The Medicare insurance program for the elderly and disabled soon will try out a possibly cheaper way to help people recover from health problems outside of the hospital — adult day care.
Some experts say extra services at most day-care centers — activities, socializing and on-site nurses — could also help patients recover faster and prevent costly complications that Medicare would have to pay for later.
“We’re able to pick up on the subtle changes” in patients, said Patty McCabe, a registered nurse who has worked at Holy Cross Hospital’s adult day-care center near Washington for nearly 23 years.
There are already about 3,400 adult day-care facilities across the United States, and more than 60 percent provide some health services, according to a Wake Forest University study.
Medicare currently does not cover day care for adults, though it does cover visiting nurses and medically necessary care in nursing homes.
Those who need help arranging meals, taking medicine or need other supervision can pay for day care out of their own pocket or will sometimes be covered under Medicaid, the insurance program for the poor.
Under the three-year Medicare test program, scheduled to start early next year, centers could see more demand as the population ages — especially if Congress makes it permanent.
Medicare, which serves 43 million Americans, wants to see if treating more patients at fewer locations is more efficient — saving the government and home health-care companies money.
“Adult day care programs (and) assistant programs like that clearly have a big impact,” Medicare chief Mark McClellan said. "It seems like it would make sense to coordinate those services with acute health care."
Under the trial, up to 15,000 elderly recovering from any ailment that requires a nurse home visit could go to a day care center instead.
That would keep some patients out of hospitals and nursing homes, two “costly settings where the outcome is not necessarily better,” Pacific Growth Equities analyst Balaji Gandhi said.
Home health agencies coordinate visiting nurse services and would receive the Medicare payments to use for their own day care center, if they own any, or to contract with an outside one.
Providers include Apria Healthcare Group Inc., NeighborCare Inc., Amedisys Inc., and Matria Healthcare Inc., among others.
Todd Lyles, head of administration for Almost Family Inc., said his home health agency lobbied Congress for the demonstration because visiting nurses “are not as efficient as they could be,” seeing only up to five or six patients a day.
“The model is very similar to the physician model that disappeared years ago. Doctors used to make a lot of house calls. But doctors don’t make house calls today because it’s not an efficient use of their time,” he said.
Nurse on staff
Many adult day-care facilities already recognize the need for some medical care and have a nurse on staff.
Even more are adding medical services, said Linda Velgouse, who heads home and community-based services for the American Association of Homes and Services for the Aging. “They are doing many of the things home health care agencies are doing,” she said.
At the very least, advocates said the Medicare trial could introduce daytime care to those who may have never considered it. It could also reduce stress and improve the health of patients’ caregivers, many of whom are also Medicare beneficiaries.
The Visiting Nurse Associations of America are more skeptical. Bob Wardwell, vice president of regulatory and public affairs, said seeing more patients at one place may not actually save any money and that it may increase home health companies’ liability.
“It adds a wrinkle if we (home health firms) are paying for things we have no reasonable control over,” he said.