December 6, 2021

Patients Should Have the Option to Choose Home: Case Study

Home healthcare is an essential care option for patients recovering from a hospital stay and in need of continued treatment for an acute or chronic health problem. Unfortunately, many patients do not have the option to recover at home. Instead, many Medicare beneficiaries must receive care in a skilled nursing facility following hospitalization due to limited care options under Medicare’s current payment structure.

To better understand the real impact of these limitations and why the ability to recover at home should be prioritized for seniors, the case study below examines a 65-year-old whose choice in their preferred post-acute care setting was limited, resulting in their admission to a skilled nursing facility:

The patient went to the hospital for a planned surgery for mandibular cancer. The patient had extensive surgery to remove the cancerous mass from their mandible and surrounding tissues. This surgery resulted in the placement of a tracheostomy, gastrostomy tube for tube feedings, and a wound vac to the donor site. 

Despite the patient’s complex needs, they were doing very well following the procedure with the help of therapy. The patient had begun to learn how to care for their trach and how to administer tube feedings. With their recovery going well, the wound vac was able to be removed prior to discharge, and they received daily wound care orders. Physical and occupational therapies were ordered, and the patient’s doctors recommended “Community Based Services.”

Prior to being hospitalized, the patient reported they were completely independent. They were able to drive themselves and walk independently without using an assistive device. They were hoping to return home at discharge but did not have any local family or friends who were able to help them at home. Even though the patient’s recovery was progressing well, they still needed short term daily care at home to return to normal. This included a need for assistance with activities of daily living, as well as daily clinical care for their wound in their left lower extremity, and daily physical therapy to continue regaining their strength. 

Due to the lack of post-acute care options to receive care at home, they reluctantly went to a short-term skilled nursing facility for rehabilitation and daily wound care at discharge. Even though this was not the patient’s first choice, they had no other option because of the lack of choice in their Medicare post-acute coverage.

If patients had greater access to additional home health services following hospitalization, patients would be able choose their post-acute care setting in many instances. To address this gap, Congress is working to pass the Choose Home Care Act of 2021 (S.2562/H.R. 5514), which would expand eligible patients’ ability to receive clinical and extended care services at home. With the Choose Home benefit, this nursing home eligible patient would have a cost-effective and preferred care option to access home-based services including skilled nursing, therapy, meal preparation, transportation, and personal care services for 30 days after leaving the hospital.

As America’s senior population grows and continues facing the impacts of the pandemic – including the risks of care in institutional settings – it is an essential time to modernize and expand the benefits of the Medicare system in the best interest of beneficiaries.

 To urge your lawmakers to support this important bipartisan legislation, click here.