Will the Elderly & Disabled Benefit or Suffer from the Recent Department of Labor Homecare Ruling?
By Pamela D. Wilson, CSA, MS, BS/BA, CG
Government rulings related to healthcare often have unintended consequences. Policy and law makers sometimes fail to give consideration to industry realities that arise as the result of what may appear to be clear and simple decisions. My least favorite for the past several years is Section 3025 of the Affordable Care Act that established the Hospital Readmissions Reduction Program.
This program resulted in hospitals refusing to admit my clients for numerous reasons, preferring instead to place my clients on “observation” (rather than a formal hospital admission that supports the required stay for admission to a rehabilitation community) or refusing to admit my elderly clients at all suspected to have one of the specific conditions that would result in financial penalties to the hospital if my clients were to return within 30 days for any concern related to the same condition. Conditions many elderly experience like pneumonia, heart failure, COPD and more now result in financial penalties to hospitals. Holding patients on “observation” shifts costs from the hospital to the patient due to higher insurance costs paid by the patient and avoids potential financial penalties to hospitals for readmission.
I remember one particular client who I was certain was experiencing a bout of pneumonia. Two days in sequence my client was refused hospital admission; hospital staff reporting that there was no confirmed medical condition supporting admission and treatment. Calls to the client’s primary care physician for intervention fell on deaf ears. The third day my client was sent to a different hospital, admitted with bi-lateral pneumonia, and died several days later in my opinion due to a delay in treatment. What do the doctors say when situations like this occur or when they really do not want to provide treatment? I commonly hear, “he or she is old.”
I’m sorry but age should not be an excuse to delay or refuse treatment. Did the government really believe that hospitals wouldn’t find ways to avoid financial penalties? Did any involved in the Act ever consider this possibility when the act was being written? Possibly not—the easy answer for hospitals is to avoid admitting patients who have the conditions specified in the Hospital Readmissions Reduction Program. Or possibly yes—avoid admitting the elderly in the hope that the person dies and no longer utilizes Medicare benefits that increase during the last several years of life.
The August 21, 2015 ruling by the Department of Labor FLSA Regulations for Homecare Workers may be the most recent controversial ruling. This issue has bounced back and forth since 2007 in a decision posed to the Supreme Court, Long Island Care at Home, Ltd. V. Coke, 551 U.S. 158 (2007). Home care employees working for third party agencies who provide domestic companionship services will now receive minimum wage, overtime, and travel time pay. Companionship services are defined by the Department of Labor as fellowship, protection, and some care services that include dressing, bathing, feeding, meal preparation, and light housekeeping. In my opinion this ruling has pros and cons for care agencies and the elderly and the disabled that remain to be seen.
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Pamela D. Wilson, MS, BS/BA, CG, CSA, Certified Senior Advisor specializes in working with family and professional caregivers to navigate healthcare and aging concerns. Wilson, an expert in the field of caregiving, has personally helped thousands of family and professional caregivers since 2000 in her career as an advocate, a care navigator, and an educator. Through her company, The Care Navigator, she is an advocate and service provider in the roles of guardian, power of attorney, care manager, and transition specialist. She was producer and host of The Caring Generation®, from 2009 to 2011, an educational radio program for caregivers on 630 KHOW-AM. In addition to her work at the Care Navigator, Pamela gives back to the community by serving as chairperson of the Community Ethics Committee in Denver, Colorado.
Her new book, The Caregiving Trap: Solutions for Life’s Unexpected Changes, will be available on October 6, 2015 through all major bookstores as well as on PamelaDWilson.com. You can find her on YouTube, Facebook, Twitter, and Linked In.