Senior care at home: reducing or adding to cost?


Recently the governor of Pennsylvania, Tom Wolf, declared that he wanted to move several thousands of individuals covered by Medicaid fund from nursing home environments into home care. Read Article…

He determined the savings could add up to hundreds of millions of dollars every year. It’s a potential win for the individuals who may be able to return to a home environment for care – a clear preference for the majority of Americans.

Meanwhile, less than a year ago the journal Health Services Research reported on a study that showed that individuals receiving services and support at home experience many more preventable hospitalizations than those living in nursing home – at a substantial cost to the government’s checkbook. The Forbes article that discusses this dilemma points out that this not a simple correlation, but rather a complex one with many variables.

One of the key equalizers is caregiver training, both for the home care providers and for family caregivers. Teaching direct care providers what to watch for and how best to communicate even small changes to their supervisor or the person’s healthcare provider can have a big impact on hospitalization rates. Family caregivers who are armed with training and support can become a powerful part of the prevention team, too.

When caregivers are empowered with this knowledge they can spot and report changes in condition quickly, often avoiding costly hospital care. Who better to notice the smallest change than the caregiver who spends consist, frequent time with the person?

Clearly cost issues will continue to determine public policy as we are faced with a higher proportion of elders and fewer healthcare resources in the future. Now is the time for the home care provider to start tracking their own client hospitalization rates and investing in training for their team in strategies to prevent unnecessary hospitalizations. With the variety of training options available, including access to over 500 training resources here at the Institute for Professional Care Education, we can show that home care is both a preference and a safe, economical alternative.

15 Responses to “Senior care at home: reducing or adding to cost?”

  1. Bill Estey

    As pointed out in this discussion, there are many variables to consider. There is a known shortage of healthcare workers, particularly those of “boomer” age. This presents significant challenges to the shifting of care from a LTC approach to in-home healthcare. Additionally, it is increasingly difficult to obtain ‘urgent’ care with a PCP. Perhaps a best practice approach would be enrollment in a PACE program where those who are Medicaid recipients can receive day services, clinic support, and in-home services as well.

  2. Dave

    While I have heard the data used, I am concerned that the data dates to the 2003-2005 time-frame. I would like to see current data after the attention directed by hospitals to reduce re-admissions to avoid financial penalties.

  3. Ralph Digneo

    I agree with the original concept, however with the consumer choice model there are many flaws. In Pennsylvania with the consumer option and the outside vendor it uses (PPL) there is no training, no supervision and little to no accountability. We as an agency have nurses visits to determine change in conditions, monthly training, yearly background checks and weekly field visits by our supervisory staff. I believe that is how you keep the most vunerable citizens safe in their homes.

  4. Janis Deets Nowak

    All options need to remain available. Those with community supports and willing family/friends should have the option to remain in their own home. But for those who do not have a support system, the option to live in a group setting must remain. It will require flexibility and compassion on the part of the “system” to deliver care in the best setting possible for each unique person/situation.

  5. Stephen G. Venanzi

    For the past 20 years, after leaving a full time practice as a Marriage, Family Therapist, I joined the ranks of those working in the Dementia Care World as an RCFE Owner. I immediately noticed that there was a “Regression to Dependency” in our demented clients, not unlike what you would experience in a small child. What I brought from my understanding of human development taught me that, “when people come into the world they don’t have a mind of their own.” All human beings make use of a process that most psychologists call ‘mutual cueing.’ During the first 18 months of a person’s life, it’s mother or mother other, which is what I sometimes call our caregivers, sometimes hundreds of times a day, cues with their infant. This cueing is internalized by the child and becomes it’s homeostasis, acting to provide stability to the human psych for the rest of thier lives, or not. The or not part is because as Donald Winnecott pointed out years ago, there are no perfect mothers, only ‘good enough’ ones. So too with caregivers. Some are good mother others connecting and cueing with thier clients. As the older person regresses the name of the game is care ratio. Any one who has worked in the field of elder care for any length of time knows this. So it doesn’t make sense to have a person in a skilled nursing facility unless they absolutely need it for some medical necessity, because the ratio’s can’t come close to what small 6 beds provide, which is usually no more than a 3 to 1 ratio. The rationale here is plan to see, but that is not what governs our current care program for the demented elderly. That question is for another time. Hopefully this helps you with your understanding of why skilled nursing facilities for demented elderly is not the best practice. Steve

  6. Jillian Pickett

    Home Care companies are going to have to buckle down and begin following standards that empower their employees (HHAs) to provide the exceptional care that is needed to care for a senior at their home. Home Instead Senior Care as a network is leading the industry with professional development for their CAREGivers. Those that are expected to support the home care model must be educated in the safety and health concerns of the aging individual. There are studies conducted by HISC, Inc. that have shown the improved outcomes of patients that are discharged home with a Home Instead Senior Care CAREGiver. Many home care companies do not take the initiative to provide support and education to their staff, therefore many home health aids are working independently with the skills they have developed on their own. In any working environment, those that are not supervised will behave the way they see fit. Through quality assurance, communication and education a home health aid can support the effort to keep the senior patient at home and out of the hospital saving Medicare dollars.

  7. Ann

    I think it takes about 15 years in the field, on the ground, with the residents and with patients with a myriad of age-related challenges to fully understand that there needs to be a continuity of care. It’s easy for someone to take a “soundbite” example from one’s own personal experience and generalize that to the entire population. We’ve got people younger and younger with mental health and dementia such as frontal temporal from a myriad of causes. We’ve got the diagnosed Asperger population aging as well. We’re going to adapt – and we are already adapting – big time. If the patients in SNF’s continue to inch their way into RCFE’s, those RCFE’s will just become another version of skilled nursing facilities. Are they already? In California I wonder if we will transition from Community Care Licensing to CA Dept. of Mental Health and to the CA Dept. of Public Health. The level of care over the past 10-20 years in RCFE’s has dramatically changed. Who will care for the more fragile, the more medically needy in RCFE’s especially the 6 bed “mom and pop” type “homes”? Good luck with staffing. The issues are Huge.

