In the last 4 weeks I’ve attended 2 excellent home care focused conferences. The first was the Washington Home Care Association (WAHCA) annual conference followed soon after by the Home Care Association of America’s (HCAOA) conference in Kansas City. Here are my takeaways and how they might impact the larger world of eldercare.
Every home care conference I’ve been to in the last 18 years has featured sessions on clinical, training, supervisory topics, management, finance, and updates on state and federal regulations. These conferences did not disappoint. But by far, the issues that got the most attention at both conferences were the Affordable Care Act (AKA Obamacare), and the demise of the long-standing Federal Companionship Exemption.
The Affordable Care Act (ACA) is a tremendously complicated law with the intent of providing health insurance to the tens of millions of Americans without it. For home care agencies, there are both opportunities and challenges. The opportunities come from provisions in the ACA that encourage our health care system to move away from fee-for-service models in which health care providers are compensated by the number and complexity of the procedures, visits, and tests they perform. In its place, the ACA encourages mechanisms such as Accountable Care Organizations in which providers would be compensated for actually keeping people healthy. As every home care agency, home care agency client, mother and grandmother knows, health outcomes improve when a discharged patient returns home to nutritious meals, clean sheets and clothes, help to the restroom, and help taking medications. Home care agencies are currently outside the traditional healthcare system because they do not provide “skilled” care. This will be changing in the next few years.
The ACA contains another provision, the “Employer Mandate,” which will change the way some agencies provide health insurance to their own employees. Many companies are struggling with the complexities of complying with the mandate.
Without getting into too much mind numbing detail, the Companionship Exemption allowed Washington State home care agencies to provide live-in care on a daily rate and pay arrangement. The demise of the companionship exemption will mean live-in care will become somewhat more complicated and expensive. I’ve heard some agency owners saying they will be giving up providing live-in care, but that remains to be seen.