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Extend Medicare's 'rural safeguard' to help Oregon seniors stay home

Published by The Oregonian
Fawn Barrie
May 25, 2017

Ask your parents or grandparents where they want to spend their twilight years and most will likely tell you, "In my home." A recent survey of Oregonians over the age of 45 conducted by AARP found that 85 percent responded that as they age, they wish to remain in their own homes with caregiver assistance rather than relocate to facility-based care.

Thanks to a Medicare safeguard enabled by Congress, even seniors living in remote parts of the country have the option to remain at home as they get older. This is particularly important to Oregon seniors.

Oregon is home to approximately 667,500 residents age 65 years and older, of which 43.5 percent live in rural communities. Further underscoring the importance of readily available senior care is that population is expected to increase by 105 percent by 2050.

Each year, millions of Medicare beneficiaries continue living in their own homes thanks to the program's home health benefit. Whether they receive home health services following a hospital stay or because of a health status change, home healthcare providers help seniors receive care in a safe and comforting environment.

This isn't simply a matter of convenience, it's good for the federal budget. Home healthcare reduces unnecessary hospitalizations and nursing home stays. A new analysis by The Moran Company found that annual spending on a per-beneficiary basis is lowest for home health compared to all other care settings.

The lower cost is even more impressive considering the health of its recipients. Seniors receiving home health services are older, have more chronic health conditions, are more likely to have a disability, and are generally lower income than other Medicare beneficiaries.

Yet despite the lower cost, not all Medicare beneficiaries have the same access to home health services. Seniors on Medicare in rural counties receive fewer home health services compared to those in urban counties, even after accounting for population differences.

The discrepancy is even more troubling considering that recipients in rural areas experience many chronic conditions and disabilities at higher rates and more likely to live in poverty. In addition, rural home health beneficiaries live about twice as far from their doctor and hospital as urban beneficiaries.

Congress has recognized the critical need for home health services in rural areas, as well as the challenges of providing it. Since 2000, Congress has worked in a bipartisan way to authorize additional reimbursement for home healthcare provided in rural areas. This "rural safeguard" was most recently extended, but it expires on Dec. 31.

I strongly urge Congress to extend the rural safeguard so that rural Medicare beneficiaries - like their urban counterparts -- can access high quality, cost effective home healthcare allowing them to remain at their home as they age.

Americans aging in rural communities already face a variety of challenges that individuals in large towns and cities rarely encounter, including limited resources and access to community services. Let's not make access to home health care another struggle for our rural seniors. Congress can protect home-based care for rural seniors by doing what they have done for nearly 20 years: Ensuring the Medicare home health rural safeguard is extended beyond this year.

Fawn Barrie is executive director of the Oregon Association for Home Care, which represents a majority of Oregon's rural home health agencies.

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