Nursing Home Reimbursement: A case study

The current financing structure of Pennsylvania nursing homes is not sustainable

Nursing homes play a critical role delivering long-term services and supports (LTSS) to older adults and individuals under the age of 65 with disabilities. Despite this, these facilities face serious threats to their financial viability. A new report documents the increasingly important role nursing homes play in Pennsylvania, the key demand and supply factors affecting nursing home performance, and highlight implications for the financial viability of nursing homes going forward.

Edward Alan Miller

Editor-in-chief Edward A. Miller

Using data from a variety of sources, the researchers demonstrate that the demand for nursing home care is expected to increase, but the reimbursement level from Medicaid — the growing source of payment for nursing home residents — is causing a financial strain on these institutions. The report, “The Case for Funding: What is Happening to Pennsylvania’s Nursing Homes,” was written by researchers with the LeadingAge LTSS Center @ UMass Boston and funded by The Jewish Healthcare Foundation.

Data between 2010 and 2018 indicate that nursing homes are serving lower income individuals with more challenging diagnoses, including more severe cognitive impairment and psychiatric illness, as length of stay and occupancy has declined. Coupled with Medicaid as a payment source for increasing numbers of residents, the researchers expect to see more nursing homes face financial challenges in the coming years.

“The current financing structure supporting nursing home care in Pennsylvania is not sustainable,” says Edward Alan Miller, PhD, one of the report’s authors and Professor of Gerontology at UMass Boston. “Unless the reimbursement rates paid by the Medicaid program are brought more in alignment with the costs of providing high quality care in a safe manner, providers will face increasing challenges caring for Pennsylvania’s most vulnerable residents.”

Data on professional and support staff in nursing homes also indicate a concerning trend:

  • Even as patients are presenting with more challenging diagnoses, overall staff hours among direct care workers have remained relatively unchanged over the last ten years and RN hours have declined slightly.
  • Compensation for direct care workers has remained relatively flat, increasing by only 1.9% per year from 2012 to 2019. When adjusted for the medical consumer price index, real wages have declined an average of .78% annually during the time examined.
  • While certain individual quality metrics have improved — such as declines in the numbers of bed sores — overall aggregated quality scores have not.Marc Cohen, PhD

“The growing gap between what facilities need, as reflected in charges, and the Medicaid reimbursement rate has come at a time when nursing homes are being asked to care for an increasingly complex and frail mix of residents,” says Marc Cohen, PhD, one of the report’s authors and Co-Director of the LeadingAge LTSS Center @ UMass Boston. “The result has been increased cost shifting to individuals and families who must pay for care privately or take on additional caregiving responsibilities. Nursing home services represent a critical component in Pennsylvania’s continuum of care. Our study demonstrates that more needs to be done to support them.”

How do we build a culture of person-centered care for older adults?

A new report shows that whether care preferences for older adults are considered is heavily influenced by race, income, and other variables.

 “When thinking about your experiences with the healthcare system over the past year, how often were your preferences for care taken into account?”

This question was posed in a healthcare study to approximately 20,000 people over the age of 50 and living across the U.S. The University of Michigan Health and Retirement Study (HRS) is a longitudinal panel study surveying a representative sample of Americans. This ongoing study provides valuable data that researchers are using to address important questions about the challenges and opportunities of aging. The HRS is one of the first to explore the issue of person-centered care. Marc Cohen, PhD

In one of the first studies to examine this new data, three researchers analyzed responses to the question of healthcare preferences in a recent report on person-centered care. The researchers — Marc Cohen Ph.D., Ann Hwang M.D., and Jane Tavares Ph.D.— wanted to understand how aging adults experience care, if their preferences are acknowledged, and whether their experiences vary by race and ethnicity, wealth and income, and/or insurance status.

“The delivery of person-centered care — defined as care that is guided by individuals’ preferences, needs, and values — is an important factor in high-quality healthcare systems,” says Hwang.

