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VOL. 127 | NO. 44 | Monday, March 5, 2012

Home Alone

Access to in-home health services declines as need rises

By Aisling Maki

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For many senior citizens, access to homemaker services – such as housekeeping and grocery shopping – enables them to continue living in the comfort of their own homes for as long as possible.

LaQuita Dawson of Meritan takes a blood pressure reading at the home of patient Howard Green. Green receives home care 7 days a week, 12 hours a day.  

(Photo: Lance Murphey)

Melanie Keller, executive vice president of Meritan – a Memphis-based nonprofit that provides a vast array of services for seniors – said as little as two two-hour visits each week can mean the difference between placing a senior in a hospital or nursing facility.

“It makes good, common economic sense to invest in some of these in-home services,” she said. “I would even classify meal delivery and homemaker services as preventative. If you have good nutrition and a clean home environment, then your health status is going to be better overall.”

For some seniors, a home health worker may be the only person with whom they interact regularly, and that companionship can help prevent depression, which has detrimental health effects.

The need for homemaker services continues to grow, with the first of the nation’s 70-million strong baby boomers turning 65 last year.

“We’re getting ready to get inundated with people who need those services,” Keller said.

But despite the aging population, home health care continues to see cuts at both the state and federal level. Keller said Medicare only provides skilled services, such as nursing and occupational therapy, and does not reimburse for convalescent care.

“Just the federal cuts in home care since 2008 have been about 16 percent,” said Keller, who also serves on the board of the Tennessee Association for Home Care, a statewide nonprofit. “Home health is about 4 percent of Medicare spending, yet it’s taking 10 percent of the cuts in Medicare, so it’s very disproportionate.”

According to TAHC, TennCare – whose Choices program provides non-medical long-term care services for the elderly and disabled – last July implemented a 4.25 percent cut for home health.

“The plan in the budget is to eliminate the homemaker part as a stand-alone benefit,” Keller said. “If the person needs homemaker services, they would blend that with the personal care. But homemaker services by themselves – that environmental support – would completely go away.”

In addition to the reduction of homemaker services, other services under the TennCare Choices program scheduled for rate reductions are personal response systems and home delivered meals.

Personal response systems provide Choices clients with immediate access to a call center for help in emergency situations, and the rate change will reduce the number of companies able to provide the service to Choices clients.

The rate reductions for home delivered meals will also reduce the number of organizations able to provide that service to Choices clients. Keller said budget cuts include a 19 percent reduction in frozen meals and 5.8 reduction in hot meals delivered to client homes.

“I know it’s going to affect this area, and have an even greater impact on the rural areas because it’s a little more difficult to provide services in a rural area when you’re talking about time and travel,” she said.

More home health cuts came in January, after the Centers for Medicare & Medicaid Services refused to pay states for an error in payments, resulting in an additional 4.25 percent cut in home health.

“There will never be enough public funding,” said Kathryn Coulter, chief development officer for the Aging Commission of the Mid-South, which contracts with various home health agencies for nonmedical services. “We certainly have lots of private pay providers for home care, so if individuals have the resources, there are services in the community that can be purchased. Unfortunately, I don’t think there will ever be enough public money to provide the care for everyone who needs it.”

There is a sliver of good news on the horizon. A bill by state Sen. Mark Norris and Rep. Gerald McCormick is currently moving through the General Assembly to restore close to 2 percent of the January cuts to TennCare home health reimbursement.

Keller said she regularly meets people facing difficult decisions, including leaving their jobs to care for aging family members.

“And then you have people leaving the workforce,” she said. “Personal care out of pocket, through a reliable agency, is about $16 an hour at least four hours a day. Most people can’t afford it. And if you have people staying at home, that ultimately impacts the economy.”

Keller said that from an economic standpoint, it simply makes more sense to keep seniors out of hospitals and costly nursing home facilities, and living in their own home environment for as long as possible.

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