The Business Case for Reimbursing Family Caregivers
Paying family caregivers works through Medicaid waiver programs. It can work with other payers.
A few weeks ago, I wrote that family caregivers solve the direct care workforce shortage. We step in to do more when the help we need isn’t available.
That insight led me to wonder: If we’re doing what a home health aide in a home health or hospice organization would do, why aren’t we being reimbursed?
We already have a model that works in the Medicaid space through programs like Structured Family Caregiving and Self-Directed Services. Through Self-Directed Services, a Medicaid recipient (your caree) can hire a family member to provide care.
We need a program, let’s call it the Family Cares Program, in the home health, Hospital At Home, palliative care and hospice spaces, as well. Keep in mind that home health benefits through Medicare are short-term and typically begin after a hospitalization or a decline. The caree qualifies for home health benefits when he or she requires care from a nurse or physical therapy, speech-language pathology, or continued occupational therapy services. Visits from a home health aide complement the services provided from a nurse or therapist.
A traditional Medicare plan wouldn’t allow the flexibility to reimburse a family caregiver. A Medicare Advantage plan does. About 6% of Medicare Advantage plans currently provide support for family caregivers.
With a Family Cares Program:
providers develop (or contract with) a Family Cares Program which trains, supports and reimburses the family caregiver. The provider determines the reimbursement rate based on length of coverage for services, level of care needed and the payer’s reimbursement rate. With Structured Family Caregiving programs, for instance, the provider must reimburse the family caregiver a percentage of the daily rate it receives. Medicare reimburses hospices providers for a daily rate and makes this daily payment regardless of the number of services provided on a given day, including days when the hospice provides no services. (This fact — that hospice gets paid every day regardless of whether services are provided — made me absolutely furious when I cared for my parents, who received hospice services. The hospice provider, short on staff and, honestly, competence, provided minimal help and support for us. We provided the care while the hospice provider kept the money.)
the caree annually selects the family caregiver who will be reimbursed. The selection could take place in the fall for the next year (like in October for benefits that begin in January). Because home health benefits begin after a hospitalization or a decline, a family caregiver would be have to be ready to go prior to the start of the benefit. When hospice services begin, the caree again can choose which family member will be reimbursed. If that’s not possible, then the family makes the selection. With an annual selection, the family also can effectively plan for which family member takes on the role of Family Care Manager, perhaps rotating the role among family members.
The family caregiver who will provide care can become a Certified Family Care Manager. We developed this training so that family caregivers who leave the workforce to provide care have a resume without a gap and because we saw the pool of money available because of the direct care workforce shortage. (Read my article from 2019, Opportunities and Challenges When Family Caregivers Get Paid, in CSA Journal.)
For providers, a Family Cares Program helps them:
Avoid costly hospital readmissions. I believe the family caregiver is the best prevention for hospital readmissions because we ensure medications are managed, the discharge plan is followed and our caree attends follow-up appointments.
Avoid unnecessary hospitalizations. Family caregivers work effectively to prevent hospitalizations because we understand home is the best place for everyone.
Meet quality standards. We’ll see more and more payers tie reimbursement to quality outcomes. The daily care from a family caregiver delivers a quality outcome.
Communicate effectively with both the patient and the family. I recently delivered a workshop called Healing the Life-Long Family Rift to a group of health care professionals. The attendees overwhelmingly complained about having to update several family members about a patient’s care and progress. With a Family Care Manager in place, health care professionals communicate with one family member.
For the Family Care Manager, the Family Cares Program provides:
reimbursement when care needs increase. The reimbursement may be short term but it’s a start.
an opportunity to be reimbursed for each caree. We’ll see one member of a family provide care to several carees at the same time. As the Family Care Manager oversees the care of several family members, he or she can be reimbursed when home health and hospice services begin. A Family Care Manager may be reimbursed from several payers for the care they provide to several family members. In addition, the Family Care Manager could be paid by the caree to bring in additional income. In my family, my parents hired my sister, my niece and my nephew to provide. The Family Care Manager could have several sources of payment: payers and carees.
training to help manage difficult family dynamics, stress management and strategies for future care needs.
support to manage the care budget and their own finances.
an opportunity to connect to a community of other Family Care Managers.
For the payer, the Family Cares Program provides:
a system navigator — the Certified Family Care Manager — who connects all the systems to ensures a caree’s quality care, and effective use of benefits. (The family caregiver is the only one in the system that touches all 17 Caregiving Systems.)
a continuation of care. For instance, a caree might move smoothly from a hospital discharge to home health because the Family Care Manager manages that transition. A smooth transition could happen from a Hospital At Home program to home health to palliative care and from palliative care to hospice services.
an effective crisis prevention plan. The Family Care Manager works with providers to prevent unnecessary ER visits and hospitalizations.
Of course, family caregivers do all this for free. From a payer and provider perspective, why pay us if already provide this kind of invaluable service for free?
Because we’re done doing this for free. We’re going to expect that a payer and a provider reimburse us for providing care. We can choose which home health, palliative care and hospice provider we use. Our caree has a choice when selecting a Medicare Advantage plan. We’ll pick the provider and the plan that takes care of our caree and us.
Let’s Continue the Conversation
Join me on September 29 at 1 p.m. ET (Noon CT, 10 a.m. PT) to talk out the possibilities and consider what our next steps could be to advocate for a solution like a Family Cares Program.
Upcoming Events
We’d love for you join us for these upcoming events:
We do our best to keep our career on track as we manage our caregiving responsibilities. Sometimes, though, we need to take a leave because of a crisis, our caree's decline, our caree's transition to a different care setting or our caree's end of life care needs. On September 22, we'll help you think through when you may want to use either a paid leave benefit or Family Medical Leave. We'll also help you effectively manage your leave so you're ready to return to work. Register to join us for Planning Your Temporary Leave During Your Caregiving Experience, a two-hour event on September 22 which begins at 11 a.m. ET.
Our free monthly planning sessions help you consider options for getting paid for providing care, create your Family Emergency Plan and build your own Respite In Place space. Register to join us.
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