Despite the healthcare industry’s assertions that it is becoming more patient-centered, the researchers found that one-third of all older adults (age 50 and over) said their care preferences were “never” or only “sometimes” considered.

Using 2016 HRS data — the most recent data available — the survey revealed stark disparities based on race and ethnicity. While 8% of White respondents said their needs and preferences were  never considered, 16% of Black and 27% of Hispanic respondents gave that answer. The researchers also found that, across all service settings, people who felt that the health system never took account of their care preferences were more likely to forego medical care. They visited a doctor fewer times and were less likely to use home care and outpatient surgery services. The largest impact was on use of prescription medications: they were 39% less likely to use prescription medications. Continue reading

“Older Adults and COVID-19: Implications for Aging Policy and Practice”

New webinar explores the impact of the pandemic on older adults

View the full slide set here, and a video recording from the 2.5 hour webinar is available here.

Edward Alan Miller, Gerontology Department Professor and Editor-in-Chief of the Journal of Aging & Social Policy (JASP), led the webinar “Older Adults and COVID-19: Implications for Aging Policy and Practice” based on a JASP special issue and book of the same title. The February webinar drew more than 500 registrants from around world to learn about the ramifications of the pandemic for older adults and their families, caregivers, and communities.

Edward Alan Miller

Editor-in-chief Edward A. Miller

“We are extremely gratified with how the webinar turned out, drawing participants and viewers from throughout the United States and globally,” said Miller. “It illustrates how the problems and issues brought to the fore by the pandemic will continue to reverberate well beyond the present day to the years to come.”

The ongoing COVID-19 pandemic has prompted an outpouring of scholarly work on the effect of the pandemic on various populations. Older adults – as well as their formal and informal caregivers – have received a disproportionate share of the pandemic’s impacts. Direct exposure to the virus led to a higher rate of hospitalization and death among older populations, particularly in nursing homes and other congregate living environments. This reality prompted mandates meant to mitigate the virus’ effects on older adults and which, in turn, led to unintended consequences, such as increased social isolation, enhanced economic risk, delays in receiving medical treatment and other supports, and latent ageism.

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Boston’s Older Population: Increasing in Racial Diversity, but Quality of Life is Shaped by Racism, Discrimination

A new report from UMass Boston identifies aging equity among Boston residents

The number of Boston residents aged 60 and older has increased by more than one-third in the last eight years and more than half of older residents are persons of color. However the experiences of these older residents differ substantially depending on race, ethnicity and gender, and challenges their abilities to thrive.

A new report, “Aging Strong for All: Examining Aging Equity in the City of Boston,” by researchers at the University of Massachusetts Boston, documents disparities across three dimensions that impact quality of life — economic security, health, social engagement — and identifies opportunities for stakeholders to ensure an environment in which “aging strong” is possible for all Boston residents. Jan Mutchler

“It has never been more critical to strategically pursue greater equity in the aging experience of Boston residents,” says Jan Mutchler, PhD, director of the Center for Social and Demographic Research on Aging at UMass Boston, a professor in the Department of Gerontology and one of the study’s authors. “The numbers of older adults are increasing and stakeholders share a growing recognition of the powerful ways in which inequity, racism, and discrimination shape health outcomes and the aging experience, amplifying the need to examine and remediate disparities in aging.”

The report identifies substantial disparities across racial and ethnic groups, such as:

Economic security

  • Poverty rates are especially high among Asian Americans and Latinos, and more than one-third of these residents age 60 or older live in households with incomes below the federal poverty line.
  • Sizable gaps differentiate racial groups. For example, while a similar share of non-Hispanic White, Black and Native American people aged 66 or older receive Social Security benefits, percentages receiving Social Security are considerably lower for Latinos and Asian Americans.
  • Housing costs in Boston place a heavy burden on older residents and half or more of renters age 60 or older pay more than 30% of their incomes for housing. Fewer homeowners bear such a heavy cost burden for housing, but older Black, Latino and Native American homeowners are at amplified risk for being cost-burdened.

