While the dynamics of the care workforce continue to shift, low and falling wages may be holding back new workers from entering the space, according to a new report from the Institute for Women’s Policy Research released Thursday.

The report looked at data from 2005 to 2015, during which time the U.S. market saw the care workforce—including child care and adult care workers—grow by 19%, with most of that growth within adult care specifically.

“Especially around elder care, [workers] are mid-career, further along, and more educated, even where there are more immigrant workers,” Jeffrey Hayes, job quality and income security program director at the institute, told Home Health Care News. “Despite the fact and the proven quality of the workforce, the wages are stagnant or falling.”

Workforce makeup

One of the most significant trends in the care workforce is the high growth rate of men entering the field, the Institute for Women’s Policy Research report found.

Although the care industry is still dominated by women, men represent a rapidly growing part of the workforce. Between 2005 and 2015, the number of male care workers grew by 42%, compared 17% growth for women, according to the report. Women currently make up about 88% of the care workforce.

The growth rate of male workers was surprising to researchers, Hayes said.

“The growth rate [for men], the numbers are impressive,” he said.

In addition to more men in the field, the past decade has brought forth a higher prevalence of workers of color and foreign-born workers. For the entire care workforce, the numbers of racial and ethnic groups increase 19% from 2005 to 2015. Hispanic and other or mixed groups increased 48% and 57%, respectively, with the fastest growth in employment by any race and ethnic group within home-based adult care.

Foreign-born workers were also more likely to be naturalized U.S. citizens and have been living in the country for at least 10 years. Current immigration policy debates could potentially impact the rise in the immigrant population in the workforce, however.

“Something has to be done to make sure we have proper programs in place to bring in workers with these skills,” Hayes said. “Overall, it’s better to let wages go up and attract workers already here in the job.”

Low wages

It is well-known that home care workers are among the lowest paid jobs in the nation, with a median hourly wage of just $10.49 in 2017.

Home care workers are increasingly more educated and older, but that isn’t necessarily translating to higher wages. For many industries, greater education levels and an older workforce suggest a larger skill set and corresponding higher wages, according to the report.

But for home care workers, the opposite seems to be true. From 2005 to 2015, male care workers saw wages dip 16.5%, while women saw wages decline 5.2%, according to the report. While men’s wages declined faster, they had higher wages overall compared to women.

A significant portion of the workforce population also lives in poverty or near poverty, the report found.

“It looks like many of the workers are living in povery or near poverty,” Hayes said. “Generally, when we look at employee groups, jobs [are[ one of the key ways people get out of poverty in the U.S. [Here], it looks quite high.”

The Institute for Women’s Policy Research is a Washington, D.C.-based organization that conducts and communicates research focused on shaping public dialogue and policy.

The report was supported by the MacArthur Foundation Small Grants Program for Fellows, with collaboration from the National Domestic Workers Alliance and Caring Across Generations.

Written by Amy Baxter

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Caris Healthcare, L.P. and its wholly-owned subsidiary, Caris Healthcare, LLC, have agreed to pay $8.5 million to settle allegations they violated the False Claims Act by knowingly submitting false claims and retaining overpayments for patients who were ineligible for the Medicare hospice benefit because they were not terminally ill, the Department of Justice (DOJ) announced.

Caris Healthcare is a for-profit hospice chain that operates in Tennessee, Virginia and South Carolina.The government’s complaint alleged that Caris admitted patients whose medical records did not support a terminal prognosis.

The complaint further alleged that when Caris was alerted to the ineligibility of patients, the hospice provider continued to submit claims and took no meaningful action to determine if it had received improper payments. 

Barbara Hinkle, a registered nurse who formerly worked for Caris Healthcare, filed allegations in a lawsuit as a whistleblower. Under the False Claims Act, the whistleblower’s share will be $1,402,500.

