less than $3,800. Her stomach knots up a couple of months before the next premium is due, as she fears another spike. “They had a business model that just wasn’t sustainable from the get-go,” she said. “Why they didn’t know that is beyond me, but now we’re getting punished for their lack of foresight.”

Read Full Article (Requires Signing-Up for a Free Account or Subscription)

 

NHPCO Webinar: CMS Special Focus Program

NHPCO will be hosting a Council of States focused webinar on the Special Focus Program on December 5th at 2PM (MST).

HHAC members are eligible and encouraged to attend. 

Please register here.

 
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