In The News

Diabetes Multiplies Hospital Admission Risk for Home Health Patients, Study Finds

McKnight’s | By Adam Healy
Home health patients with diabetes are three times more likely to be hospitalized than those without, according to a new study published in Nursing Outlook
Almost half of home health patients suffer from diabetes. According to the study, it is one of the most common chronic conditions among people in this population. Among 5,300 community-dwelling home health patients with diabetes, the study recorded a hospital admission rate of 29.5%, affected by risk factors such as past hospitalizations, decreased performance in activities 
of daily living, depression or unhealed acute injuries.
The researchers compared this to people with diabetes in assisted living. These people may struggle more with activities of daily living or have greater cognitive impairments, the study noted, but they had a lower rate of hospital readmission due to access to round-the-clock assistance, meaning they were able to receive more timely preventive care 
For home health patients, one of the best predictors of hospital readmission was whether a person had been hospitalized in the past six months. Home health patients who had been recently hospitalized were more than twice as likely to be readmitted. Another strong predictor was someone’s function completing activities of daily living. The participants who struggled to manage their daily activities were more likely to be hospitalized. 
Conditions such as depression, decreased cognitive function and unhealed acute injuries like ulcers were all found to impact people’s ability to manage activities of daily living. While assisted living patients had greater access to support for these conditions, home health patients who lack access faced a higher risk of hospitalization, according to the study. Therapy services and other health interventions can help manage these conditions and help prevent rehospitalization, the researchers noted. 
Other research has found that staffing problems in the home care industry may lead to discontinuity of care, which can increase a patient’s risk of hospital readmission.


Report: Engaging Family Caregivers, Diversifying Referral Mix are Keys to Sustainability

Home Health Care News | By Patrick Filibin
Home-based care providers have an opportunity to differentiate themselves by honing in on what they’re great at.
A number of factors are transforming the environment in which home-based care providers operate: the rise of value-based care, regulatory scrutiny, reimbursement falling behind rising costs and staffing shortages.
Amid all of that, more than ever, providers need to sell their worth.
“Whether it’s value-based care, talking about diversifying risk or other factors, the opportunity to meaningfully differentiate an organization through the lens of its strengths is actually a tremendous opportunity for smaller providers to compete against larger ones,” Transcend Strategy Group President and CEO Stephanie Johnston told Home Health Care News.
In a new research report, Johnson and her colleagues outlined a number of potential strategies that providers can follow to be better equipped for change in home-based care.
It’s no longer enough for agencies to trust that high-quality care and word-of-mouth reputation alone will sustain their businesses, the report argues.
In order for agencies to thrive today and in the future, a strong value proposition to payers is a critical aspect of an agency’s business operation. In particular, having a diversified referral mix could be a core component for driving sustainability.
“Way too often — and still recently — we hear people tell us that they are still relying on a primary referral source to drive volume,” Johnston said. “Basic risk management will tell you that [strategy] is too risky for today’s care providers at home. They need to think about diversifying their referral mix.”
Johnston compared it to an investment portfolio. Logic would tell an investor not to go all in on one investment asset. Instead, one would manage risk across multiple assets.
“That’s exactly what home care providers should do,” Johnston said. “They should think about a referral portfolio that they’re managing that should include relationships with physicians, hospitals, SNFs and patients and families themselves.”
Relying on hospitals as a primary referral source, where highly acute patients are likely to come from, can create unwanted exposure when staffing becomes a problem, for instance.
From a staffing perspective, Transcend’s report also encourages providers to embrace family caregivers. Many providers, the report argues, are focusing on fighting for the same pieces of the pie.
By looking outside the box and welcoming family caregivers into the employee fold, the pie can be expanded.

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For Home Care Providers, HCBS Operating Environments Still Vary Greatly From State to State

Home Health Care News | By Joyce Famakinwa
More than three years after the start of the COVID-19 pandemic, the U.S. is still seeing major gaps in long-term care for seniors, according to a new AARP report
“We know that some states are taking steps to innovate or put new policies in place, such as paid leave for family caregivers, or a payroll tax credit for family caregivers, but state action is generally falling short of what the aging populations in these states need, so that people can live their final years or even decades in dignity with access to the best care possible,” Susan Reinhard, senior vice president of AARP Public Policy Institute, said during a Thursday press call.

