In recent months there has been a growing chorus of advocates for the aging and disabled in the United States, and they are calling for home care agencies, caregivers, and local government agencies to step up and ensure that when these men and women need support, they can get it. Unfortunately, there has been increased confusion, especially for those who will require long-term care.
One of the troublesome aspects that seems to be causing confusion involves the requirement that a person show signs of improvement in order to continue relying on in home care (paid for through Medicare). As the federal government has been cracking down on Medicare and Medicaid fraud and abuse through home care, it appears that those efforts have led to unintended consequences, confusion, and even frustration for some agencies.
As noted by a blog posted by Elder Law Answers (the blog entitled, Home Health Care Patients [w]ith Chronic Conditions Are Having Trouble Getting Medicare):
“According to a Kaiser Health News article, confusion over whether or not improvement is required (it is not) is one part of the problem. Another issue is that home health care workers are afraid they will not get paid if they take on long-term care patients. In an effort to crack down on fraud, Medicare is more likely to audit providers who provide long-term care. This encourages providers to favor patients who need short-term care.
In addition, Medicare’s Home Health Compare ratings website may be having a negative effect on home health care agencies’ willingness to provide for long-term care patients. One measure of care qualify is whether a patient is improving.”
If clients are not expected to improve with their health situation (either due to age, disability, or other factors beyond their control), and if that’s going to add a negative strike against the home care agency, it stands to reason that such an agency would be wary of offering services. After all, if they are only going to earn a negative score for something it can’t control, why would a home care agency want to take on that reputation of offering ‘less than ideal’ care just because a patient is not improving?
The situation is complex and unfortunately the aging and disabled are caught in the middle. It’s important that home care agencies understand the rules, expectations, and provide optimal care, even for those with chronic conditions, but the Center for Medicare and Medicaid Services does need to address some of the concerns expressed by agencies already impacted negatively.
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