Home care for seniors has new urgency

It's called the senior tsunami.

As more than 78 million baby boomers are approaching retirement age, U.S. age demographics are shifting significantly. Seniors 65 and older will soon constitute 20 percent of the population. By 2020, it's estimated that 12 million older Americans will need long-term care.

With this aging of our population, home care takes on a new urgency. Elder care is fast becoming more of a growth industry than child care. The infrastructure, however, is not yet in place to handle this coming age wave of American retirees.

The Olmstead decision, passed by the Supreme Court in 1999, ruled that the elderly and disabled have the right to enjoy care in the least-restrictive environment possible. To seniors, this usually means in their homes. But having the right to live in your home and having access to the resources necessary to do so are often two very different issues.

But funding of the infrastructure needed to support the Olmstead Act has not followed. And it's extremely expensive to raise Medicaid payouts to meet this need. For example, just a 2 percent reimbursement increase in Minnesota would mean more than $70 million in additional spending. Meanwhile, the for-profit model of home care hasn't yet matured.

A 2006 study conducted by Ecumen, a nonprofit provider of senior housing, concluded that 89 percent of baby boomers surveyed want to live their retirement years at home rather than in an assisted-living facility or nursing home. Despite this expressed wish, 75 percent of Medicaid payments still go to nursing homes, even though Minnesota nursing homes have downsized 6,000 of their beds over the past five years.

A shift in focus and in resource allotments needs to happen in the near future to accommodate this overwhelming preference for home care.

Both baby boomers and their parents are interested in staying out of what is commonly known as the ''broken hip'' revolving door of hospitals, rehab centers and short-term nursing home placements. But what can be done to prevent the fall that causes a broken hip? How can retirees keep their current lifestyle without significant interruption?

There are several basic levels of home care to choose from:

Personal care attendants provide assistance with activities of daily living such as dressing, bathing, feeding, transferring, etc. and are not licensed by the state. This type of care is typically paid for by Medical Assistance.

Private duty care -- basically private-pay care -- provides assistance with non-medical needs such as shopping, cooking, transportation and companionship and involves household management services but no hands-on medical care. Some long-term care policies will cover such home care, but reimbursement terms and exclusion criteria vary. Reverse mortgages and long-term care insurance are two financial resources that seniors use to pay for private duty care.

Licensed Class B home care agencies employ home health aides to serve ambulatory and medically stable clients.

Licensed Class A agencies serve seniors who are non-ambulatory, require help taking medications or need diabetic monitoring, wound care and other hands-on skilled care.

Medicare-certified skilled home care is typically received on an acute, intermittent basis following an illness, injury or change in disease status. Such services are physician-driven and reimbursement is contingent on the individual demonstrating progressive improvement and being home-bound. Most people aren't aware of these policy restrictions and erroneously assume that Medicare automatically pays for any and all home care services ordered by a physician.

New technologies are also making home care a more viable option today. Telehealth systems, including home sensors and online e-records, offer ways to make home care more time-efficient and cost-effective. Telemonitoring companies offer remote monitoring so nurses can potentially ''visit'' three times as many patients per day.

Other industries are adapting to accommodate the senior age wave as well. Some homebuilders, for instance, are now using universal design standards, since it is much easier to build a handicap-accessible house upfront than to retrofit an existing structure.

Changes in the home care industry yet to be realized include implementation of best practices and comprehensive training as well as higher compensation for home health care workers. They now make $7.50 to $12 an hour -- on par with a McDonald's employee -- even though their skill levels suggest a $16- to $18-an-hour pay range. If compensation levels don't increase, there will be an ever-growing shortage of home care staff.

Another challenge is the ''silo'' fragmentation of health care and support services created by regulation. Disjointed or repetitive communication flow between public sector service agencies and consumers often makes navigating the world of home care circuitous.

A redesign of the overall care coordination and care management system is badly needed, and the Minnesota HomeCare Association will soon be crafting a model to demonstrate a new care coordination strategy.

Proactive home care at the onset of physical or cognitive decline can make a significant impact on the health and life expectancy of those 62 and older.

Just as seniors often build a ramp to gain better entry to their homes, the public policy and private business sectors need to build a similar ramp to make home care more accessible to those on the first wave of the coming senior tsunami.

Neil Johnson is executive director of the Minnesota ­HomeCare  Association, a nonprofit statewide group that promotes the delivery of quality care in a variety of home living environments. He can be reached at njohnson@mnhomecare.org or 651-635-0607. Further resources are at www.mnhomecare.org.