Trends in Home-Based Long Term Services and Support (LTSS)

February 06, 2017

When Medicaid was first launched in 1965, nursing homes were by the far the dominant setting for long-term care. However, over the last 20 years, particularly the last decade, we have witnessed a dramatic shift to home-based care. In fact, 2013 marked the first time Medicaid’s Long Term Services and Support (LTSS) programs spent more on home and community-based care than nursing facilities.

There are several factors fueling the trend towards home-based care, reflecting both consumer preference – convenience and motivation to stay independent – and financial implications, with Medicaid paying facilities on average $140/day for long-term care compared to $500/day for post-acute services. Equally important, the Supreme Court’s Olmstead decision determined that “the unjustified institutionalization of persons with disabilities violates the Americans with Disabilities Acts,” and the 2010 Affordable Care Act opened new opportunities for states to experiment and refine managed care models.

According to the 2015 CMS Actuarial Report, of the total $496.6 billion in federal and state Medicaid spending, nearly 25 percent or $116 billion was spent on LTSS. At the same time, growth in home-based LTSS shows no signs of abating, as Baby Boomers are projected to live longer than any previous generation. In addition, advances in medical technology and nutrition make it easier to live independently longer, even with chronic health issues.
While examining the increasing demand for home-based care, it’s also important to take into account the potential shortfall in the availability of skilled nurses ready to deliver care and how this can impact everything from compliance to liability and quality of service. According to reports from the Bureau of Labor Statistics, 500,000 nurses will be retiring by 2022, creating the need to fill one million nursing positions coming online as a result of attrition and the patient population expanding.

Education, safety and HIPAA training will be critical for ensuring the next generation of nurses is well-prepared to meet this growing demand for home-based care among older populations. For example, when working with the elderly, effective and efficient safety training is particularly important. There are many things that need to be taken into consideration, such as changes in cognitive condition like advances in Alzheimer’s, the need to manage multiple medications and schedules, diet and nutrition regiments and the utilization of preventive care measures. If these often complex measures are not properly managed, it represents a significant risk for serious health issues, soaring costs for emergency care and liability ramifications.

Thankfully, advancements in innovative wearable technologies, such as environmental sensors, Kinect cameras to track activity and sensors to monitor vitals, are paving a new way for effectively delivering and monitoring home-based care. Tracking of vitals in real-time can alert a care giver to a sudden health change, providing an incredible opportunity to address an issue before it develops into a more serious condition. Yet, this proliferation of patient data also poses new privacy and compliance issues, as information from these new technology solutions must confirm to rules dictated by HIPAA.

One prevalent risk is password sharing, with Modern Healthcare reporting 1 in 5 healthcare workers share their security credentials with colleagues. While it may seem to be an innocuous error, it is a serious cyber security risk and a violation that can lead to fines, lawsuits and reputational damage for Managed Care Organizations (MCOs). There are countless other examples of risks that home-based care can signify, reinforcing the importance of effective and efficient safety and compliance training to mitigate exposure.

The benefits of home-based LTSS have been well-documented – efficiencies in care, greater patient satisfaction rates and even cognitive improvements through maintaining a more active lifestyle and interacting with technology. As the shift from the nursing facility setting is only increasing in velocity, while there remains a significant need to control healthcare costs, it is more imperative than ever that nurses and other care givers are well-prepared to succeed in this new healthcare dynamic. This will help ensure high-quality care while reducing the risks of exposure to liability, whether through negligence, the mismanagement of patient data or a variety of other factors.