March 10th, 2014
Editor’s Note: This post is also coauthored by Robert Berenson, an Institute Fellow at the Urban Institute.
This post is the fifth in a periodic Health Affairs Blog series on palliative care, health policy, and health reform. The series features essays adapted from and drawing on an upcoming volume, Meeting the Needs of Older Adults with Serious Illness: Challenges and Opportunities in the Age of Health Care Reform, in which clinicians, researchers and policy leaders address 16 key areas where real-world policy options to improve access to quality palliative care could have a substantial role in improving value.
Alongside the challenge of improving insurance coverage for palliative care, caregivers and practitioners face a continuing challenge in mobilizing long-term services and supports (LTSS), that is, personal assistance to those unable to perform basic tasks of daily living. These services are an essential part of palliative care. Whatever a patient’s wishes, unless LTSS are available to support patients and caregivers at home, the emergency department and the hospital become the only option when a symptom or caregiver exhaustion crisis occurs.
But identifying, accessing and coordinating long-term care services are not easy. Further, financing to support these services is beyond the scope of standard insurance. Few people have private long-term care insurance, and Medicare’s coverage of nursing homes and home health is contingent on the need for skilled nursing or therapy care. MedPac reports that in 2011, Medicare-covered nursing home stays averaged only about 27 days and home health aide (personal care) visits averaged only about five per home health user. Although a recent legal settlement has required CMS to clarify that coverage is not contingent on evidence of patient improvement, the skilled care requirement remains intact.Read the rest of this entry »