Texas Doctor and Nurses Convicted in Home Health Fraud Scheme 

One physician and two nurses were found guilty of health care fraud in Texas, and one physician and one nurse guilty of conspiracy to commit health care fraud, for their roles in a home health fraud scheme topping $11.3 million, according to the DOJ. 

According to trial evidence, the defendants engaged in the scheme to defraud Medicare by submitting and causing the submission of fake and fraudulent claims through Timely Home Health Services, a home health agency, and Boomer House Calls, a physician house call company. 

Kelly Robinett, M.D., 70, of Denton County, Texas, and Kingsley Nwanguma, 47, of Dallas County, were each convicted of one count of conspiracy to commit health care fraud and three counts of health care fraud. Joy Ogwuegbu, 42, of Collin County, was convicted of four counts of health care fraud

The evidence showed Robinett, a doctor of osteopathic medicine, certified services that were often not provided for patients he had never seen, the DOJ stated. Ogwuegbu, a registered nurse, falsified nursing assessments. Nwanguma, a licensed vocational nurse, falsified nursing notes, making it appear as if Medicare beneficiaries were qualified for and were provided skilled nursing services, according to the DOJ.  

Written by Amy Baxter

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The 2019 state budget includes a 10% unencumbered increase for Medicaid fee-for-service personal care attendant services and a 29% increase for Medicaid FFS skilled nursing, therapeutic care and hospice, both effective July 1, 2018.

In addition, the budget secured unencumbered annual inflation increases (COLA) for all Medicaid home care and hospice rates starting July 1, 2019. The plan is a first for a state Medicaid home care or hospice program in the nation, according to the Rhode Island Partnership for Home Care.

“By adopting an annual COLA, this will ensure that Medicaid-contracted home care and hospice providers will remain competitive in the labor market and meet the challenges of cost inflation for medical equipment and supplies, operational costs, workers’ compensation and professional liability insurance rates and federal and state taxes that have otherwise hindered providers from accepting Medicaid patients and have closed providersthat had a high Medicaid patient census ratio,” Nicholas Oliver, executive director of the Rhode Island Partnership for Home Care, said in a statement.

States frequently pass incremental increases to Medicaid programs to keep up with rising wage rates and inflation, though many home care agencies have to lobby for these actions themselves.

Personal care attendant services received small wage pass-throughs in 2008, 2017 and 2018 state fiscal years. However, skilled nursing, therapeutic care and hospice hadn’t received rate increases since 2002, according to the Rhode Island Partnership for Home Care.

“Hospitals and nursing homes have annual rate adjustments and fight to keep the COLA every year,” Oliver told HHCN. “Why can’t home care?  …  We saw the COLA as a vehicle to be able to not advocate for dramatic increases, but get us where we need to be.”

The new budget will ensure that home care providers don’t have to continue lobbying for new rate increases annually.

“I think our legislature is tired of hearing [they] need to remember us year after year, so they created a mechanism in Rhode Island in statute that allows us to have our rates adjusted  annually based on cost inflation,” Oliver said.

Written by Amy Baxter

The post Rhode Island Secures Rate Escalators for Medicaid Home Care Program appeared first on Home Health Care News.

Specifically, Humana is acquiring a stake in the home health and hospice business of Kindred Healthcare (NYSE: KND) as part of a joint venture with two private equity firms. In addition to Kindred, Humana is buying hospice provider Curo for $1.4 billion, also with private equity firms. The company’s purchase underscores the booming business of hospice care—though the move from insurer to provider also highlights big grabs by insurance companies into lucrative and somewhat controversial businesses, The New York Times reported.

Humana’s decision to bet on hospice, rather than on primary care, proves it wants to own health care in the home and take on end-of-life care. At the same time, the deal places Humana “squarely in the middle of the debate” of emerging hospice issues, according to the NY Times.

“In short, Humana, which provides Medicare Advantage plans to about 3 and a half million people for their medical needs, also wants to dominate care for those at the end stages of life, whether it provides aid in a home setting or in a facility,” the article reads.