  8. S Melendez

    Individuals who are able to return to their home environment for care, is their best medicine. It is true those individuals receiving services and support at home experience less hospitalizations, depression and recover quicker from non-life threatening aliments .
    Through personal experience, (in 2002 I brought my mother home to live with me after suffering a massive stroke, wheelchair bound, completely paralyzed ( right side), speech impaired, dementia/ Alzheimer’s … etc Dr’s didn’t give her much hope.) without question Family members, care givers NEED to be counseled & armed with much knowledge & training before making a life altering decision to care for an aging individual at home. The impact of caring for and aging (disabled) loved one is immense. Healthcare providers and family members MUST be a team in order to provide the best care for the individual. It takes time and patience from everyone involved, but believe me it can be done. It is priceless when you are able to see the happiness, good health, good care of the individual being care for at home rather than in a nursing facility. Mother is 92 years old,( she folds towels, does crafts, gardens all with being confined to a wheelchair & the use of one arm) it’s been 14 years since she came home from the Nursing Facility.
    Medicaid funding still necessary for individuals receiving services and support at home. I believe family member counseling & training should be covered by Medicaid funds (for a determined period of time) . Government Public policy needs to be looked at carefully in order to crack down & prevent Medicaid fraud abuse, by those so called family members “friends, nieces, nephews etc…” . Many that are acting as providers/caregivers just wait for the monthly check, while they abuse, neglected those individuals they pledged to take care for. It is sad, but true. (We were blessed by having been assigned the best provider in the world, she is heaven sent)

  9. Alexander

    OUR Opinion:
    The feeling is better at home.
    IS FACT.
    The old Person need: personal room, food, access of communication, cleaning (clothes and body), and entertaining.
    The Senior Care at Home, we suppose, only workday, 8-9 hours 5 days a week,
    while the old Person’s relatives are working.
    The risk too high, if the old Person stay at home alone, if the Care less them 8-9 hours.
    Today the price of Care at Home in our Country: $ 20.00/hour.
    With this price, monthly ( 5 days a week, 4 weeks/mo): 4 (weeks)*5 (days)*9 (hours)* 20 ($/h) = $ 3,600.00 / mo.
    Our ALF’s full price between $ 2,500.00 – $ 5,000.00 / mo, with personal room, personal bathroom, food, cleaning, washing and entertaining, depend on the Resident’s health history.
    The Home Care representative able to prepare the special food, if necessary?
    Who will take care the old Person in the night, if the relatives must work the next day, and Saturday& Sunday, if the Family like to go out from they home, without the old Person?
    The Care by Family members are skilled?
    The Care by Family members able to prepare the special food, if necessary?
    Who will take care well the old Person if his/her weight is too high?
    What’s the idea, if the Care need 24 hours/day (Limited Mental Care, Escape, or some else)?
    What the opinion of Family’s, and the old Person’s?
    We suppose they are only the basic questions.

    ALF Manager

  10. Carlotta

    I have been doing Homecare for 16 years now. I have been trying to get people to see this fact. So many people could function just fine at home with some help. Eating properly, taking their medication and keeping them clean makes such a difference.

  11. Stephen

    Yes, I support all, home care is the best quality life for all seniors, hope all States support this proposal
    NHA , LVN,
    RCFE administrator 32 years

  12. Kathy

    In addition to the points made below, states continue to move the minimum wage up and the payment rates remain stagnant. The home care agency owners that I know do not have a lot of “fluff” built into their profit margins to absorb a lot of additional costs. Also, hiring and retaining competent caregivers remains a challenge for all of us. Some days it feels like nothing but challenges all around……

  13. Rachelle Simmons

    I work for a non medical home health care company. We place non medical caregivers in our elderly client’s homes. Most of our caregivers are CNAs, MAs, in nursing school, retired nurses or individuals with 5+ years experience with on the job training. Most of our clients are not at nursing home level yet, but we have quite a few that are. I do believe that honoring a loved one’s wishes to stay home is very admirable, however I would like to point out just ONE important aspect. That is the family dynamic. If an elderly person is in their 70s to 80s then their children are not of retirement age and still need to work. If an elderly person is in their late 80s to late 90s then their children are of retirement age, but probably not in much better physical shape than their parents and have ailments of their own. Also, you would be surprised at the amount of dysfunction and rivalry that happens between parents and children and sibling vs sibling, drug abuse, financial strain, etc…a lot of skeletons in the family closet. While and elderly person may respond well to an outside caregiver, they do not so much with family members. I don’t mean to sound negative, I have witnessed many family situations where you can see the bond and loving care. It warms my heart to see the family members pull together. You can feel the love. But I have also witnessed the dark side as well.

  14. Sharon Brothers

    Thank you to everyone for joining the conversation on this important topic. The variables are many and complex, but it is clear that there is an army of dedicated senior care professionals working in all care settings to preserve the dignity, independence and preferences of those receiving care.

    That’s a good thing, since we’ll all be personally affected at some point in time – if not already!

  15. Beth Ann

    I totally agree with the governor, the government would also save money if nursing homes would transfer qualified residents from a skilled setting (Medicaid paying $200/day) to an assisted living facility (Medicaid paying $30/day). Someone would need to visit the Nursing Homes and determine if residents were candidates for assisted living facilities because the Nursing Home is not so willing to transfer the resident because that would decrease their census and income.


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