The report found that 53% of Medicaid long-term services and support spending for seniors and adults with physical disabilities went to home- and community-based services.
Plus, 12 states spent the majority of Medicaid long-term services and support funding on home- and community-based services. This is an increase from seven states in 2009.
Family caregivers were also a big focus area of the AARP report. 
“No.1 is prioritizing family caregivers — 48 million family caregivers who really are the backbone of the long-term care system,” Reinhard said. “They are providing more than $600 billion in unpaid care. They need help – paid sick leave, tax credits and other mechanisms to address the family caregivers’ health and financial needs, so that they can stay on the job, frankly.”
The report concluded that states that had policies meant to support family caregivers needed to maintain their policy framework, but also make sure that those policies were effectively implemented. It also found that states with strong family caregiver supports in place tended to have better overall long-term services and support systems. 
The report also dug into the home- and community-based care infrastructure. 
“It’s important to address a whole infrastructure, such as increasing support and training for home health aides for home visits, supporting the ability to access and use medical devices and equipment, and most important is updating key Medicaid regulations and payment models,” Reinhard said.
AARP found that between 2018 and 2020, 21 states improved their Medicaid spending balance by 10% or more, while 6 other states declined by at least 10% during that time period.
The report found that 23 states saw a 10% or more increase in home care costs. Inflation, growing demand and consumer preference for home care over nursing homes are some of the contributing factors to these higher costs.
Additionally, 16 states saw a 10% or more decrease in home health aide supply, while 18 states saw a 10% or more increase.
Ultimately, Reinhard stressed the importance of enhancing long-term care support and services for seniors. 
“It’s really critical that we improve the aging experience for all Americans across the country,” she said. “Our ability to get this right largely depends on our ability to care for our loved ones … that requires providing both humane and holistic long-term care support and services.”
Click to See State Scorecard


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Government Shutdown Averted with Little Time to Spare as Biden Signs Funding Before Midnight

AP News | By Lisa Mascaro, Kevin Freking and Stephen Groves

WASHINGTON (AP) — The threat of a federal government shutdown suddenly lifted late Saturday as President Joe Biden signed a temporary funding bill to keep agencies open with little time to spare after Congress rushed to approve the bipartisan deal.

The package drops aid to Ukraine, a White House priority opposed by a growing number of GOP lawmakers, but increases federal disaster assistance by $16 billion, meeting Biden’s full request. The bill funds government until Nov. 17.

After chaotic days of turmoil in the House, Speaker Kevin McCarthy abruptly abandoned demands for steep spending cuts from his right flank and instead relied on Democrats to pass the bill, at risk to his own job. The Senate followed with final passage closing a whirlwind day at the Capitol.

“This is good news for the American people,” Biden said in a statement.

He also said the United States “cannot under any circumstances allow American support for Ukraine to be interrupted” and expected McCarthy “will keep his commitment to the people of Ukraine and secure passage of the support needed to help Ukraine at this critical moment.”

It’s been a sudden head-spinning turn of events in Congress ahead of the midnight funding deadline after grueling days in the House pushed the government to the brink of a disruptive federal shutdown.

The outcome ends, for now, the threat of a shutdown, but the reprieve may be short-lived. Congress will again need to fund the government in coming weeks risking a crisis as views are hardening, particularly among the right-flank lawmakers whose demands were ultimately swept aside this time in favor of a more bipartisan approach.

“We’re going to do our job,” McCarthy, R-Calif., said before the House vote. “We’re going to be adults in the room. And we’re going to keep government open.”

If no deal was in place before Sunday, federal workers would have faced furloughs, more than 2 million active-duty and reserve military troops would have had to work without pay and programs and services that Americans rely on from coast to coast would have begun to face shutdown disruptions.

“It has been a day full of twists and turns, but the American people can breathe a sigh of relief: There will be no government shutdown,” said Senate Majority Leader Chuck Schumer, D-N.Y.

The package funds government at current 2023 levels until mid-November, and also extends other provisions, including for the Federal Aviation Administration. The package was approved by the House 335-91, with most Republicans and almost all Democrats supporting. Senate passage came by an 88-9 vote.

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