Long-Term Care Is Increasingly Becoming Managed Care At Home

Medicaid long-term care is rapidly changing, and some of those trends may eventually remake the way all of us receive personal assistance as we age or become disabled.

Nearly half of all states are now providing Medicaid long-term care benefits through managed care, and 13 states are requiring older adults to receive care that way. At the same time, four out of five states are expanding home care benefits through Medicaid and 16 are even beginning to provide housing services with their Medicaid dollars. These are just a few of the key findings in the Kaiser Family Foundation’s latest annual survey of state Medicaid programs.

How Can Frail Seniors Who Live At Home Get Better Care?

We all want to live at home as we age. But while we may not want to admit it, getting the support we need can be much tougher at home than in a nursing home or assisted living facility.

For all their problems, nursing homes or residential care facilities can be an efficient way to deliver care to many people who live in one building or on one campus. Aides can visit multiple residents by walking down the hall. A community bus can provide transportation. Social supports and activities are readily at hand. Meals are available in the dining room.

What New Managed Care Regulations Will Mean For Frail Elders

Federal regulations are finally catching up with a decade of seismic change in the delivery of Medicaid services. More than 650 pages of proposed new rules are aimed at overseeing managed care, which has become the standard health care delivery system for low-income adults and children, and is now being expanded to include both medical care and long-term supports and services for older adults and younger people with disabilities.

Many of the new regulations are aimed at boosting consumer protections for those enrolled in these managed care plans, including frail elders.

Senators Want To Improve Medicare For Seniors With Chronic Diseases, But Are Ignoring Half The Problem

A powerful bipartisan group of U.S. senators wants to improve medical care for older Americans with chronic disease. By doing so, they are taking an important step in improving the health and quality of life of these seniors.

But so far at least, they are focusing on only half the problem. While older people with chronic conditions do need improved medical care, they also need better social supports, personal assistance,  access to services such as transportation, and safe and affordable housing.  Improving delivery of medical care without including social supports is like pumping air in a flat tire without first fixing the puncture.

Why are So Few Low-Income Seniors Enrolling in Managed Care Plans?

What if they gave a managed care plan and nobody came?

That seems to be the problem with California’s ambitious effort to enroll more than 400,000 low-income seniors and younger people with disabilities into a fully-integrated care program that covers both medical treatment and long-term supports and services.  The idea has enormous promise, but relatively few Californians seem willing to participate. And many who have been automatically enrolled are dropping out.

The California program, called Cal MediConnect, is a demonstration program aimed at the so-called dual eligibles–people who receive benefits from both Medicaid and Medicare. The goal is to improve health outcomes and save money by managing care for those who are high-risk and high-cost patients.

A Modest Step To Improve Medicare Post-Acute Care

Medicare has a huge and growing problem caring for patients after they have been discharged from the hospital. After years of talk, Congress may be about to take a modest but important first step toward cleaning up the mess, and making sure that patients get care that gives them the best chance to live a healthy and active life after a surgery or acute medical episode such as a stroke.

Social Supports for Seniors (And Others) Begin To Go Mainstream

For decades, seniors and others with chronic illness have had to scale a seemingly insurmountable barrier built by the health care system, aided and abetted by Medicare and Medicaid.

On one side of the wall was medical care, mostly controlled by doctors, hospitals, drug companies, and skilled nursing facilities. Medicare paid them to do as many medical procedures as possible, and not surprisingly, that’s what they did.

On the other side: social supports such as community and family assistance, good nutrition, exercise, transportation, and safe housing—none of it paid for by Medicare. Some was funded by other government programs but not through physician practices.

Want To Know Where Senior Care Is Headed? Keep An Eye On Kindred Healthcare

For an important clue into the future of senior care in the U.S., watch Kindred Healthcare, a $5 billion company that operates in 47 states.  As recently as 2010, half of Kindred’s business was generated by its skilled nursing facilities. This year, only one-fifth of its revenues will come from its nursing and rehab centers. In a major strategic shift, Kindred is betting the company on in-home care, hospice, care management, and fully integrated care services.

In an aggressive effort to expand its homecare business, earlier this month Kindred moved to buy Gentiva Health Services for $1.6 billion. Gentiva, which is fighting the takeover, is a $2 billion home care provider with 47,000 employees in 40 states.

Better Coordinating Long-Term Care and Medical Treatment

The most important trend in care for the frail elderly and younger people with disabilities may be what’s called managed long-term supports and services, or MLTSS. This effort to combine medical care with long-term care would replace today’s disorganized, ineffective, and even dangerous system with one that can bring together complex care that’s being delivered by many different providers.

Done well, this model has the potential to improve the quality of life for those receiving care and save money. Done poorly, it puts an extremely vulnerable population at even greater risk than it is today–and may not save money.

Wyden Bill Would Integrate Medicare Health Care, May Open the Door for Long-Term Care

A new Medicare payment model would encourage health systems to provide fully-integrated medical care for people with chronic disease, according new bipartisan legislation sponsored by senators Ron Wyden (D-OR) and Johnny Isakson (R-GA), and congressmen Erik Paulsen (R-MN) and Peter Welch (D-VT).  The measure would allow, but not require, participating providers to offer long-term services and supports as well as medical treatment.

The bill is important because more than two-thirds of all Medicare recipients suffer from at least two chronic conditions. And they often struggle to organize their treatment among different specialists and primary care doctors under fee-for-service Medicare. Wyden, the bill’s main sponsor, is in line to become chairman of the powerful Senate Finance Committee which has jurisdiction over the Medicare program.