Skilled Home Healthcare Services
Why Home Healthcare is Important
- Every 13 seconds, another American turns 65 years old. That trend will continue for the next 20 years.
- There are 40.4 million seniors in the U.S., 12 percent of the population. In 20 years, that number will total 70 million, or 20 percent of the population.
- More than 27 million of these individuals are over age 70, and more that 1 million are over age 80.
- More than 43 million people in the U.S., 19 percent of the population, provide care for an elderly family member or friend.
Source: Senior Helpers
Skilled Care Provided in the Home
- Cardiac & Pulmonary Care
- Neurological Rehabilitation
- Wound Care
- Intravenous (IV) Therapy
- Pain Management
- Chronic Disease Management
- Medication Management
Source: Centers for Medicare & Medicaid Services
Case Study: Veterans Affairs' Home Based Primary Care (HBPC)
- The VA has provided comprehensive primary care services to veterans in their homes since 1972 in an effort to keep patients in their homes and reduce inpatient hospital days.
- The program was specifically designed to target patients with complex chronic diseases through an interdisciplinary team of health professionals.
- HBPC showed a reduction in inpatient hospital days by 62 percent and a reduction in nursing home bed days by 88 percent.
- The mean total VA cost of care dropped from $38,000 to $29,000 per patient per year for patients enrolled in the program (a 24 percent reduction).
Source: Beales JL, Edes T. (2009). Veteran's affairs home based primary care. Clinics in Geriatric Medicine 25(1); 149-154.
About Skilled Home Healthcare
- Home healthcare agencies provide services to patients who are homebound and require skilled care (nursing or therapy).1
- Many healthcare treatments that were once offered only in a hospital or a physician's office can now be safely, effectively, and efficiently provided in patients' homes by skilled clinicians. Home healthcare is generally less expensive, more convenient, and as effective as care provided in a hospital or skilled nursing facility.2
- Home healthcare can serve as an intermediate level of care for patients who have difficulty accessing outpatient care or who need intensive assistance with an acute or chronic health problem. For example, Medicare beneficiaries returning home after a hospitalization often receive home healthcare to assist them with the transition.3
- In 2010, approximately 3.5 million Medicare beneficiaries received home healthcare services.4
- In 2010, more than 500,000 registered nurses, licensed practical nurses, home healthcare aides, and other practitioners provided home healthcare to patients.5
About Home Healthcare Patients
- Almost 70 percent of home healthcare patients are senior citizens and 60 percent are women.
- Home healthcare patients are more likely to live alone and have poorer health status.
- Home healthcare patients had an average of 4.2 medical diagnoses per patient at the time of interview.
- Patients' most common diagnoses included: essential hypertension, heart disease, diabetes mellitus, chronic obstructive pulmonary disease (COPD), osteoarthritis, malignant neoplasm, and cerebrovascular disease.
- Home healthcare patients are more likely to have 3 or more impairments with Activities of Daily Living (ADLs)6,7
- The vast majority of seniors (89%) say they want to age in place – i.e., live independently and remain in their home.8
What is the Role of Home Healthcare in America?
- Chronic diseases, such as COPD, diabetes and heart failure, are among the costliest to Medicare – and are the most common health conditions being successfully managed by skilled home healthcare providers.
- Analysis demonstrates that the skilled home healthcare profession has the experience, structure, technology, and transparency best suited to meet patients' chronic disease management needs.9
- According to MedPAC, skilled home healthcare visits permit beneficiaries to shorten or avoid post-acute stays at skilled nursing facilities and other higher cost post-acute care settings.10
- Home healthcare helps patients avoid the inherent risks of hospitalization including infection, delirium, depression, infection and functional decline. Studies show older people, particularly the frail and elderly, have a 23.3 percent risk of being unable to return home after even a very short hospitalization and require nursing home placement.11
Skilled Home Healthcare is Cost Effective
- In 2009, Medicare's average Part A & Part B payment for a home healthcare visit was $14512 , compared to $373 for a day in a skilled nursing facility, and $1,80513 for a day in the hospital.
- According to Avalere Health, skilled home healthcare services saved the Medicare program $2.81 billion over three years. Approximately $670 million is attributable to 20,000 fewer hospital readmissions.14
- A study by the Agency for Healthcare Research and Quality15 showed that approximately one in 10 of the nearly 40 million U.S. hospitalizations are potentially avoidable. The admissions in the study were for conditions for which hospitalization could be avoided with appropriate outpatient care, including skilled home healthcare services.
- Patients 65 and older accounted for 60 percent of the potentially preventable hospitalizations.16 Skilled home care can help ensure seniors maintain their health and avoid episodes requiring acute, facility-based care.
1. Medicare Payment Advisory Commission: Home Health Services. In Report to Congress: Medicare Payment Policy March 2011.
