Changing Benefits of Home Care During COVID-19

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By Nate Cohn, Missouri Administrator, Emerest 

When COVID-19 started affecting our nation’s hospitals at a record pace, physicians and healthcare experts focused on the impact on our healthcare system. Focus shifted when as many as 40% of U.S. COVID-19 deaths were potentially linked to nursing home-acquired infections. This brought attention to not only nursing homes but home care services as well. Over 5 million people in the United States receive some form of paid home care. Despite the advantages of home care, extra precautions will be needed to continue providing care for home-based patients, many of whom have disabilities or mobility constraints.

Demand for Home Care Increases

Before COVID-19 became a household name, the Centers for Medicaid Services Office of the Actuary (CMS) issued a report projecting that approximately $109B was to be spent on home healthcare services and this expense was expected to grow to more than $180B in fewer than eight years. Then COVID-19 invaded our lives, hospitals, and nursing homes, and those numbers quickly became obsolete.

When caring for the aging population, avoiding nursing home and long-term care wherever possible is critical. Many healthcare providers would agree that the right in-home care model can keep patients healthier and happier in the comfort of their own home. Additionally, home health care models may be implemented at a lower cost to insurers, both public and private. Unfortunately, for many families, this level of care is not financially feasible without a supplemental insurance care option.

Missouri Case Study

In August 2020, Missouri citizens voted to expand Medicaid coverage to insure approximately 230,000 citizens who would not otherwise qualify under existing income requirements. Missouri Medicaid, also known as, MO HealthNet, provides coverage for medical, dental, and vision care, as well as other services for children, low-income individuals and families. The program also provides care for the blind and the disabled. For many, this coverage offers a lifesaving safety net, especially when many feel the stresses and worries brought on by a global pandemic.  Families can rest a little easier, and the elderly and disabled at risk of being placed in a long-term care facility now have home-care alternatives to consider. 

For families facing the pandemic, surviving in an unstable economy due to COVID-19, and caring for an elderly relative, knowing they have alternative options to nursing home care makes a big difference. Funding for in-home care created by the additional Medicaid expansion allows more families to create multi-generational living arrangements and avoid nursing home care for their aging parents or grandparents.

As beneficial as these new programs sound, they can be challenging to navigate. Meeting eligibility requirements and ensuring the right services and finding the right caregiver can be a daunting task. Therefore, it is imperative the consumers work with well-reviewed and respected agencies to ensure that they received their full benefits and will not experience any pause in service or negative tax implications. Additionally, respected agencies face challenges, as the industry is riddled with poor customer service and has been subject to rampant fraud.  

The Right Workforce

In the home care industry today, approximately 90% of the workforce are women who have not completed college. Nearly 60% belong to racial or ethnic minority groups with a disproportionately high rate of illness and death from COVID-19, and only one-third of home care workers are employed full-time. This means that many workers are traveling to different homes to create a full-time workload. This increases the risk to the health care provider and the patient due to exposure to multiple people and the possibility of carrying the virus from one patient to another.

In this context it is notable that Missouri Medicaid’s Consumer Directed Services program, enables aged and/or disabled participants to hire family or other trusted individuals for their home care needs. This can be a friend, neighbor, or family member (other than a spouse) that helps clean, cook, run errands, and assist with other household chores. By working with family and friends, as opposed to an agency worker, those at a higher risk of adverse outcomes from COVID-19 are able to limit their exposure to the virus. 

COVID-19 has made care delivery more complicated across all care settings, and in-home care has not been left out of the challenge. At Emerest, we’ve seen the client lists grow to support new recipients as a result of the pandemic and now with the incoming Missouri Medicaid expansion. The quality of a patient’s lives depends on the quality of the care they receive. If there is a silver lining to this pandemic, it is an opportunity to expand how home care is provided and prioritizing the workforce. Delivering quality home care requires not only providing for the patient, but just as important, the caregiver as well.  Today’s in-home caregivers need access to services that enable them to focus on their patients. This means ensuring compliance, providing technologies that enhance the caregivers’ role and fair and timely compensation. Most importantly, offering a level of customer service that provides caregivers and patients with the education and support needed. 

With our new normal taking shape, the home care workforce needs a career ladder with growth opportunities. Workers should have the opportunity to obtain additional training, expertise, and competencies, such as caring for a COVID-19 patient or one recovering from it. The more focus and support we give our home care givers, the better care our elderly relatives will receive, and the better the family will feel about the care being provided. 

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