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Elder Index at Work: Helping Improve Access to Medicare Savings Programs in Massachusetts

multigeneration portraitThis article is one in a series of stories about how people across the country are using the Elder Index to understand the true cost of living for older adults and its economic implications. If you know someone who would like to receive information about these stories, send us a note at gerontologyinstitute@umb.edu.

The cost of health care is one of the most common economic problems facing older adults across America. In more serious cases, it can lead to a bleak choice between paying for medicine or affording other basic needs.

These are familiar facts of elder life to the Massachusetts Senior Action Council, a grass roots organization focused on public policy and community issues affecting the health and well-being of older adults.

Research on policy options to address the problem led the council to focus on Medicare Savings Programs, which help qualified beneficiaries with health costs. Though the programs are run by the federal government, states have the ability to change eligibility standards for their older adults.

The council launched a campaign to make the Medicare Savings Programs available to more Massachusetts elders. It took years but finally paid off when Gov. Charlie Baker signed the state’s 2020 budget, which included a policy that now offers an estimated 40,000 older adults access to more than $150 million in new annual benefits.

A key resource in the successful effort: The University of Massachusetts Boston’s Elder Index, a free online tool that provides realistic and detailed cost of living data for older adults living in every U.S. state and county. Continue reading

Transforming the Future of Aging

Bei Wu works toward improving health status through research and policy

If the world of academic gerontology had a rock star, it would be Bei Wu, MS ‘97, PhD ’00.

Recognized for her extensive research and pursued by top tier universities, Wu has become an international leader in the field since graduating from the University of Massachusetts Boston’s Department of Gerontology. Add the years in policy work before earning her doctorate and Wu chuckles that, having spent more than half of her life in the field of gerontology, she herself is now experiencing the aging process.

“I’ve become my own study subject,” Wu says.

Today, Wu is the Director of Global Health and Aging Research at the Rory Meyers College of Nursing, and Director for Research at the Hartford Institute for Geriatric Nursing at New York University (NYU) and the inaugural co-director of NYU’s Aging Incubator, a university-wide aging initiative.

Given her considerable success in gerontology, it’s fitting she credits her grandmother — with whom she was extremely close — for nudging her into the field. Born in Shanghai, Wu’s parents left her and her brother in their grandparents’ care when the two were young. After college, Wu accepted a research position with the Shanghai Commission on Aging only after prompting by her grandmother.

“At the time, very few people thought aging would be a challenging issue in the future,” Wu says.

But writing policy briefs and launching studies on intergenerational support with the United Nations Population Fund convinced Wu to pursue graduate studies. With no options available in China, she chose UMass Boston.

“UMass Boston has had a significant impact on my career,” Wu says. “The gerontology program has a critical mass of excellent faculty.” Continue reading

Raising awareness, enabling support for unpaid caregivers

Family caregivers have an important job; supporting their needs will make their work and lives easier

Imagine caring for a child with medically-complex special needs while balancing responsibilities for other family members and trying to maintain a full-time job. Or, consider caring for a parent with dementia whose needs take time away from one’s own family and work.

These are examples of family caregivers —unpaid, and often, untrained — who help parents, spouses, children and adults with disabilities, and other family members with varied needs such as bathing and dressing, managing medications and more complex medical care, and everyday tasks such as preparing meals and keeping track of finances. These are just a few examples of the work they take on so their loved one can receive the care and supervision needed and remain at home.

There are more than 43 million people nationwide who serve as unpaid caregivers. The tasks caregivers take on, as well as the caregivers themselves, are diverse. Given the critical role they play in the continuum of care, it is important to understand how to assist and support their work. To do this, the National Academy for State Health Policy contracted with the LeadingAge LTSS Center @UMass Boston and Community Catalyst to learn what specific services and supports caregivers need and to develop recommendations for change.