2 Center for Medicare and Medicaid Services. Medicare and You. 2011.
3. Medicare Payment Advisory Commission: Home Health Services. In Report to Congress: Medicare Payment Policy March 2011., p178
4. Medicare Payment Advisory Commission: Home Health Services. In Report to Congress: Medicare Payment Policy March 2011.
5. Bureau of Labor Statistics http://www.bls.gov/oes/2008/may/oes291111.htm#ind
6. Caffrey C, Sengupta M, Moss A, Harris-Kojetin L, Valverde R. Home healthcare and discharged hospice care patients: United States, 2000 and 2007. National health statistics reports; no 38. Hyattsville, MD: National Center for Health Statistics. 2011.
7. Centers for Medicare and Medicaid Services. A Profile of Medicare Home Health: Chart Book. Washington DC: August 1999
8. Clarity/Prince Market Research 2007 Aging in Place Study. Retrieved from http://www.marketingcharts.com/direct/seniors-fear-loss-of-independence- nursing-homes-more-than-death-2343/clarity-aging-in-place-importance-living-independently-seniorsjpg/
9. Suter P, Hennessey B, Harrison G, Fagan M, Norman B, Suter WN. (2008). Home-based chronic care. Home Healthcare Nurse 26(4); 223-229.
10. Medicare Payment Advisory Commission: Home Health Services. In Report to Congress: Medicare Payment Policy March 2011., p178
11. Covinsky KE, Palmer RM, Fortinsky RH, et al. Loss of Independence in Activities of Daily Living in Older Adults Hospitalized with Medical Illnesses: Increased Vulnerability with Age. JAGS. 2003; 51: 451-8.
12. Dobson DaVanzo & Associates, LLC analysis of MedPAC data presented in March 2011 Report to Congress: Medicare Payment Policy.
13. Medicare and Medicaid Statistical Supplement - http://www.cms.gov/MedicareMedicaidStatSupp/09_2010.asp#TopOfPage.
14. Medicare Savings and Reductions in Rehospitalizations Associated with Home Health Use. Avalere Health, LLC. June 2011.
15. Potentially Preventable Hospitalizations for Acute and Chronic Conditions, 2008, Agency for Healthcare Research and Quality, November 2010.
16. Potentially Preventable Hospitalizations for Acute and Chronic Conditions, 2008, Agency for Healthcare Research and Quality, November 2010.
2 Center for Medicare and Medicaid Services. Medicare and You. 2011.
3. Medicare Payment Advisory Commission: Home Health Services. In Report to Congress: Medicare Payment Policy March 2011., p178
4. Medicare Payment Advisory Commission: Home Health Services. In Report to Congress: Medicare Payment Policy March 2011.
5. Bureau of Labor Statistics http://www.bls.gov/oes/2008/may/oes291111.htm#ind
6. Caffrey C, Sengupta M, Moss A, Harris-Kojetin L, Valverde R. Home healthcare and discharged hospice care patients: United States, 2000 and 2007. National health statistics reports; no 38. Hyattsville, MD: National Center for Health Statistics. 2011.
7. Centers for Medicare and Medicaid Services. A Profile of Medicare Home Health: Chart Book. Washington DC: August 1999
8. Clarity/Prince Market Research 2007 Aging in Place Study. Retrieved from http://www.marketingcharts.com/direct/seniors-fear-loss-of-independence- nursing-homes-more-than-death-2343/clarity-aging-in-place-importance-living-independently-seniorsjpg/
9. Suter P, Hennessey B, Harrison G, Fagan M, Norman B, Suter WN. (2008). Home-based chronic care. Home Healthcare Nurse 26(4); 223-229.
10. Medicare Payment Advisory Commission: Home Health Services. In Report to Congress: Medicare Payment Policy March 2011., p178
11. Covinsky KE, Palmer RM, Fortinsky RH, et al. Loss of Independence in Activities of Daily Living in Older Adults Hospitalized with Medical Illnesses: Increased Vulnerability with Age. JAGS. 2003; 51: 451-8.
12. Dobson DaVanzo & Associates, LLC analysis of MedPAC data presented in March 2011 Report to Congress: Medicare Payment Policy.
13. Medicare and Medicaid Statistical Supplement - http://www.cms.gov/MedicareMedicaidStatSupp/09_2010.asp#TopOfPage.
14. Medicare Savings and Reductions in Rehospitalizations Associated with Home Health Use. Avalere Health, LLC. June 2011.
15. Potentially Preventable Hospitalizations for Acute and Chronic Conditions, 2008, Agency for Healthcare Research and Quality, November 2010.
16. Potentially Preventable Hospitalizations for Acute and Chronic Conditions, 2008, Agency for Healthcare Research and Quality, November 2010.
