Given a choice, most older adults prefer aging-in-place rather than moving to a nursing home or assisted-living facility. Unfortunately, older homes and apartments frequently pose safety hazards for seniors – from lack of grab bars in the bathroom to shelves too high to reach without a ladder.
Associated Press Medical Writer Lauran Neergaard describes this scenario – and what can be done about it – in her recent piece, “Home repair for health? Simple fix-ups may keep low-income seniors independent.” Although I first read the article on The Christian Science Monitor website, (with an AP credit), this is an issue that strikes a chord in communities throughout the United States, and in Canada, too.
Aging-in-place presents numerous challenges for seniors. Something as routine as traveling to a doctor appointment for chronic disease management becomes burdensome if there are difficulties with activities of daily living and transportation, poor understanding of care plans, confusion about prescriptions, or mild cognitive impairment which affects ability to follow a plan or care or remember instructions. Visits by nurse practitioners and home health care nurses are important elements for successful aging in place. Medication reconciliation, monitoring of vital signs, nutritional and mental health checks, and a friendly face can sometimes mean the difference between living at home or an institution, especially if caregivers are not nearby.
Potential safety hazards in older adults’ homes are plentiful, and the potential for falls is high — one in three people over age 65 experience a fall; hip fractures or other serious injuries mean a drastic change in quality of life, further mobility limitations and impact a person’s ability to live independently.
Technology is another tool that makes aging-in-place more achievable. While remote monitoring and telemedicine have been around for years, reimbursement has been an ongoing issue for clinicians. Several bills making their way through Congress would provide more equitable Medicare and Medicaid reimbursement for telehealth services. Currently, CMS only reimburses for Medicare patients living in rural areas; Medicaid is a bit more generous.
However, CMS is strongly considering modifying their payment policies to primary care providers who manage complex chronic conditions through remote services. They are proposing a new rule beginning in 2015 allowing for separate payments to physicians for managing select Medicare patients’ complex chronic care needs. Specifically, reimbursement will cover beneficiaries with “multiple significant chronic conditions (two or more),” according to the CMS press release. This includes development and revision of a care plan, consultation with other providers and specialists, new billing codes, and providing care over a 90-day period. Eligibility will require an in-person annual wellness visit.
CMS threw significant support behind the concept of a patient-centered medical home — recommending that a single practitioner provide these services, with beneficiary consent, for a one-year period.
Safer homes, coordinated care for complex conditions, and care management through technology. Individually these are important steps; taken together, are a powerful boost to allowing many seniors to age in place.