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TIME MAGAZINE: COVID-19 Exposed the Faults in America’s Elder Care System. This Is Our Best Shot to Fix Them

June 15, 2021 (Time Magazine) – When COVID-19 hit the United States, nursing homes in Washington State took the first hit, producing deadly outcomes for older adults. Conditions within long-term care facilities enabled a harrowing spread of any pandemic, let alone a novel coronavirus. Compounding on this, leaders within institutional care were slow to respond when it arrived.

The plight of residents in long-term care facilities across the United States is detailed in a report by Abigail Abrams from Time Magazine. It begins with individuals living at Life Care Center in Kirkland, Washington, in late February 2020 where COVID-19 killed dozens in just a few weeks.

The shocking death rate created a sense of panic and by early March the families of those living within Life Care Center held a press conference appealing to the public on behalf of their loved ones.

“Our families are dying. We don’t know what to do. Our calls for help aren’t working,” said Kevin Connolly, whose father-in-law lived in the facility. “We have limited resources to battle this disease, and I think somebody somewhere decided that this population of people wasn’t worth wasting resources on.”

Nursing homes vs infection

Many nursing home residents live in shared rooms and rely on staff who tend to numerous patients and who often work at various other facilities. The industry’s low pay and long hours make for high turnover. These characteristics can create a lack of consistency in controlling the spread of infection.

The nursing home industry is losing occupancy rates, workers, and money. The long-term care industry could lose an estimated $94 billion between 2020-2021 due to the costs involved in both fighting the pandemic and losing occupancy, according to The American Health Care Association and National Center for Assisted Living (AHCA/NCAL).

America is aging rapidly. According to the Census Bureau, around 10,000 Americans turn 65 every day. Most people want to age at home rather than in an institution. Still, people who qualify for Medicaid and Medicare have little to no choice in where they receive long-term care after reaching old age. Governments in many states mandate that they enter long-term care facilities even when home-based care services are available.

In many cases, when a person does not qualify for government-funded care or chooses to avoid mandated care in a nursing home, a family member must often forfeit a job to take on the responsibility of caregiving. And if no one in the older adult’s circle of support can provide that care, paid home based care is challenging to find due to worker shortages. Many workers are leaving the historically low-wage industry, according to the Bureau of Labor Statistics.

Policy helps pave the way to home and community-based care.

Policy momentum is growing toward home and community-based care for the elderly across the nation. One home-based care program available to Medicaid/Medicare recipients has a 45-year proven track record of success and operates in more than 31 states. PACE (Programs of All-Inclusive Care for the Elderly) saves the government money while offering a high-touch, team-based approach to eldercare for people 55 years or older who qualify for nursing home level care.   It receives a payment per participant to provide medical care and dental care, day center programs, meals, home health aides, and many other services to keep seniors safe and living in their own homes and communities. PACE aims to keep this elderly population out of hospitals and nursing homes while incentivizing a flexible, creative, team-based approach to care. On average, states pay PACE programs 13% less than the cost of other Medicaid services.

“The nature of payment provides significant flexibility, as well as really strong incentives for PACE organizations to really proactively monitor and get out in front and address existing and emerging health needs,” says Shawn Bloom, president, and CEO of the National PACE Association.

Data collected during the pandemic show that seniors enrolled in PACE contracted COVD-19 at just one-third the rate of those in nursing homes, according to the National PACE Association.

The push for greater government funding for programs like PACE is growing. President Biden’s proposal to spend $400 billion on home care over the next 4 years could pave the way toward boosting access to more Americans. And proposed legislation in California, Assembly BILL (AB) 540, would allow eligible seniors to be automatically informed about PACE right along with other Medicaid and Medicare options.

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mHealthIntelligence: California Provider Sees Telehealth as an Integral Part of PACE Programs

WelbeHealth President Matt Patterson says COVID-19 has taught the industry a good lesson on how to use telehealth, and it should be a permanent part of the senior care service.

By Eric Wicklund

 – A California-based healthcare provider is integrating telehealth into its PACE programs, saying the connected health platform improves its ability to provide value-based care for seniors in their own homes.

While the focus of PACE programs has been on in-person care, the coronavirus pandemic prompted many to shift to connected health to maintain contact with their patients. For WelbeHealth, that meant partnering with Grandpad to equip patients with senior-friendly mHealth tablets that allow them to connect with caregivers on-demand and access health and wellness resources online.

“COVID-19 introduced the need for us to pivot to telehealth,” says WelbeHealth President Matt Patterson. “And in the process, we have saved lives.”

