For all of the time and attention given to the current national discussion on health care reform, no one knows exactly what the American health care system will look like when reform legislation is passed by Congress.

If predictions about the current proposals are correct, regarding the most recent legislation produced by the Senate Finance Committee, those of us in the home care industry will be forced to deal with cuts to Medicare home health providers of $43.2 billion over 10 years and another $7.9 billion to hospice care providers over the next decade (National Association for Home Care & Hospice, NAHC Report, Oct. 13).

This reality hits just as the need for services to support an aging population is expanding at a faster rate than ever before.

In 2009, the market for in-home care nationwide is projected to reach approximately $15 billion, exhibiting a decade-long average compound annual growth rate of 10%. This industry is in its infancy.

Today, there are 36 million adults age 65 and over in the United States. This population is expected to nearly double to 70 million over the next 30 years. With an increasing average life expectancy for Americans reaching over 75 years of age, the need for senior care will continue to escalate.

Providing care for older family members is a fact of life for millions of Americans. This responsibility is increasingly falling on family members in the so-called “sandwich generation,” ages 30 to 60. According to a study by the University of Florida, one in ten American workers is a caregiver. Complex issues associated with long term care, eldercare and disability care is increasingly affecting productivity.

A National Alliance of Caregiving/AARP study estimated that each year, businesses suffer a $29 billion loss in productivity due to absenteeism, workplace interruptions, care crises, and diverted supervisor time. Workers who find the competing demands of work and caregiving too much may have to choose family over their jobs. AARP found that 11% of employees who are caregivers took a leave of absence; 7% worked fewer hours; and 3% turned down promotions. Meanwhile, 10% quit altogether. This creates a serious financial and emotional toll.

Over 20 million Americans belong to this so-called “sandwich generation.” Feeling stretched, overwhelmed, and under-supported, this segment of consumers has particular needs and hopes that the private care industry should understand and address. Products and services designed for a world where one’s middle years bring a decrease in responsibility and an increase in personal time are completely out of step with today’s reality.

:: A recent study by the marketing firm Communispace polled sandwich generation caregivers and found:

  • 45% like the idea of a flexible home health insurance plan that would cover their parents as well as themselves and their spouse at different periods in time
  • 47% would like to have the ability to carry their parents as well as their kids on their health insurance
  • 40% like the idea of someone who could transport their parent to the doctor, sit with them when the doctor gives them a diagnosis and treatment plan, and then report it all to them
  • 26% like the idea of a combined Senior Center and Child Daycare Center
  • 26% like the idea of a service to dispense or remind their parents to take their medication
  • 22% like the idea of a service that would install webcams in their parents’ home and their own to let them monitor them.

Blog_111409-2Private duty/private pay services may be as basic as respite care to providing relief to family caregivers, homemaker services, bathing and grooming assistance, transportation, and an array of non-medical services in the home. Newer services such as telehealth and telemedicine, pet care, and travel assistance are gaining popularity. If home health and hospice funding is reduced, individuals will be forced to pay out of pocket for 12-hour and 24-hour care, nursing care, physician care, and other medically-related services currently covered.

So as the economy may eventually be deemphasizing care in the home away from medical services to the less invasive non-medical, home care aide services which offer a cost-effective alternative to assistance with the activities of daily living, the need for private duty and private pay services will grow. Greater emphasis will be placed on the private citizen finding ways to afford them, ranging from tapping savings, getting family help, long-term care insurance, or reverse mortgages.

Relief may come through the passing of The Community Living Assistance Services and Supports (CLASS) Act, a proposed, additional long-term care provision included in the Senate Finance Committee’s and House of Representatives’ health reform legislation (Private Duty Source, Oct. 23).

:: The CLASS Act would create a national, voluntary disability insurance program under which:

(1) All employees are automatically enrolled, but are allowed to opt-out of enrollment;

(2) Payroll deductions pay monthly premiums; and

(3) Tiered benefits are provided, based on the level of disability, to purchase non-medical services and supports that the beneficiary needs to maintain independence.

The benefit would make about $27,000 per year in assistance available to those who need it, and that would “take a big chunk out of the financial obligation,” experts have noted. In the view of the ARCH National Resource Center for Respite and Crisis Care Services funded by the U.S. Department of Health and Human Services, the CLASS Act “would create a solvent, affordable, premium-based, national insurance program providing cash benefits that can be used for assistance with the activities of daily living to help people avoid becoming impoverished by spending down Medicaid eligibility levels. The CLASS Act complements the Community First Choice Option and Medicaid, Medicare, and private long term care insurance.”

Even though all segments of health care are being cut, home health services are being cut disproportionately. The plan calls for cuts of a little more than 17% in federal money to the home care services industry. This makes zero sense given that the need for these services are exploding, but there is a basic issue we can all agree on: It is far cheaper to take care of people in home care and maintain their independence as long as possible as opposed to an acute care setting.

As a private duty provider with 25 years of experience, we know people prefer to be taken care of at home. And at some point, although economics are very important, humanity is important too. We cannot lose sight of this.

NOTE: For more information on The CLASS Act, visit

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