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The Fragility of the Caregiving Infrastructure
Home Care Magazine
On March 31, 2021, President Joe Biden proposed a sweeping $2 trillion infrastructure package dubbed the American Jobs Plan. The proposal includes funding efforts for highways, bridges, transit systems, water supplies, the electrical grid and more. An unexpected inclusion is $400 billion dollars for home- and community-based care for seniors and people with disabilities; the package would also increase wages for in-home caregivers.
During his presidential campaign, Biden had said he would devote $450 billion to allow more older Americans to receive care at home; homecare’s position in the package is described in a White House fact sheet as an administration effort to “solidify the infrastructure of our care economy.”
“It’s expanded services for seniors,” Biden said in a news conference about the proposal. “It’s homecare workers, who go in and cook their meal, help them get around and live independently in their home, allowing them to stay in their homes—and I might add, saving Medicaid hundreds of millions of dollars in the process.”
Care at Home
Fifty-seven percent of Medicaid’s long-term care budget goes to home- and community-based services; this amounted to $92 billion in the 2018 federal budget year. While all states offer some form of this service, 41 have waitlists totaling nearly 820,000 people, with an average wait of 3.2 years. The American Jobs Plan would expand these services in order to eliminate the wait list—and would treat in-home care like institutional care. One way the plan would do this is by expanding the Medicaid Money Follows the Person program, which aims to move seniors back into their homes.
“The past year has led to job losses and threatened economic security, eroding more than 30 years of progress in women’s labor force participation,” reads the White House fact sheet. “It has unmasked the fragility of our caregiving infrastructure.”
Caregiver Wages
The U.S. Bureau of Labor Statistics reports that the median pay for a homecare worker was $12.15 per hour in 2019. Homecare workers are often women and people of color, with immigrants making up nearly one-third of the workforce. Overall, nearly half of the homecare workforce lives in a low-income household, with 43% of workers relying on public health care coverage such as Medicaid. One-third don’t have insurance from their employer. A portion of the $400 billion would help workers receive “a long-overdue raise, stronger benefits and an opportunity to organize or join a union,” according to a statement from the administration. Homecare groups have said that Medicaid reimbursement will need to compensate for any increased wages, which the plan addresses.
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What you Need to Know About Vaccines and Vaccine Safety
At least 20% of adults have consistently said that they would not get vaccinated or would do so only if required, and a lack of accurate information continues to be a concern among those who are not ready to get a COVID-19 vaccination. To address these fears, it's important to emphasize the facts, including how the accelerated timeline for the COVID-19 vaccine does not translate to compromises on safety.
In a new Healthcare Triage YouTube series, funded by NIHCM Foundation, Dr. Aaron Carroll explains the history of vaccines and vaccine development–one of the greatest public health achievements of all time–in six short, consumer-friendly videos covering:
- · the timeline of COVID-19 vaccine development and the mRNA vaccine approach
- · the history of anti-vaccine sentiments, vaccine legislation, and societal backlash (Part 1, Part 2)
- · how vaccines work with the immune system
- · the history of vaccine development (Part 1, Part 2)
Dr. Carroll is a Professor of Pediatrics at Indiana University School of Medicine and the host of the award-winning Healthcare Triage series on YouTube. |
COVID-19 Updates
CDC: You Don't Need to Mask Outdoors if You Are Vaccinated
As reported by The Washington Post, “Federal health officials said Tuesday [04/27/2021] that fully vaccinated people can go without masks outdoors when walking, jogging or biking, or dining with friends at outdoor restaurants. Officials said the changed guidance was aimed at helping those who are fully inoculated return safely to old routines, while encouraging others to get their shots to counter highly contagious new variants.”
In general, people are considered to be fully vaccinated 2 weeks after their second dose of a 2-dose vaccine series (e.g., Pfizer or Moderna), or 2 weeks after a single-dose vaccine such as Johnson & Johnson’s Janssen vaccine. If someone does not meet these requirements, they are not fully vaccinated and should continue to take full precautions. Additinoally, those who have a medical condition or are taking medications that weaken your immune system, may not be fully protected even after vaccination. The new recommendations are for personal consideration and are not intended for healthcare settings.
