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Home Health Care is on the Rise, but Regulations Are Often Lacking

Chris Murray
Posted on: October 12, 2018 by Chris Murray

America’s population is aging faster than ever, with a sharp uptick in the number of people entering the Medicare system over the past decade. Between 2017 and the end of the first quarter of 2018, 1.2 million “baby boomers” became Medicare beneficiaries, bringing the total number of beneficiaries in the program to a staggering 58 million U.S. citizens. This rapid aging of the population has given rise to expanded hospice and home health care admissions. Unfortunately, regulations governing the operation and safety of home health care services have lagged behind, leaving many elderly patients vulnerable to neglect, abuse, and financial fraud. While insurance for home health care providers forms the foundation of risk management, government regulations must be strengthened to protect our aging population.

Factors Influencing Home Health Care Growth

Hospitals across the country have increased their discharge of patients to skilled care facilities and home health care providers in recent years. According to a data analytics firm, acute care hospitals released approximately 22% of their patients into such facilities in the first quarter of 2018 alone. Home health care agencies took on 20% of hospital discharges during the same period. Several factors have influenced growth in this healthcare sector. Changes in patient payment models and in the Medicare Advantage program have made home health care more attractive, and declining health has generated an increased demand for skilled nursing care.

A Vulnerable Population

The vast majority of home health care services provide compassionate care for the elderly and for those with severe health concerns. Because of lax regulatory oversight, however, many patients find themselves at risk of theft, neglect, or worse – suffering at the hands of care providers with checkered pasts. In a highly-publicized case, an elderly patient in the greater Boston area had lost the ability to walk and needed help with daily activities. She found a caregiver on a state-sponsored website – a caregiver with experience in the field. Unknown to the patient, the caregiver also had a lengthy criminal record spanning 20 years, with criminal charges including assault and battery, check forgery, and prescription drug possession. The patient soon noticed that her finances were being funneled away, with fraudulent charges to her credit cards and a quickly-dwindling bank account. She estimated that her caregiver had stolen over $20,000 from her. The patient’s story is only one of hundreds of similar stories, with failures of the government to oversee the industry and its caregivers.

Many states have little, if any, protection for patients who may rely on home health care providers. Home health aides may not be required to submit to background checks, and training of these caregivers is brief or nonexistent. In some states, no licensing of any kind is required to become a home health aide. This has created an atmosphere where fraud and abuse of at-risk patients is commonplace.

Changes in Regulations

To address the rising instances of elderly abuse and financial fraud, state and federal regulators have worked together to implement changes in applicable laws. Licensure of home health care providers is now required in 70% of states, with more to follow in the coming years. The Centers for Medicare & Medicaid Services has also implemented rigorous safety standards to protect at-risk patients, focusing on patient safety though employee training and further regulatory oversight. It is clear that regulations lag behind growth in the home health care sector, but improvements in patient safety laws and caregiver requirements are beginning to take shape.

On the part of caregivers, the role of insurance for home health care providers cannot be overstated. This specialized form of risk management protects home health care personnel and their staffing agencies from the losses associated with liability claims. By protecting the financial assets and the employees of an agency, that agency is more able to deliver continued care for patients who depend on these critical services.

About Caitlin Morgan

Caitlin Morgan specializes in insuring assisted living facilities and nursing homes and can assist you in providing insurance and risk management services for this niche market. Give us a call to learn more about our programs at 877.226.1027.

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Posted in: blog Home Health Care