Inadequate Personal Care at Home Increases Overall Medicare Costs

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Medicare home health coverage plays a vital role in supporting the health, safety, and well-being of adults in need of community-based care. Unfortunately, the Center for Medicare Advocacy (the Center) regularly hears from Medicare beneficiaries and their families about their inability to access care, or the appropriate amount of care, despite meeting the necessary coverage criteria. For instance, while Medicare authorizes personal hands-on care (such as assistance with toileting and ambulation), access to home health aides continues to shrink. Not surprisingly, the failure to provide adequate care to beneficiaries in the community is increasing overall Medicare costs.

According to a recently published study in the Annals of Internal Medicine, poor support in the activities of daily living negatively affects annual Medicare spending. The May 2019 study, entitled “Medicare Spending and the Adequacy of Support With Daily Activities in Community-Living Older Adults With Disability: An Observational Study,” finds that poor support for “mobility and self-care is associated with higher Medicare spending, especially in the middle and lower ends of the spending distribution.” In a post on The Commonwealth Fund’s website, the authors suggest, “more than $4 billion in additional spending may have been incurred by Medicare in 2015 as a result of excess costs related to inadequate support . . . .” The authors note that more than one in five beneficiaries reported negative outcomes because of inadequate support, including difficulty toileting, problems with ambulation, and medication errors.

As our Medicare Platform states, the Center is committed to reducing ongoing barriers to care by ensuring home health coverage for beneficiaries who meet the necessary coverage criteria, as well as ensuring beneficiaries have access to legally authorized home health aides. To learn more about our efforts to protect and improve the home health benefit, please visit our Home Health Care webpage at https://www.medicareadvocacy.org/medicare-info/home-health-care/.

June 13, 2019 – D. Valanejad

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