Even after full vaccination, CDC general guidelines should still be followed by everyone, to avoid the spread (e.g., wear a mask, social distance 6’ apart, avoid crowds and poorly ventilated spaces) until more is known. See full set of new guidelines for those who have been fully vaccinated at: https://www.cdc.gov/coronavirus/2019-ncov/vaccines/fully-vaccinated.html
Fauci Says U.S. Should See Turning Point in the Pandemic ‘within a few weeks’
If the U.S. continues its vaccination pace, “literally within a few weeks, we’re going to start to see a turning around of the dynamics,” Fauci said on Monday. “Not down to no infections,” he said. “If you’re waiting for classic measles-like herd immunity, that’s going to be a while before we get there. But that doesn’t mean we’re not going to have a significant diminution in the number of infections per day and a significant diminution in all of the parameters, namely hospitalizations and deaths.” Visit the CNBC website for more details from the interview.
NBC News reports that, “After a worrisome uptick in Covid-19 cases in the United States in recent weeks, there are encouraging signs that the situation is beginning to stabilize, according to the Centers for Disease Control and Prevention. New reported infections fell by 21 percent over the past week, with the most recent seven-day average coming in at just over 54,400 cases per day.”
New At-home Pill to Treat Covid Could be Available by Year End
CNBC reports, “Pfizer’s experimental oral drug to treat Covid-19 at the first sign of illness could be available by the end of the year. Health experts say the drug, taken by mouth, could be a game changer because people newly infected with the virus could use it outside of hospitals. Researchers hope the medication will keep the disease from progressing and prevent hospital trips.” |
Submission Deadline TOMORROW for 2021 HHAC Call for Speaker Proposals
If you are interested in speaking at HHAC's 2021 Annual Conference, please submit a Speaker Proposal no later than Friday, April 30, 2021. Our Annual Conference will be returning to a live audience October 11-12, 2021 in Keystone, Colorado, so please plan for your sessions to be live and in-person.
Click here to submit a proposal. |
Bipartisan group of senators reintroduces HEAT Act
McKnight’s Senior Living
Diane Eastabrook
April 27, 2021
Newly reintroduced legislation would provide Medicare reimbursement for audio and video telehealth visits provided by home health agencies during the ongoing pandemic and future public health emergencies.
Sens. Susan Collins (R-ME), Ben Cardin (D-MD), Roger Marshall (R-KS) and Jeanne Shaheen (D-NH) introduced the Home Health Emergency Access to Telehealth (HEAT) Act late last week. An earlier version of the measure was introduced last October.
“Home health serves a vital role in helping our nation’s seniors avoid costly hospital visits and nursing home stays and remain right where they want to be — in their own homes,” Collins said. “Our bipartisan bill would ensure that seniors in Maine and across the country retain access to remote home health service during public health emergencies.”
Both Cardin and Marshall noted that telehealth during the pandemic has improved access to home healthcare. “This legislation allows the flexibilities necessary for our home health providers to continue assisting their patients while keeping them safe and at home,” said Marshall, a medical doctor.
Shaheen pointed out that people in rural areas have care access challenges. “Increasing coverage for audio and telehealth services has long been an issue in our more rural areas, but the COVID-19 pandemic further exposed how urgently this must be addressed,” Shaheen said.
HEAT would authorize Medicare to reimburse for home health services provided through telehealth during a public health emergency where virtual visits can be used appropriately. The services would not be reimbursed unless the beneficiary consents to receiving services through telehealth.
In recent weeks, a handful of states including Ohio, New Jersey and South Dakota have passed legislation or amended rules regarding reimbursement for telehealth services through Medicaid.
A number of home health organizations and agencies including LeadingAge, the Visiting Nurses Association and the National Association for Home Care & Hospice have endorsed the Senate bill. |
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