However, hospice’s growth over the last several years has also given rise to worries about increasing fraud, neglect and malfeasance across the space.

“Companies have been accused of signing up people who are not terminally ill, denying visits from a nurse or even refusing a needed trip to the hospital,” the NY Times reported.

Too little care is a common danger across the industry, the article alleged, citing for-profit companies that are more driven by profits than quality of care. Some private companies can make as much as 40 cents of profit for every dollar of revenue, or a 40% profit margin, Emily Evans, a managing director for Hedgeye Risk Management, told the NY Times.

Those high profit margins have been driving a lot more interest in the hospice space, including a new influx of investments from private equity groups in both home health care and hospice.

Kindred and Curo have both had to pay millions in settlements after being accused of overbilling Medicare for hospice care services as well as accusations of kickbacks.

Other insurance providers, including UnitedHealth Group, have sold their hospice businesses as a result of these ongoing billing issues and lawsuits across the industry.

Some providers may see that the margin is simply worth the risk, the NY Times reported. Humana will also be able to better align its roughly 3 million Medicare Advantage members with in-home care services through its new acquisitions.

“Analysts say any insurer offering a Medicare Advantage plan would benefit in seeing patients opt for hospice, rather than continue much more costly treatments at the end of life,” the article reads.

Insurers that can direct terminally ill patients to hospice care can save money under the Medicare hospice benefit and also provide the care to members trhough its own hospice service line.

Coupled with Humana’s home health care business, “Humana wants to own the home,” Chas Roades, a consultant and founder of Gist Healthcare, told the NY Times.

Humana may also even be eyeing a future in which hospice care is part of Medicare Advantage—and possible carve-ins have been floated.

Written by Amy Baxter

The post NY Times: Humana Wants to ‘Own the Home’ appeared first on Home Health Care News.

First up, a survey from Japan revealed that more than half of all visiting nurses have experienced some sort of harassment when going into patients’ homes. When asked whether they had experienced physical, mental or sexual harassment, half of respondents said yes for each category, the survey by the National Association for Visiting Nurse Service found.

One of the biggest impacts of hospice care is ensuring that people don’t die alone. That holistic sentiment is strong in one prison-based hospice care, at the California Medical Facility in Vacaville. Read the report by Reuters here.

A home health care aide reportedly ripped off a client by stealing thousands of dollars and taking off for a beach vacation.

Most read

The opioid crisis has reached a fever pitch across the country, and hospice providers are taking on a bigger role in caring for patents and families affected by the epidemic.

The relationship between doctors and home health agencies is wrought with communication issues, but the patient-doctor relationship has similar issues that hamper care coordination.

Written by Amy Baxter

The post Must-Read News: Half of Visiting Nurses Experienced Harassment appeared first on Home Health Care News.

The deal will establish the clinics inside two Walgreens stores in Kansas City, Missouri, operated by Partners in Primary Care, a wholly-owned subsidiary of Humana. The venture could also expand to other markets over time, the companies announced Wednesday.

The news comes amid a string of recent M&A activity and deal speculation for Humana. The company recently made moves to acquire a stake in Kindred Healthcare (NYSE: KND), the nation’s largest home health care provider, in a $4.1 billion deal. Walmart (NYSE: WMT) has also been rumored to potentially buy Humana.

The clinics are scheduled to open this fall and will complement Walgreens pharmacy services and the the four Partners in Primary Care locations that opened in Kansas City in 2017. Partners in Primary Care is a primary medical group practice operating in South Carolina, North Carolina, Kansas and Missouri.

“This unique partnership supports Humana’s multi-faceted approach to health care in this community and is a continuation of our senior-focused care strategy which is centered on integrating care through clinical programs that intersect health and lifestyle,” Bruce Broussard, Humana president and CEO, said in a statement.

