New Report Highlights Significant Home Care Challenges, Gaps, and Opportunities Amid Growing Demand for Services

Integrated Home Care Services

Integrated Home Care Services, Inc. (IHCS), the nation's leading independent home care benefits administrator of home health, durable medical equipment (DME), and home infusion services, has released a new report highlighting the results of an in-depth survey of health plan executives.

The report entitled "Are Health Plans Prepared for Home Care's Rapid Ascent?" details findings from a survey of 47 health plan leaders familiar with their plan's home care offerings. The independent survey was conducted in September 2022 by national healthcare consultancy Sage Growth Partners.

Results show a growing recognition of the value of delivering healthcare within the home, as well as a rising demand for home-based services among patients and their family members. Ninety-one percent of survey respondents said demand for home care services has risen over the past five years—and they expect that trend to continue. That's consistent with both industry and the Centers for Medicare & Medicaid Services' projections.

Additionally, 96% of respondents indicated that home care costs have increased over the past five years, with more than one-quarter saying costs have increased more than 10%.

"Nationally, there continues to be a significant growth in demand for home care services," said Christopher Bradbury, CEO of IHCS. "This is not surprising, given the surging senior population, the popularity of home care, the advances in homecare-related technology and the significantly lower costs of home care services when compared to facility-based care."

Among other key findings in the report:

• 80% of respondents predicted the increase in home care utilization is permanent.
• Only 38% said their organization is performing "very well" when it comes to supporting the home care needs of plan members. While 60% said they do this "moderately well."
• Nearly two-thirds say executives meet rarely or occasionally to discuss home care.
• 75% said reducing the administrative burden of home care is a top benefit of delegating services to a third party. About 50% said improving service coordination is a key benefit.

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Supreme Court Declines to Hear Case Against Home Health Certificate of Need Laws

Home Health Care News | By Andrew Donlan
 
A home health care company hoping to operate in Louisville, Kentucky has hit a road block in its fight against Certificate of Need (CON) laws.
 
CON laws vary by state. Some have home health CON barriers, while others do not. That results in some states having far more home health agencies than others.
 
Because Kentucky has CON laws in home health care, Dipendra Tiwari and Kishor Sapkota – two Nepalese immigrants – were met with resistance when they tried to open up an agency specifically tailored to the Nepali speaking people of Jefferson County and Louisville.
 
Due to language barriers, Tiwari and Sapkota believed that there was a need for home health care services in the community, and were hoping to keep more Nepali-speaking people out of nursing homes by offering up these services. The agency was to be dubbed Grace Home Care.
 
After a request for a CON was denied by the state of Kentucky, Tiwari and Sapkota filed a lawsuit. The lawsuit was dismissed, however, and eventually, they requested for the U.S. Supreme Court to review their case. They failed to convince the court, however.
 
“In these cases, the challengers often mischaracterize what CON laws do, what they represent and how they actually function,” Matt Wolfe, a shareholder at the law firm Baker Donelson, told HHCN in an email. “Each state’s CON law operates a little differently, but every CON law allows for and encourages public input, involves various stakeholders – including businesses, providers, and patients – and is flexible to adapt its approach to the changing needs of the communities it covers.”
 
CON laws have undergone much legal scrutiny in the past, something that Wolfe does not think will stop just because of this case in Kentucky.
 
Home Health Care News has reported on the pros and cons of certificate of need laws in the past. While some believe that CON laws uphold quality in home health services, others argue that it hurts access and also deters competition. In Tiwari and Sapkota’s case specifically, they were trying – in part – to argue CON laws are unconstitutional.
 
“There is a coordinated and well-funded campaign by ‘free market’ special interest groups to continue to bring these types of legal challenges to the constitutionality of CON laws in federal and state courts,” he said. 
 
And while the cases against CON laws often make intellectual sense, Wolfe does not believe that the evidence has created a good case against them.
 
“CON laws play an important role in ensuring access to quality, affordable care,” he said. “The reality is that health care is not provided in a free market. Repealing or substantially limiting CON laws would do nothing to address access issues. In fact, in states that have repealed CON laws, we have seen a proliferation of providers with no appreciable improvement in access. Instead, home health agencies experience small and unsustainable patient censuses.”

Do We Choose When We Die?

Barbara Karnes

Dear Barbara, my mother suffered from dementia. She passed away in 2019. I was at her side and saw her take her last breath. Does a person with dementia know that she is dying? Neither of my sisters made it over before she died but I believe that she waited for them until the last minute.

You asked if I think your mother waited for your sisters to arrive before she died even though she had dementia. Yes, I do believe a person has some limited control over the time that they die, even if they have dementia.

If you are present with a person at the moment they take their last breath, you are there because they wanted you there. If you are not there, just missed the moment, tried to be there but weren’t, that was a choice also. Generally, it is a choice of love and protection. For some reason the dying person thought it would be better if you weren’t there. Being there and not being there are both gifts.

I believe we are more than our physical body, that there is a “driver” to this vehicle we call our body. It is the “driver” that has control beyond the physical. The “driver” does not have dementia, so the “driver” is aware.

Know that the driver is working very hard to release from a non-functioning body. I do not believe what we would think of as “normal thoughts” are going through the person’s mind, whether they have dementia or not.

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New Resource Available: PHQ-2 to 9 Cue Card

CMS is offering a cue card to assist providers in coding the Patient Health Questionnaire (PHQ-2 to 9) as referenced in the coding guidance for D0150. This resource is intended to be utilized during the Patient Mood Interview as a supplemental communication tool that provides a visual reference to assist patient selection of symptom frequency.

The cue card is offered in two sizes which can be viewed or printed and is available in the Downloads section of the HH QRP, IRF QRP, and LTCH QRP Training pages.

If you have questions about accessing the resources or feedback regarding the trainings, please email PAC Training. Content-related questions should be submitted to the HH QRP Help Desk, IRF QRP Help Desk, or LTCH QRP Help Desk.