Pamela Nadash, PhD, Associate Professor of Gerontology at the LeadingAge LTSS Center at UMass Boston and Eileen J. Tell, a Gerontology Institute Fellow, the project’s co-leads, were part of the team that analyzed the more than 1600 responses.

The research team began by analyzing over 1600 responses from family caregivers and caregiver organizations collected from a recent Request for Information (RFI). The RFI asked respondents to talk about their most pressing needs or concerns as a caregiver and what they would specifically recommend to address those concerns. Continue reading

Book Investigates the Pandemic and its impact on Older Adults

Journal of Aging and Social Policy special edition examines scope,
impact and lessons drawn from Covid-19 for older adults

A special double-issue of the Journal of Aging and Social Policy (JASP) that focused on Covid-19 has been released as a book. “Older Adults and Covid-19: Implications for Aging Policy and Practice” provides 28 articles written by leading gerontology researchers. The authors offer perspectives from around the globe on a host of issues surrounding the virus and its impact on older adults, their families, caregivers, and communities.

Edward Alan Miller

Editor-in-chief Edward A. Miller

Originally published in June 2020, this issue’s release as a book by Taylor & Francis Publishing indicates that the critical questions raised and the policy changes proposed to protect this vulnerable population moving forward deserve continued attention.

“This book is important because nearly everything addressed in the special issue six months ago is still relevant today which reflects poorly in our response as a nation,” said Edward Alan Miller, PhD, a professor at UMass Boston and editor-in-chief of JASP.

As Miller points out in the book’s introduction, older adults have been hit particularly hard by the pandemic. Exposure to the virus has resulted in older adults dying in disproportionately higher numbers, especially in long-term care facilities. Government-mandated actions to lessen the impact of the virus on older adults have had adverse consequences such as increased social isolation, separation from family members, enhanced economic risk, and challenges getting basic needs met. Continue reading

How COVID-19 Has Changed Everyday Life for Older Adults, Long After Pandemic’s Onset

By Taryn Hojlo

How do older adults think about the COVID-19 threat and go about their lives now, many months after the virus first changed their approach to activities of every kind?

Of course there is no single answer to that question, and the way older adults look to the future with the pandemic remaining a real threat varies as well. The Gerontology Institute Blog contacted several members of the Osher Lifelong Learning Institute at UMass Boston to ask them about how they approached the problem and how it affects their routines. They offer a small sample of everyday lives among older adults in the age of COVID-19.

Mona, 69, and Phil Rosen, 72 in Easton, Mass.

 When news of the coronavirus first appeared, Mona and Phil were both reasonably concerned about contracting the virus. They isolated themselves from friends and family, only leaving the house for essential activities. However, they’ve begun to venture out a bit more in recent weeks – while still being careful to adhere to health authority guidelines. Continue reading

Institute Talk: A Conversation with Lisa Gurgone on Supporting Area Agencies That Provide Elder Services

Lisa Gurgone is the executive director of Mass Home Care, the trade association representing the Commonwealth’s network of 28 Aging Services Access Points (ASAPs) and Area Agencies on Aging (AAAs). This single, statewide network of coordinated care delivers home and community based services to over 60,000 individuals per month, providing over $600 million per year in services.

Gerontology Institute Director Len Fishman spoke with Gurgone recently about home care services and how the COVID-19 pandemic has affected both consumers and workers providing care. The following transcript has been edited for length and clarity.

Len FishmanLen Fishman: What would a composite profile of a consumer you serve look like?

 

 

 

Lisa GurgoneLisa Gurgone: The typical age is 82 and about one in five are 90 or older. About 55 percent live alone. We have a lot of women with basic homecare needs, someone to help with shopping and food prep. They may need some bathing assistance or have trouble getting dressed in the morning. People sometimes stay in our system for a very long time and may need additional services as they age. We might sub-contract with a visiting nurses association to provide more skilled care. It runs the gamut but the goal is to help these people stay in the community as long as they want. Continue reading