We put our loved ones into Skilled Nursing Facilities (SNFs) in effort to keep them safe and give them access to the skilled, tailored medical care they need. However, COVID-19 put the limitations and risks of SNFs into stark relief.
Mere months after the first outbreak, more than 50,000 COVID-19 cases and 10,000 deaths were reported at skilled nursing facilities (SNFs). These represented 11% of all COVID-19 cases and 27% of the total deaths in the U.S. at the time. This number was worse in some areas of the country, with some states reporting more than one-half of COVID-19 deaths occurring at nursing homes. And experts warn this astonishing figure is likely undercounted as not all states were publicly reporting data at that time.
Despite the increasingly dire numbers, Medicare patients had no other option but to be placed in a SNF after discharge from acute care, should their medical needs warrant ongoing specialized care. This placed countless otherwise healthy seniors at risk for the deadly virus when they entered these COVID-19 hotspots after discharge from the hospital.
Under pressure to act quickly to protect older adults, the bipartisan Choose Home Care Act of 2021 (S.2562/H.R. 5541) was introduced by Sens. Debbie Stabenow (D-Mich.) and Todd Young (R-Ind.) in the Senate, and by Representatives Henry Cuellar (D-Texas) and James Comer (R-Ky.) in the House.
In a nutshell, the Choose Home Care Act of 2021 will give Medicare patients who would normally be discharged to a skilled nursing facility the option to choose home-based extended care instead.
The act will allow Medicare patients to receive the same level of skilled tailored care that was previously only available in a SNF to be provided to them at home, all the while reducing Medicare spending—an estimated $925 million a year in Medicare savings, to be exact.
The benefits of home health care for eligible Medicare recipients are nothing new; the Medicare Home Health Benefit has delivered health care in patient-preferred settings for post-acute and rehabilitative care for several decades now.
Choose Home simply expands the pool of eligible home health care recipients to include those assigned to skilled nursing care after being discharged from the hospital.
The National Association for Home Care and Hospice published a chart that illustrates the proposed benefits of the new act:
Who is eligible for Choose Home?
An assessment tool that measures an individual’s place of care preferences, functionality, medical conditions, recovery goals and family caregiver concerns will largely determine the accessibility of the Choose Home option.
In order to be considered, the individual must meet the following requirements:
- Must be Medicare beneficiaries with the enhanced home health benefit
- Must live at home
- Must meet Medicare skilled nursing facility (SNF) eligibility requirements
Once approved, the individual will receive traditional home health benefit services in addition to the expanded Choose Home package of services that includes:
- Skilled nursing care
- Primary care
- Personal care
- Continuous remote monitoring
- Home adaptations
- Transportation services
Who coordinates this complex network of care?
The amount of coordination can seem overwhelming to family caregivers, which is why eligible patients will be referred to a Home-Based Extended Care-qualified home health agency. This agency will coordinate all care starting from the hospital discharge for the first 30 days, then home health services steps in and continues the care beyond the initial 30 days as clinically indicated.
A silver lining in a sea of dark clouds
The pandemic period stressed our medical resources to the brink. However, the pandemic uncovered many areas of unaddressed need and has provided the opportunity to address these health care gaps with bipartisan legislation such as Choose Home. Post-acute care options for U.S. older adults will experience a safe and effective transition from hospital to post-acute care.
As stated by the National Association for Home Care & Hospice and the Partnership for Quality Home Healthcare, the goal of this act is to, “Promote a safe, effective recovery, increased patient and family satisfaction, and reduced exposure to infectious diseases, as well as significant cost savings to the Medicare program compared to skilled nursing facility costs.”