Broadcast Retirement Network’s Jeffrey Snyder discusses the differences between Home Care and Home Healthcare and who pays for what with the Association of Healthcare Journalists’ Liz Seegert.
Jeffrey Snyder, Broadcast Retirement Network
Joining me now is Liz Seegert. She’s a contributing editor for the Association of Healthcare Journalists. Liz, so great to see you.
Thanks for joining us this morning.
Liz Seegert, Association of Healthcare Journalists
My pleasure, Jeffrey.
Jeffrey Snyder, Broadcast Retirement Network
I am really excited to talk to you because I know the work that you do, you do spend a lot of time educating people. And we’re gonna talk about home care versus healthcare. I guess my first question is, how do you differentiate between the two?
What is home care versus healthcare? Or are they similar or analogous to one another?
Liz Seegert, Association of Healthcare Journalists
They’re analogous, I would say, but most people get home care and home healthcare mixed up and are unsure who pays for what. So the best way I can describe it is home healthcare, which is often covered by Medicare, which most people over 65 have some form of, involves more skilled care. And it’s done or given often in conjunction with things like wound care or being discharged from a rehabilitation facility.
If you break your hip, they might send a physical therapist to your house. Those are considered health related. So recovering from an illness, an injury, that requires skilled nursing care.
And that’s covered by Medicare. Home care is what many older people and people with disabilities rely on. Those are things like the personal care assistants that might help you get dressed in the morning or might help you with shopping or cooking or just making sure you take medicine.
at the right time. They are not licensed RNs. They are not licensed paraprofessionals, but they are often skilled and trained in related issues like dementia care or pediatric care.
Jeffrey Snyder, Broadcast Retirement Network
That’s- Really important. Sorry, go ahead. Finish your thought, I’m sorry.
Liz Seegert, Association of Healthcare Journalists
That’s often paid for by Medicaid, which is the low income healthcare program for both older adults and people who don’t meet the federal poverty level. The difference is that people think they’re entitled to home care and they’re not. You have to qualify either financially or you’re stuck paying for it out of your own pocket.
Jeffrey Snyder, Broadcast Retirement Network
My apologies for interrupting you, Liz. Let me follow up on that. In your experience, and you know the market better than I do because you write about it each and every day, are more seniors looking to age in place, stay in their homes, their townhouses, their condos, and therefore they fall into this category potentially of needing home healthcare and home care potentially?
Liz Seegert, Association of Healthcare Journalists
Absolutely. Most people, according to surveys I’ve seen from AARP and from other organizations, say that somewhere between 85 and 90% of people want to age in place. And if they can’t stay in their own home because of stairs or other limiting issues, then they want to move into perhaps an apartment, but in the same community they’ve always lived in.
That’s where their friends are, that’s where their dry cleaners is, that’s where their pharmacist is, and it’s just a much more comfortable environment.
Jeffrey Snyder, Broadcast Retirement Network
And I can understand that. I mean, why would you want to pick up, sell off things? You know, presumably you’d have to downsize, live in a smaller area.
And again, there’s so much disruption. But let me ask you, are there enough societal resources? And by that I mean, you mentioned Medicare, you mentioned Medicaid in terms of paying for some of these or not paying for some of these, but do we have the caregiving, the long-term care, the home care resources available for what, you know, is a large swath of people retiring and maybe looking for these services?
Liz Seegert, Association of Healthcare Journalists
The short answer is no, we don’t. Some of this depends on what state you’re in and some of this depends on even where within that state. For example, where I live in the Hudson Valley in New York, it’s very car dependent.
So you immediately need people who are able to drive as opposed to somebody in, let’s say, New York City where they could take public transit. So there is some modest barriers like that. But the biggest problem is recruitment and retention of home care workers.
Most of them make less than $20,000 a year. Many of them are on Medicaid themselves because they don’t meet the poverty guidelines for health insurance. Many of them work two or three jobs because it’s often a part-time gig with a home care agency.
So they have to work double shifts. And there just is a big problem among home care agencies retaining skilled workers. You want somebody that’s done this before.
You want somebody that knows how to lift somebody out of a chair or help them take a bath without hurting the person or themselves. And people are leaving for jobs at Target or McDonald’s or places where it’s not as physically demanding. And quite frankly, the hourly wage is a lot better.
Jeffrey Snyder, Broadcast Retirement Network
With that being said, does technology at all play a role in helping to ease some of these challenges or supplement or complement some of the work being done? Because there’s been a lot of, I’ve been reading a lot of stories in your publication and in others about robots, artificial intelligence, even specialized canes, for example, that can help people get, they have GPS is built in, absolutely amazing. But short question, does technology play a role here or can it play a role?
Liz Seegert, Association of Healthcare Journalists
Yes, it absolutely can play a role. Personally, I don’t believe it can substitute for a human, but it can augment it. For example, there are basic things like fall detection systems that can be put in the house that would automatically alert a caregiver, family member or 911, similar to the life alert, but it would be put through the house.
And a lot of people have the life alert and don’t wear them. My own father was one, but there are smart homes. There are stoves that automatically turn off.
There are devices like Alexa that can call a virtual doctor, for example. But I don’t think it takes the place of somebody in the home helping you to get dressed in the morning or making sure that you eat your meals. That being said, there are also some robots like Elecube that kind of act as a companion that can interact with an older person, that can have a conversation, play some simple games, take the vital signs like blood pressure or heart rate and share that with a physician.
But I think we’re a long way off yet from that Jetsons kind of vision that many of us might have about what robots can actually do.
Jeffrey Snyder, Broadcast Retirement Network
Yeah, I was actually thinking about the movie I, Robot with Will Smith, and I think his grandmother had a robot that helped her. Anyway, as I digress, but I think your point is well made. Let me ask you about pricing, because you talked about Medicare and Medicaid and what they do and don’t cover, but is home care pricing different?
Is it then healthcare pricing that’s in home? I mean, is it more? Sounds to me it’d be more expensive if you need someone to kind of sit with you and help you out in person.
Liz Seegert, Association of Healthcare Journalists
It absolutely is expensive. And again, those prices vary based on honestly what kind of insurance you have. Some Medicare Advantage plans, for example, will pay for limited home care.
They may direct you to certain agencies, home care agencies that they work with. So they may authorize say 10 hours a week. Honestly, 10 hours a week isn’t a lot if you need help every morning.
And often they have a minimum of let’s say four hours a day. So you’re stuck then if you want the home care paying for the difference out of pocket, and that can quickly get expensive because while the workers themselves may be making 12 or $15 an hour, the family may be paying the home care agency 30 or $40 an hour. So unless you have some wealth stashed, it can add up very quickly.
As I said, if you’re on Medicaid, then you qualify for a whole different range of services depending on the state you’re in, even depending sometimes on the county you’re in, but that can provide more consistent care. Medicaid reimburses these home care agencies at a rate even lower than Medicare, which is not very high to begin with. So a lot of agencies don’t wanna take Medicaid patients.
So it becomes this conundrum of even if the services might be paid for, you can’t find the workers. And it’s a real catch-22 and it puts a lot of burden on the family.
Jeffrey Snyder, Broadcast Retirement Network
Yeah, I’ve been reading stories about caregivers basically having challenges keeping jobs because they’ve had to take care of a loved one and even having some form of anxiety and depression, which obviously can have a major impact not only on your psychology, but also your health. Liz, we’re gonna have to leave it there. Great article and look, this is an ongoing challenge.
We’re all gonna have to figure it out because this is not going away. And we look forward to having you back on the program again very soon. Thanks for joining us.
Liz Seegert, Association of Healthcare Journalists
My pleasure.