Four Eye-Opening Trends in Non-Acute Care
May 16, 2018
Following are some key facts and trends about this increasingly important sector of the care continuum.
Two-thirds of those age 65+ will need some type of long term care
Unlike most healthcare, long-term care is focused not on curing an illness but rather on allowing individuals to attain and maintain an optimal level of functioning. It is a “wide array of medical, social, personal, and supportive housing services needed by individuals who have lost some capacity for self-care because of a chronic illness or disabling condition” (US Senate Special Committee on Aging, 2000). The lifetime probability of becoming disabled in at least two activities of daily living or of being cognitively impaired is 68% for people age 65 and older (Family Caregiver Alliance, 2016). In 2015, some 8,357,100 people received support from one of the five main long-term care services (Family Caregiver Alliance, 2016).
Post-acute care is under increased CMS scrutiny
Post-acute care (PAC) is the skilled nursing care and therapy that often follows an inpatient hospital stay (Blum, 2013). It typically includes care provided in one of four settings: long-term acute care hospitals (LTACHs), inpatient rehabilitation facilities (IRFs), skilled nursing facilities (SNFs), and home health agencies (HHAs). Post-acute care has come under increased scrutiny lately, as healthcare organizations focus more attention on integrating and improving service delivery across the continuum of care. According to the American Hospital Association (AHA), PAC services are used by nearly 42% of Medicare beneficiaries who are discharged from a hospital (AHA, 2015). The AHA also quoted a 2013 Institute of Medicine (IOM) report which concluded that some 73% of the variation in Medicare spending is attributable to care provided in the PAC setting. As a result, CMS is taking several steps to reign in cost from this sector. Beginning in FY2018, skilled nursing facilities will suffer financial penalties if their hospital readmission rates are higher than expected. CMS has also just instituted (April 2016) a mandatory hip and knee replacement bundled payment program in selected markets in the U.S. The payment bundle includes the inpatient care for the joint replacement surgery and all additional care provided during the 90-day period following discharge. CMS has proposed to bundle 50 percent of all PAC payments by 2020. According to the AHA, “These and other efforts to deliver, assess and pay for episodes of care that cover multiple settings are expected to reduce the overall volume of PAC services” (AHA, 2015).
The nursing home model of care is on the decline
A number of new housing trends are redefining the traditional nursing home model, providing a variety of options for aging seniors. As our population ages, there is an increasing clamor for more affordable and more enriching living experiences for senior adults. One industry expert makes a number of predictions about the future of assisted living (Stevenson, 2013):
- Richer experiences for memory-challenged residents. Redmond, Washington-based Aegis Living is building a senior community reminiscent of the 1950s. They are re-creating the look and feel of this time period to support seniors with dementia who deal best with long-term memories.
- Technology enhanced senior care. Up-and-coming technology is likely to revolutionize the provision of senior care as we know it. Be on the lookout for everything from smart carpets that can predict falls and personal care robots to smart home computer systems that keep track of medications.
- Multi-generational housing. More and more families are likely to pool their resources to modify existing homes to suit multiple generations or move into a place that is built to house both young families and older adults.
- Aging in Place. For seniors who want to remain living independently in their own home for as long as possible, the home health care and personal care industries are stepping up to provide assistance. The Bureau of Labor Statistics predicts job growth of 70% for home health and personal care aides over the coming decade.
Staffing will be a major challenge for home care providers
The aging of the U.S. population is fueling high growth in the home health care sector. The traditional home health care market, valued at $77.8 billion in 2012, is projected to grow to $157 billion by 2022 (Thomas, 2016). Two-thirds of the care provided in the home is traditional home health and home nursing care, but hospice, therapy, and home-maker services are also being supplied (Thomas, 2016). With this growth comes demand for increased staffing— something that will prove difficult in this arena.
In 2013, an estimated 1.3 million home health aides were in the process of entering the job marketplace, with 50% growth in demand expected on top of that by 2018. This growth makes the home health market one of the fastest growing fields in the U.S. (Halvorson, 2013). Many see wages as a key challenge moving forward. According to a recent report in the Lubbock Avalanche-Journal, nearly half of all home care workers live at or below the poverty line. Many rely on government benefits such as food stamps, and make as little as $9.70 per hour—that’s 4 cents less per hour than fast-food workers (Seewer, 2012).
As the above trends show, the non-acute world is in flux. Providers in this sector are struggling with increasing demand due to an aging population, the absorption of new technology, the difficulty of documenting outcomes, and the pressure to integrate to offer services that span the continuum of care. Five years from now, non-acute care will look very different than it does today.
This article is taken from the complimentary HealthStream eBook, Healthcare Trends Beyond the Hospital Walls. Find it here, as well as other information and resources.
Family Caregiver Alliance “What Is Long Term Care?” https:// www.caregiver.org, March, 2016.
Halvorsen, Chad, “Top 7 Challenges Facing Home Health Care Agencies in 2013,” When I Work, http://wheniwork.com/blog/top-7-challengesfacing-home-health-care-agencies-in-2013/, June 13, 2013.
Seewer, John, “More aging baby boomers facing health care challenge,” Lubbock Avalanche-Journal, http://lubbockonline.com/business/2012-08-11/more-aging-baby-boomers-facing-home-health-care-challenge#.VumuU6Mo4kJ, August 12, 2012.
Stevenson, Sarah, “8 Predictions about the Future of Assisted Living,” A Place for Mom, http://www.aplaceformom.com/blog/2013-8-27-futuresenior-care/, August 27, 2013.
“The Role of Post-Acute Care in New Care Delivery Models,” TrendWatch, American Hospital Association (AHA), http://www.aha.org/research/reports/tw/15dec-tw-postacute.pdf, December, 2015.
Thomas, Sarah, MS, et al, “Home health care: New Opportunities and challenges for care provided inside the home,” Deloitte Center for HealthSolutions, http://www2.deloitte.com/us/en/pages/life-sciences-and-health-care/articles/center-for-health-solutions-home-health-care-newopportunities-and-challenges-for-care-provided-in-the-home.html, 2016.
U.S. Senate Special Committee on Aging, February, 2000.