Government’s Plan for Staffing Crisis Focuses on Families Filling the Gap
The 2018 United States Census Bureau report shows that as soon as 2035, older adults will outnumber children in the US. With the population aging, the demand for healthcare services increases significantly when the healthcare industry faces potential critical staffing shortages. Outpatient procedures occur more frequently than ever, and hospital discharges happen days sooner than before. Patients go home with tubes, catheters, IVs, and other medical equipment with family members learning how to manage what to do on the day of discharge or from a home health nurse. Based on changes occurring in the healthcare industry, what is the government’s plan for the staffing crisis? The answer is simple but off-base. The federal government wants families to pick up the slack.
Can One Person Do It All?
As federal healthcare regulations push patients out of hospitals into home care, the government expects families to provide the care hospitals can’t. Can they? According to the Us Census Bureau, single-person households increased from 20.6 percent to 36.2% between 1985 and 2020. When a household only has one adult, is it realistic to expect that person to be both a stay-at-home caregiver and the household’s breadwinner? No, it’s impossible. Therefore, are we creating an impossible situation for sustaining the health and well-being of the person we send home needing care? Have we saved money if they must return to the hospital in worse condition than before?
Are Family Units Reliable Sources?
Is the family unit a reliable consideration for home care? The loyalty of the family to care for one another is steadily eroding. Once extended families lived close enough to lend a hand; now, many families only know cousins by name, if at all. Each family unit must rely upon itself for survival. They have no aunts or uncles, grandparents, or siblings to call for extended assistance. With the increase in the divorce rate, runaways, family abandonment, abuse, etc., the government’s plan to rely on family to care for its own after hospital discharge is short-sighted. In many cases, no family may be available to contact.
In 2014 Congress passed IMPACT (Improving Medicare Post-Acute Care Transformation Act of 2014). IMPACT brought about major changes in how home health agencies, long-term care, rehab facilities, and hospitals interacted. For example, they are now all graded on the same measures of success. That means that companies must regularly send reports to one government agency telling them how well they did on certain criteria.
Each company collects information from their staff and customers on specific things on certain types of events (called Meaningful Measures) such as:
- For example, how many new wounds do patients obtain while under their care?
- How many new infections do patients acquire, and the number of unexpected deaths that occurred?
- The number of falls that happened.
Medicare provides payment to the health care company based on the scores received on those reports. Besides paying facilities based on their quality of care defined by their Meaningful Measures scores, there is also a proposal to implement new models of care that require hospitals and home health agencies to partner in receiving payments for care.
For example, in 2020, Patient-Driven Groupings became effective matching the payment to the individual patient’s needs. In addition, home health value-based purchasing (HHVBP), another new government program set for implementation nationwide in 2022, provides reimbursement to home health agencies based on the quality of care they provide.
What does that mean for families? On the surface, you would think that means that agencies would provide better care. However, having been in healthcare for almost 30 years, it likely means that agencies will focus all their resources on ensuring they do well on those measurements. As a result, staffing will decrease in other areas, and care overall declines because the focus becomes documentation rather than the care itself. When care becomes tied to money, quality almost always suffers.
Funding Not Included
Another reason we have seen an increase in family caregivers is that states have pushed the responsibility to provide services for low-income and special-needs families to local governments. However, requiring the local governments to provide the services did not include the funding to make it happen. As a result, many families no longer receive services. They either cannot afford to pay the copay or shared cost for services or if the locality does not provide the service, they cannot drive the distance to where it is now available.
Service companies continue to struggle with finding solutions to this issue. Consumer-Directed Services is one way Medicaid helps those eligible access care options when services are not readily available. However, Consumer-Directed Services are not a true solution to this dilemma because they also have limited funding. Under Consumer Directed Services, the family can find a neighbor or family member to pay for needed care.
No Money Available
Medicaid is supposed to pay the family member for doing the agency’s job, which provided the care but is no longer available. Unfortunately, with the cut in funding at the local level, Directed Services no longer has money available in many circumstances to pay for assisted care. The result is either using personal funds until the money in the bank runs out or doing without the service.
Home Care Options
Some families find it necessary to place loved ones in assisted living facilities or other rehabilitation centers. To protect yourself and your family, check how well various agencies score facilities using Medicare’s comparison measurements. Their website is called Home Health Compare (https://www.medicare.gov/homehealthcompare). Using this website, you can select the highest quality home health agencies providing skilled care for your area.
Hospital at Home Model
Johns Hopkins is evaluating a model as an option for the future called “Hospital at Home.” This model is used in other countries to treat patients at home who are not acutely ill. In many ways, it resembles how non-critically ill patients received care at home during COVID. For example, early discharge from the hospital to the home helps prevent patient falls, delirium, or decline in their functional abilities.
Families Carry Burden
The disadvantage for the family is that they must provide all the care received and pay for the consultations. Medicare pays none of it. Some third-party insurance carriers may pay families for the care provided, but most won’t. Therefore, the family carries the burden of missed time from work to stay home providing hospital care. Though the program provides huge clinical savings for the government and healthcare industry, it significantly increases the hardship for caregivers.