The pilot also comes as competitors in the industry are looking to expand their services and offer a more complete continuum of services. Pharmacy giant CVS Health (NYSE: CVS) is underway in a bid to acquire Aetna (NYSE: AET), the nation’s third-largest insurance provider for $69 billion. CVS also recently announced it will deliver prescriptions to consumers’ homes from its 9,800 nationwide locations.

The collaboration between Humana and Walgreens underscores that insurers are making major efforts to extend services beyond institutional care, eyeing retail as a major contributor to health in communities.

“We continue to develop new and innovative models to bring health care services closer to our customers, and deliver the trusted care our communities have come to expect from Walgreens,” Stefano Pessina, executive vice chairman and CEO, Walgreens Boots Alliance, Inc., said in a statement. “With this new initiative, we can expand the care for seniors that our pharmacists and other team members have provided for decades. I am confident that this collaboration will be a great example of the power of strategic partnership in providing better health care services in the communities we both serve.”

Written by Amy Baxter

The post Walgreens Teams Up With Humana in Senior Care Clinics appeared first on Home Health Care News.

As the health care system pushes toward value-based care over traditional fee-for-service models, 44% of health care organizations surveyed said they’d invest most in home health care, the report, Candid Conversations on Elder Care, revealed. The report was published by the BDO Center for Healthcare Excellence & Innovation, a consulting and financial firm focused on helping health care organizations drive performance. The survey involved 487 members of the New England Journal of Medicine (NEJM) Catalyst Insights Council, including executives, clinical leaders and clinicians in health care delivery organizations.

The findings reflect the current desires of aging Americans—90% of whom wish to remain in their homes during retirement—and the greater control consumers have in directing their health care.

“Seniors want care focused on maximizing quality of life rather than number of days left,” Steven Shill, assurance partner and national leader at BDO and an author of the report, told Home Health Care News. “They want to spend their last days outside of the hospital and in the comfort of their own homes.”

Beyond home health, organizations said they would invest in palliative care (44%) and geriatric caretakers (39%), which include physicians, physician assistants, nurses, APNs, home health specialists and more.

Health care executives were also focused on new technology solutions that would help ease the increasingly tight labor markets, as well as on more traditional elder-care models like skilled nursing facilities and long-term acute care facilities (LTACs)—with added emphasis on the physician care at home model, Programs of All-Inclusive Care for the Elderly (PACE).

“Providers face new pressure from the government to curb overall health care costs, but especially in senior care—with cuts to Medicare and Medicaid and greater pushes toward Medicare Advantage happening,” Patrick Pilch, managing director and national leader at BDO and an author of the report, told HHCN.

Pilch also echoed his colleague and co-author Shill, noting that seniors increasingly want to maximize their quality of life and specifically live in their own homes.

“Home health models solve both problems: They help providers improve health outcomes and reduce hospital spending, and they empower seniors to remain in their homes for longer,” Pilch said.

Technology and recruitment

Health care executives have also been focused on the need for more medical students to enter the geriatric field to keep up with the demand for senior care, in particular home health care.

Demand for elder care is projected to continue rising across the country and in all health care settings; by 2024, health care will be the biggest employer in the U.S., according to the Bureau of Labor Statistics.

“But elder care, which is less attractive to medical students both because of the negative connotations associated with aging and often lower-paying specialties, faces stiff competition in an industry already struggling with a mass talent shortage,” the the BDO Center noted in its report.

New staffing investments will be necessary, and some organizations may end up acquiring other players in the space to find staff for specific service options, the report noted.

Home-based care was also identified as the greatest opportunity for tech disruptors to improve elder care, with 63% of those surveyed identifying the sector as ripe for technological change by 2020.

Home care has already seen a number of new providers jump into the space with the promise of disruption though a technology-heavy approach to care — and often millions in venture-backed funding to the support the innovations. However, not all these providers have been successful, and several have shifted their business model away from that of a typical private duty agency.

