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Changes to Medicare could boost home care

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Jeanette Wilke, right, a caregiver for FirstLight Home Care, talks with a client, Phyllis Probst of Camp Hill, as they go for a walk.
Jeanette Wilke, right, a caregiver for FirstLight Home Care, talks with a client, Phyllis Probst of Camp Hill, as they go for a walk. - (Photo / )

When Leigh Twiford opened a FirstLight Home Care franchise in Camp Hill in December, she was familiar with the struggles families faced in caring for their older members.

Twiford and her brother cared for their father, who had Parkinson’s disease, after their mother died.

“I was driving up and down Route 95 all the time and we were pulling in friends and neighbors; it was a hodgepodge,” she said. “My brother and I were heartbroken. My parents had friends who could pinch hit, but it was hard on them, so when I had the opportunity to purchase a company I began looking at home-care franchises. I thought, this makes sense. I get it. I’m the client.”

Ohio-based FirstLight Home Care opened its first location in 2010 and now serves clients in 30 states at 160 locations throughout the U.S. In addition to Camp Hill, FirstLight has Central Pennsylvania franchises in Lancaster and York counties.

The company joins a rapidly growing home health and personal care sector, which is expected to add more than 1.2 million jobs between 2016 and 2026, according to the U.S. Bureau of Labor Statistics. As of 2016, nearly 3 million people worked in home health care.

Among the services FirstLight offers are hygiene help, mobility assistance, meal prep, medication reminders, light housekeeping, laundry, errands and transportation to doctor’s offices.

“Often a caregiver just needs a bit of a break, so we provide respite care,” said Twiford, who is also in training to provide dementia care so that she, in turn, can train her staff. She currently offers service to residents of Camp Hill, Mechanicsburg, Dillsburg, Carlisle and New Cumberland.

By next year even more clients may be able to take advantage of home-care services.

Leigh Twiford
Leigh Twiford - ()

On April 2, the Centers for Medicare and Medicaid Services published regulatory changes that will allow Medicare Advantage plans to cover home-care services. Such services typically are paid for out of pocket by consumers.

Trade groups for home-care providers have been lobbying hard for the changes, said Michael Fiaschetti, president and CEO of Harrisburg-based MediPlan Connect, which sells Medicare Advantage plans from a range of insurers. Medicare Advantage plans are offered by private companies that contract with Medicare to serve beneficiaries. One in three people with Medicare, or roughly 19 million beneficiaries, were enrolled in a Medicare Advantage plan in 2017.

Fiaschetti believes, however, that the changes are likely to be incremental because the added home-care benefits will increase insurance premiums. Nonetheless, he said offering home-care services can produce long-term benefits, like a reduction in hospitalization. He cited statistics indicating that people who receive home-care services have about 20 percent fewer admissions to the hospital and require 25 percent fewer doctor visits.

“Once they demonstrate a return on investment, chances are that more services will be covered,” Fiaschetti said.

Nursing home expenditures are also key to the equation.

According to the Pennsylvania Health Care Association, the median annual cost for a private room in a nursing home in Pennsylvania is $116,800, with semi-private rooms costing $108,847. According to the National Alliance for Caregiving, home-care coverage averages $45,000 annually and may mean the difference between staying in one’s home and going to a senior-living facility.

For the millions of American who will require some type of assistance, home care fills the gap between hospital stays, nursing home care and care provided by family members, its advocates have argued.

“Given the cost savings, it may behoove the country to offer home care coverage as part of Medicare Advantage,” said Twiford, citing a cost of $23-$28 an hour for her services. “For some, all they need is someone to help them in the morning and with their meals, medication and companionship. This can result in a substantial savings and the client has the emotional satisfaction of remaining in his or her own home.”

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