Will your patients fall through the cracks?

Changes in Medicare, acquisitions impact many

Home care is an industry under siege. Not only have changes in the Medicare reimbursement system forced more than 1,000 agencies out of business nationwide, but those agencies that are left are being devoured by corporate giants.

"The changes are coming fast. The telephone book is no longer a useful tool for a case manager trying to locate an agency for a client," notes LuRae Ahrendt, RN, CRRN, CCM, nurse consultant with Ahrendt Rehabilitation in Lawrence ville, GA. "I recently told a colleague that when I call an agency now, I listen very carefully to the name given when the phone is answered. it’s very likely to be different from the name you were familiar with six months ago."

With acquisitions and buyouts in the home health industry come other changes for case managers, she notes. "When new companies come in, they provide different standards of care, different training, and the process of bringing new people on board is delayed," says Ahrendt. "These can be positive changes, but learning new personnel policies and trying to get cases started can be cumbersome. Referring cases into the agency and getting services started in a timely manner becomes more difficult."

Of course, the other big news in home health is the new Medicare prospective payment system (PPS). "Everyone in home health seems uneasy. They aren’t sure what’s coming next, and I really believe that the initial cut backs from the Health Care Financing Administration are only beginning," she says.

Perhaps most troublesome are the patient populations no longer covered by community care benefits. "There were some provisions for basic home-making and bathing care under the old system. "The total removal of those services has left many clients and families devastated. There will be an increasing number of individuals who fall through the cracks in the coverage system between what is affordable and Medicaid eligibility. And most of those individuals are our parents."

Ahrendt and others urge case managers to encourage clients to invest in a long-term care policy with good home health benefits before they become chronically ill. "As case managers, I think we have a responsibility to encourage our clients to purchase these policies in their younger years before they need them and while they can still pass the physical and qualify for lower rates," says B.K. Kizziar, RNC, CCM, CLCP, case management consultant for Blue Cross/Blue Shield of Texas in Richardson. "Remember, private insurance and Medicare both require that a patient have a skilled nursing need before approving home health benefits. With long term care policies, it’s an activity of daily living requirement. If you need help with two or more activities of daily living, you qualify for home health benefits under a long-term care policy."

(Editor’s note: This month we present the second of our two part special report on Alzheimer’s disease. Last month, we explored managed care/community partnerships to develop programs that support patients and their families, tools for ethical decision-making, and tools for developing meaningful activities for dementia patients. This month, we focus on appropriate care for end-stage Alzheimer’s.)