Many “technology disruptors” are products and services that can make it easier for seniors to age in place at home, such as internet-connected door locks, smoke alarms, thermostats, and at-home cameras for family members to monitor loved ones. Virtual assistants like Amazon’s Alexa were also identified as home improvements.

“Technologies have the potential to streamline a lot of the administrative work that can cut down the quality time caretakers and providers are able to spend with their patients, especially amid staffing shortages,” Pilch said. “Certain technologies, like robotics, could even conduct some of the manual clinical and administrative work on behalf of staff. These tools could allow caregivers to optimize the face time they have with patients and have the empathetic conversations needed to optimize their quality of life.”

Written by Amy Baxter

The post Candid Conversations Reveal Home Health is a Top Investment Target appeared first on Home Health Care News.

A judge granted the home health agency’s temporary restraining order motion in the case, Family Rehab., Inc. v. Azar, which will temporarily ensure payments are not withheld.

A Zone Program Integrity Contractor (ZPIC) alleged in 2016 that the agency, Family Rehab, was overpaid $7.9 million, which was later lowered to $7.6 million. ZPICs are contracted with CMS to conduct audits of home health claims when fraud is suspected.

The ZPIC audit looked at 43 claims in 2016 and determined 93% of them were overbilled, according to the lawsuit, “primarily a result of documentary deficiencies related to the initial home health certification.”

Family Rehab requested a redetermination of the case from its Medicare Administrative Contractor (MAC), but the MAC only reaffirmed the ZPIC’s findings.

Eventually, Family Rehab filed suit against the Secretary of Health and Human Services (HHS), as the provider was not receiving payments while the case was awaiting a long appeals process that was delayed as a result of backlog. A hearing, which is intended to be set within 90 days, was not forthcoming “not within 90 days, and not within 900 days,” the suit claimed.

The Northern District of Texas granted Family Rehab’s motion, which enjoins CMS from withholding, recouping, offsetting or failing to pay the company from any current Medicare receivables. Family Rehab showed it would have had to close it doors without Medicare payments, and lay off staff and lapse providing care to beneficiaries.

Written by Amy Baxter

The post Home Health Agency Wins Payment Fight With CMS in ZPIC Audit appeared first on Home Health Care News.

Hospice organizations are frequently acting as a first line of support for families and loved ones of those lost to addiction through bereavement and grief counseling services—and providers aren’t reimbursed for this care.

Under the hospice Conditions of Participation (CoPs) to participate in Medicare, providers must offer bereavement services, including counseling. Without reimbursement, how these services are conducted varies widely from organization to organization based on commitments of resources.

Many hospices have taken the mission of providing grief counseling and bereavement services one step beyond their own patients, offering this care to families who were not patients, but may have been victims of the opioid crisis.

“A lot of hospices see the mission as broader than providing services to family members of folks they serve,” Edo Banach, CEO of the National Hospice and Palliative Care Organization (NHPCO), told Home Health Care News. “It turns out that if there is a shooting like at the Pulse nightclub or in Las Vegas or 9/11, an emergency of any time, it’s usually the case that the local hospice ends up providing bereavement support for first responders and individuals impacted.”

A historical legacy

Bereavement services have been a cornerstone of hospice care since the benefit was introduced, though the needs of communities have fluctuated over time, Banach said.

“As the opioid crisis has hit, the hospice community has done the same as it has for every other crisis that has occurred since the late 70s and 80s, including the HIV and AIDS [epidemic],” Banach said.

One hospice provider with a robust bereavement services program, Ohio-based Hospice of the Western Reserve, is working with other types of health care providers in the communities it operates to better serve residents afflicted by the opioid crisis.

“Collaboration with a specialty is really important in serving people,” Diane Snyder Cowan, director of Western Reserve Grief Services, told HHCN. “ … Generally speaking, these overdose deaths are not hospice deaths, but if we collaborate with addiction specialists … one of the things we’ve found is education about addition is so important for these grieving families.”

