Senators Concerned Over Home Healthcare in Underserved Communities

Senate Hearing on Home Healthcare in Rural Communities, Committee on Aging. Washington DC, 2020, Masooma Haq

Washington - At present, the home healthcare sector cannot meet the needs of elderly citizens, especially in rural communities. This shortage requires swift action from Congress as the demand for home health care services is projected to increase as the U.S. population ages and people live longer.

Lawmakers must solve a few key issues so the home healthcare industry can meet the growing demand for home health care, especially in small towns. Some of the issues include funding (cuts to Medicaid), antiquated provisions written into the benefits, and attracting qualified healthcare workers to rural communities.

In rural areas, which tend to have a higher elderly population, and isolated settings, home health care workers can be a lifeline for those elderly residents.

Francis Adams, a veteran home care healthcare worker in rural Pennsylvania who testified at the Senate Aging Committee hearing Wednesday, said he is concerned about the shortage of home healthcare workers in the United States and works overtime because of the shortage in his community.

Adams told the committee that many of the elderly in his community have to cut corners to make up for the losses to their Medicare benefits.

Senator Susan Collins (R-Maine) and a majority leader of the U.S. Senate Aging Committee said, “home health care services help patients avoid more costly hospital visits and nursing homes, it saves Medicare, Medicaid, and private insurers millions of dollars each year and allows seniors to age in the comfort and security of their own homes.”

Senator Collins introduced the Home Health Payment Innovation Act, this legislation aims to prevent further payment rate cuts. The measure would provide flexibility in waiving the “homebound” requirement for services.

“As home health agencies are adjusting to the new payment system, I believe that Congress should revisit the rural add-on payment. A well-targeted rural add-on payment is especially needed now. And it is needed to compensate home health agencies that are operating in vast rural areas, such as northern Maine, where they have to drive long distances between patients,” Collins said.

An add-on is a three percent payment modifier to reimbursements for services provided in rural and underserved areas. Rural agencies face higher overhead expenses through factors such as increased travel time between patient visits and demands for extra staff, so the add-on becomes crucial to running their services.

Another bill introduced by Collins, meant to remove obstacles to seniors receiving home health care, is the Home Health Care Planning Improvement Act. This legislation has bipartisan support in the Senate and aims to improve the access Medicare recipients have to home health care by allowing physician assistants, nurse practitioners, and clinical nurse specialists to order home health care services (not just physicians).

Medicare covers a wide range of home care services including skilled nursing care, physical therapy, speech-language pathology, occupational therapy, medical social services, and home health aide care.

According to a 2014 U.S. census report, “Between 2012 and 2050, the United States will experience considerable growth in its older population. In 2050, the population aged 65 and over is projected to be 83.7 million, almost double 2012.”

The forecast growth of the older population in the United States will present challenges to congress and programs, such as Social Security, Medicare and healthcare providers.

“We know from research that people who live along that stretch of road—and along rural roads across the country—are more likely to be older, to be sicker and to be less well-off than their peers. And, as a result, they require more health care services,” Senator Bob Casey (D-Penn.) said.

“We must invest in home health care.” The senator introduced, the Home and Community-Based Services Infrastructure Improvement Act (HCBS). This bill would provide Medicaid grants to states to support existing service providers and encourage the creation of new delivery systems to meet the needs of older adults and people with disabilities.

The HCBS funding could be used to improve infrastructure like housing, transportation, expand counseling and employment for those with disabilities and increase wages for home health care workers.

Currently, low wages (a median wage of $11.57 per hour), lack of benefits and basic protections, and isolation contribute to a critical shortage of home care workers. National workforce turnover rates were as high as 60 percent in 2014.

According to PHI, a workforce research and data center in New York City, the U.S. “needs to attract one million more workers to the home care industry by 2028 to meet the increasing demand.”

Adams believes that the government needs to improve pay, medical coverage and career opportunities for home care workers so more people will be willing to do this demanding but important work.

“A lot of the tasks I do in home care are physical—bathing, cooking meals, cleaning, helping clients go to the bathroom, driving them to and from appointments, helping them get in and out of bed—but it’s the emotional connection that really makes an impact,” said Adams.

Adams said that often, a home healthcare worker is the only person that a patient will see for weeks at a time.

Senator Casey told the committee that his legislation aims to get services to those elderly that need it the most, “My bill aims to change that—to make home-based care and services a reality for all who need it. An investment in home care is an investment in the future of rural America…”