Hartford Business Journal

www.HartfordBusiness.com July 13, 2015 • Hartford Business Journal 13 Dr. George Kuchel, a geriatrician, UConn Health Center professor and direc- tor of its Center on Aging, refers to it as "lifespan ver- sus healthspan." "We want to add life to years, not vice versa," Kuchel said. "If people live to old age, but at the cost of a lot of disease and nursing home care, that will prob- ably not be a good thing." Both Walke and Kuchel said telemedicine and other technology will play a bigger role in the next few decades providing lower-cost ways to monitor elderly patients and allow them to remain in their homes. However, the devel- opment of certain technologies — Kuchel cites surgical robots — have also been a major driver of healthcare costs, with studies showing only marginal impacts on health outcomes. He hopes the ongoing, gradual shift away from fee-for-serve health care towards population-based care will weed out certain technology that is unjustifiably expensive. Whether it's a good value or a bad one, however, technol- ogy alone isn't the answer to a healthier senior population, Kuchel said. The healthcare industry has helped increase life expectan- cy by developing better treatments for stroke, heart disease and other age-related conditions, Kuchel said, but further progress in improving senior health will require a coordinated attack from multiple players including doctors, technologists, researchers, geneticists, social workers and others. "We need to cut across silos and disciplines," Kuchel said. Kuchel is optimistic about a burgeoning area of medical research known as geroscience, which seeks to better under- stand how aging acts as a common risk factor for a variety of chronic diseases, and how different treatment strategies might better serve patients. "The way we've approached chronic diseases in the elder- ly hasn't worked very well," he said. The high cost of long-term care An older population is susceptible to various health conditions and disabilities that can require long-term care, which for some means a stay in a nursing home or other care facility. The number of Connecticut residents requiring long- term care is expected to increase over the next decade from nearly 39,000 to 49,000. Medicare doesn't cover long-term care, which means most seniors and their families end up paying for those services out of pocket, unless they have long-term care insurance. Medicaid, however, does cover long-term care for low- income elderly residents, which comes at great expense to the state. Connecticut spent $3.1 billion in 2013 on institutional long-term care, representing 12 percent of the state budget, according to the Department of Social Services. That high cost has spurred the federal and state govern- ments to attempt to change course. One of the state's main strategies for controlling long-term care costs is to keep seniors out of nursing homes in favor of less expensive home-based healthcare services. The cost difference is significant: The median annual cost for home health aide services in Connecticut, for example, is $50,336, versus $66,900 for an assisted-living facility, according to the Genworth 2015 Cost of Care Survey. A semi-private room in a Connecticut nursing home costs about $146,000 annually. Under a federally-funded program known as "Money Follows the Person," which has provided $56 million to Connecticut's Medicaid program, the state between 2008 and 2015 transitioned 2,974 nursing home patients into community settings, including care at home. The state's goal is 5,000 by next year. In the past year, the state has also provided $12 million in grants to persuade nursing homes to reduce their number of licensed beds and increase hospital discharges to community- based settings. Kuchel said he's impressed with the efforts, but rebalanc- ing alone is unlikely to be the answer to controlling health- care costs. "What we're really doing is bending the curve," Kuchel said. "We're not pushing things back, but we're certainly able to bend the curve to decrease the projected increase." One problem could be that homecare agencies, key cogs in the rebalancing equation that send nurses and other providers and assistants to patients' homes, view Medicaid reimbursements as too low. Hoyt, the homecare association head, said the first 1,000 patients that have been transitioned to homecare settings were low-hanging fruit; the next wave of transitioning seniors will be much more difficult. "Homecare agencies appreciate this attempt, but rates must go up," Hoyt said. Starr, head of the LCoA, said Connecticut's accomplish- ments thus far deserve credit. She said rebalancing is the state's most significant effort to date to prepare for an older population. "I don't want to suggest that there haven't been challenges along the way, but I think that's inherent to a transformation and a movement of that size," Starr said. Home care's time to shine Sending a doctor, nurse or other health professional to a patient's home is not a new concept. But some experts say that home care hasn't been seen as a major part of an elusive healthcare cost