Hospice of the Western Reserve has been providing services in Northern Ohio for 40 years, serving 1,200 patients and families daily, according to Cowan. Roughly 10% to 20% of families will utilize bereavement services following the death of a loved one in hospice care, she said.

However, the opioid crisis is a different type of beast, as medication administration is also an important service performed by hospices.

“It is more compelling because opioids are a part of the kind of care that hospices provide to their population, and we feel a responsibility to make sure opioids are used appropriately for our patients,” Banach said.

A major area of contention surrounding current law related to opioids in hospice care is what happens to the medications once patients die. Medications become the responsibility of the family at that point, whereby opioids can sometimes fall into the wrong hands and add to addiction struggles.

Providers are eager to change this policy through legislation that would allow hospices to take possession of medications and destroy them after a patient’s death. One such bill, the Hospice Safe Drug Disposal Act, would authorize home-based hospices to safely dispose of unused prescriptions and controlled substances. The bill was introduced in the Senate in April.

Interventions and solutions

Not all hospices provide the same level of bereavement services, since the care is not reimbursed. Those that do consistently offer programs, including Hospice of the Western Reserve, are often supported by grants and other donations.

One issue in boosting bereavement services to help families affected by the opioid crisis is the visibility of these programs, which many lawmakers aren’t aware that hospices provide.

“It’s not hidden to social services and churches making these referrals, but it is hidden to federal policymakers because Medicare doesn’t pay for this,” Banach said. “It’s hidden because hospices are doing it and communities need it, but they are not doing it without federal government money.”

Hospice of the Western Reserve provides numerous services for grieving families, including support groups, collaborations with addiction specialists and ongoing programs. And there’s more that hospices could do in the future with more support and even technology if resources become available.

“We wouldn’t mind receiving some support or funding for this,” Banach said. “We could do more if we had some support for this.”

There are some business advantages to extending bereavement services and becoming a well-known force in a community.

“The pay-off when you are serving grieving people in your community and you help them through a tough time … it turns out when their parent needs hospice care, or someone [else], they will turn to you,” Cowan said. “It only benefits the community, and hospices should be the experts in the community.”

The benefits of bereavement services are also not as visible and not often measured, but underscore the importance of hospice as community providers, accordion to Cowan.

“What keeps me in this work is seeing how [support] groups are so transformative and how people grow and change post trauma,” Cowan said. “[You see people] grieving from an opioid death and hear stories about how their lives have changed and what they are doing now, and it gives me the chills … It makes it all worth it.”

Written by Amy Baxter

The post Hospices Taking on a Bigger Role in the Opioid Crisis Response appeared first on Home Health Care News.

A VA contract company notified him his care of nearly 20 years would end after it couldn’t find caregivers to provide the round-the-clock care he needed.

The case is the latest example of the caregiver shortage, which is frequently stated as a top concern among providers in the space. Other home care providers have also had to turn away clients due to a lack of ability to staff more care.

Williamson, who suffers from Lou Gehrig’s disease, would have been given the option to move to an out-of-state nursing home had he not sued.

Williamson sued the VA in January after Roseburg VA Health Care System stated it could no longer provide services due to lack of caregivers. The provider did not find another in-home care provider for Williamson, Oregon Live reported.

“I’m pleased we were able to achieve a successful outcome that honored our veteran and his family’s wishes while also providing a safe environment for his care,” David Whitmer, the Roseburg VA’s interim director, told the AP. “Because of the complex care needed by an ALS patient, this took some time to negotiate and ensure a home-based solution that could meet all of the requirements.”

Williamson is a veteran of the U.S. Air Force, where he served 14 years.   He is on a ventilator and has a feeding tube, according to Oregon Live.

A contract company with VA Roseburg Health Care System, New Horizons, has provided Willliams with around-the-clock care at home, though the lawsuit does not detail the cost of care.

Written by Amy Baxter

The post VA Will Maintain In-Home Care for Veteran Despite Caregiver Shortage appeared first on Home Health Care News.