WelbeHealth is one of hundreds of providers focused on the senior care market, many of which participate in the Centers for Medicare & Medicaid Services’ Program of All-inclusive Care for the Elderly (PACE) program. Developed by CMS roughly 30 years ago as a capitated model of care for dual-eligible beneficiaries (ninety percent are dual-eligible), it provides all necessary medical care, therapies, long-term care and services, meals, socialization, transportation, day center services, and activities.

There are currently 135 PACE programs in 31 states, enrolling between 50 and 3,000 patients, for a total of more than 54,000 seniors served. The programs are based in a care center and feature an interdisciplinary care team (IDT) of primary care physicians, nurses, therapists, social workers, dieticians, home care professionals, and others and offers a variety of services on-site and in the home.

PACE programs have traditionally shied away from telehealth, but COVID-19 changed that line of thinking. Now Patterson and his team are at the forefront of a new wave of care providers who want to make telehealth an integral part of the program.

“It’s an exciting opportunity to extend the reach of PACE (and) do more to improve and enrich the lives of our participants,” says Patterson, a former naval surgeon who served as president of digital health pioneer AirStrip before moving into the senior care space.

Telehealth gives PACE programs with WelbeHealth’s the ability to be there for seniors at any time, and to address issues that might not be addressed during in-person visits. That’s important at a time when, mostly due to COVID-19 restrictions, seniors are experiencing high rates of depression, anxiety, stress and substance abuse.

That point has been proven in the Grandpad project. According to a case study, seniors in the WelbeHealth program logged nearly 34,000 hours on the tablets – using both synchronous and asynchronous services – between March of 2020 and March of 2021, including more than 1,500 hours accessing mental health treatment. They also used the tablets to access medical care and exercises aimed at treating cognitive decline.

Patterson says emergency measures adopted by both state and federal governments during the COVID-19 public health emergency have enabled PACE programs to use telehealth more freely. He and his company have been lobbying state officials to make those freedoms permanent.

On the federal level, a bill introduced in March and now before Congress would ensure permanent coverage for audio-only telehealth services for Medicare Advantage and PACE programs, giving providers like WelbeHealth the freedom to incorporate phone calls and non-video telehealth platforms into care plans.

The benefits of connected care are numerous. On-demand access to care providers means seniors can go about their day knowing there’s someone always available should an emergency occur. They have instant access to health and wellness resources that go beyond what they’re getting when the nurse comes by for a visit. They can also collaborate more often on medication management, keep track of daily vital signs, or just talk to someone if they’re lonely or depressed.

Patterson says the pandemic is giving WelbeHealth and others the time to prove the value of connected health and to gather data and experiences to support permanent coverage.

That will be important. CMS has traditionally been very reluctant to expand telehealth coverage and has long argued that it needs evidence that these tools and platforms improve clinical outcomes and reduce wasteful expenses and unnecessary treatments. In short, they want proof.

“PACE is an ideal model for integrating high-touch and virtual care,” Patterson counters. And he wants to do more of that.

“Telehealth is definitely not a replacement (for in-person care), but it gives us more tools, and we want to use these tools for what our participants desire,” he says. “As an organization, we only do well when our participants do well. And they’re doing well.”

 

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Why Assembly Bill 540 Must Pass: Because seniors have a right to know about the PACE option for home and community based care

WelbeHealth Administers First Shipment of COVID-19 Vaccines

LONG BEACH Dec. 31, 2020 – WelbeHealth is administering its first COVID-19 vaccines to its elderly participants this week, beginning at the organization’s center in Long Beach, California. The first seniors received their vaccinations on Wednesday, and additional vaccines will be administered next week.

WelbeHealth, a healthcare provider delivering integrated home-based care for frail seniors across California, received its first shipment of the vaccine earlier this week and rapidly deployed its plan to administer the injections to its highest-risk participants.

“This is a momentous occasion for our programs and our society. It’s essential that we all get vaccinated, not only for ourselves but for the safety and wellbeing of everyone in our communities,” said WelbeHealth President Matt Patterson, MD. “With each vaccine, we are literally saving the lives of our elders who have given so much to enrich our world.”

WelbeHealth provides care as part of PACE (Program of All-Inclusive Care for the Elderly), a longstanding Medicare and Medicaid program that enables older adults to live in the community instead of a nursing home.

At the onset of the coronavirus pandemic, WelbeHealth shifted to a remote home-based care model, providing each participant with an internet-connected WelbeLink computer tablet and delivering care in the home whenever possible. The program has a long track record of positive outcomes, including longer life expectancy and dramatically improved mental health and quality of life. The PACE model has proven dramatically safer for seniors during the pandemic, with 85-95 percent lower infection and mortality rates than nursing homes.