solution. That is, until recently. The federal Affordable Care Act has led to a steep increase in Connecticut Medicaid patients, which now num- ber more than 700,000. And Medicaid administrators have increasingly looked to homecare providers as a lower-cost way to monitor certain patients. "We've been this sleepy little industry," said Hoyt, who today represents more than 17,000 providers in the state. "All of the sudden there's this new awareness [among payers] like 'Oh, maybe we should pay for home care.'" Home care also includes aides who help patients cook meals and perform other household tasks. The number of businesses offering those services has jumped in recent years, said Linda Grigerek, president of Farmington's Companions and Homemakers, which has 11 locations across the state. Grigerek said the surge is driven by payer's recognition that such services reduce costs. "Suddenly a big light bulb went off," Grigerek said. Like many elderly care providers, Grigerek also said gov- ernment reimbursements must rise in order to ensure the industry's future. She said clients who pay out of pocket for visiting and live-in aides provide a healthier profit margin than Medicaid clients. As a result, there are some homecare agencies that don't accept Medicaid patients. Figuring out where additional money will come from still remains an issue, said LCoA's Starr. "Is it the individual? Is it the state? Is it the provider?" she asks. "There's a natural tension there." n NEXT WEEK: A $47 Billion Crisis: Connecticut's state bud- get faces expected and unexpected consequences from public and private retirements. To prevent future tax hikes, the state faces pressure to get its fiscal house in order. CT Healthcare Workforce Demands 2012 2022 Growth Personal care aides 23,244 32,090 38.1% Home health aides 8,251 11,446 38.7% Physical therapists 3,919 5,094 30.0% Mental health counselors 1,847 2,357 27.6% Physician assistants 1,716 2,270 32.3% Occupational therapy/physical therapist assistants/aides 1,722 2,334 35.5% Geriatricians* 134 340 153.7% * G E R I A T R I C I A N D A T A R E F L E C T S E S T I M A T E D 2 0 1 4 T O T A L S A N D P R O J E C T E D 2 0 3 0 N E E D S S O U R C E : C T D O L ; A M E R I C A N G E R I A T R I C S S O C I E T Y Will CT's healthcare workforce be there? By Matt Plion mpilon@HartfordBusiness.com T he healthcare and social assistance sectors provide 16 percent of Connecticut's total jobs, according to the state Department of Labor. One area of concern, however, is how the state and pro- viders will deal with a projected increase in demand for certain healthcare jobs. The American Geriatrics Society, assuming that doctors can care for 700 or fewer elderly patients, estimates that Connecticut will need to more than double its current num- ber of certified geriatricians to meet the demand expected by 2030. Connecticut already has only 54 percent of the geri- atricians it needs, according to the society. "As I tell the medical students: If you are a physician today, and you are not a pediatrician, you will be taking care of the elderly," said Dr. George Kuchel, a geriatrician, UConn Health Center professor and director of its Center on Aging. Geriatrics generally pays less than other specialties because of the high prevalence of Medicare and Medicaid patients. Unless that changes, Dr. Lisa Walke, associate chief for clini- cal affairs in the geriatrics section at Yale School of Medicine, thinks students will continue to shirk geriatric training. "What we stand to lose is optimal health and wellness for our population overall," Walke said. It won't be just doctors in demand. Lower-paying positions — such as aides who help patients cook meals and perform other household tasks — are seen as vital to serving an older population. They, too, face a recruiting challenge. The Department of Labor predicted last year that the state would need 9,000 more personal care aides by 2022, up nearly 40 percent from 2010 levels. Along with home health aides, which have a similar estimated growth rate, it's expected to be the most in-demand job in the near future. But relatively low wages for those positions, fueled in part by what many providers decry as meager state reimburse- ments, have created a turnover struggle for some agencies. Recognizing the looming problem, the state issued a plan several years ago that calls for timely collection of healthcare job openings, more training opportunities, figuring out ways to equalize pay among similar positions, and creation of a marketing campaign to attract workers to the field. Deborah Hoyt, president and CEO of the Connecticut Association for Healthcare at Home, said homecare agen- cies that provide skilled nursing and other services are feel- ing the pinch too. Certain in-demand roles, such as speech and physical therapists, are particularly tough to fill. "The workforce issues are going to get really real," Hoyt said. "They're real now already." n Homecare workers provide many services including helping older clients stay active through exercise and other activities. 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