Why the Home Care Maze Could Get Simpler

The Services

Traditionally, organizations like PHI, the Centers for Medicare and Medicaid Services and private long-term care insurance providers have defined "home care" services to include helping frail older adults and people with disabilities with tasks such as eating, dressing, bathing, taking their medication and getting certain kinds of health care services, such as physical therapy and medication infusions, in the home.

Some Medicare Advantage plans now also pay for items related to "social determinants of health," such as giving patients help with getting food and some household chores.

The Helper Bees, a 7-year-old, Austin, Texas-based company, now works with three of the largest Medicare Advantage plans and manages 13 of the 20 biggest blocks of long-term care insurance policies. Mutual of Omaha recently picked it to offer services meant to keep long-term care insurance insureds healthy and in their own homes as long as possible.

The Helper Bees home care provider network offers care manager services. It also includes providers of tech support, pest control services, errand running services and home modification services as well as home health care and basic homemaker services. The providers have agreed to offer set rates and use a standardized approach to billing.

When public plans, private insurers and policymakers are figuring out how to minimize people's need for paid care and facility care, "we need to be really creative and open-minded," Hu said. Adding non-medical services such as pest control and lawn care to the package "means being able to preserve dignity and high quality of life."

Hu noted that keeping a client out of a facility for one extra month can save at least $7,000 in facility care expenses per month.

Other Strategies

Companies like A Place for Mom already help families find care facilities.

Genworth is using its CareScout unit to organize a national home care provider network that may offer significant price discounts.

Programs of All-Inclusive Care for the Elderly are supposed to provide soup-to-nuts care, including home care, for people who have enough frailty or disability to be eligible for nursing home benefits and are still in their homes.

The Framework

The American Association of Payers, Administrators and Networks represents managers of acute health provider networks.

At this point, Hu said, home care provider network organizations are still too new to have a trade group of their own. He would prefer to see the market evolve before anyone tries to standardize and regulate the networks or service packages.

What to Do Now

But what do you do for clients, or loved ones, who need home care now?

Here are four ways to get the detailed local home care information you need to support caregivers and their families.

1. Visit clients in nursing homes and assisted living facilities and chat with the other visitors and people who work there. Some visitors and workers may know a lot about how home care and facility care really work in your community.
2. Attend in-person meetings of the local chapters of organizations such as the Aging Life Care Association and the National Association for Home Care & Hospice, to see what people are saying and who seems to be respected by the other providers.
3. Eat with your local Retired Old Men Eating Out club. Some of the men may be getting formal home care. Others are likely providing or managing home care for others.
4. Find ways to meet the local care managers and care coordinators. Use the information gained from other encounters to determine which care specialists seem to have in-depth knowledge of how care really works in your community.

Char Hu. Photo: The Helper Bees