A proposed policy related to in-home care played a noteworthy role in the tumultuous election that has reconfigured the political scene in the United Kingdom. Here in the United States, there might be lessons to draw from what happened across the pond.
Despite some sharp differences between the U.K. and U.S. health care systems, both countries are facing aging populations and grappling with similar issues, Denis Fleming, vice president for government relations at Louisville-based Almost Family (Nasdaq: AFAM), told Home Health Care News. Both nations are trying to balance government-funded and self-funded care, and the role that in-home services should play in keeping costs down and seniors happy and healthy.
As the home care industry and politicians here in the States take on these challenges, they might consider how British seniors responded to the possibility of a so-called “dementia tax.”
In April, British Prime Minister Theresa May called a snap election, gambling that her Conservative party could emerge more powerful. Instead, the Conservatives lost their majority in Parliament after the tide turned against them due, in part, to their “dementia tax” proposal.
This policy would have changed the way that Britons pay for in-home care. For the first time, people would have had to pay for their own in-home care costs out of their own pocket until they had only £100,000 in assets remaining—including the value of their home. Homes in the U.K. are worth £216,000 on average.
Opponents of the policy pointed out that if someone died of a heart attack, for instance, their assets would be intact and passed along to their inheritors. However, if someone developed dementia and required in-home services for a prolonged period of time, that person’s assets would be drained to cover care costs.
“They propose to build a system maintaining the current huge incentives to divest wealth before any need to access social care,” Chris Giles wrote in the Financial Times. “Families are best off if they give away wealth to their offspring early, if they spend the money on cruises, or even on a lifestyle that is more likely to result in a rapid death.”
Facing a backlash, May seemed to do a u-turn on this policy proposal, hurting her credibility. Post-mortems on the election, such as this one in the New York Times, cited her alienation of older voters as one reason for the Conservatives losing their majority in Parliament when votes were cast on June 8.
The election results demonstrate just how popular the in-home care benefit is to Britons, and recent polling from the AP and NORC indicates strong support for a similar government benefit here in the United States, Almost Family’s Fleming said.
Because there is no general Medicare or Medicaid benefit covering personal care services in the home, similar to what the National Health Service (NHS) provides in the United Kingdom, it’s common that U.S. seniors who need help with activities of daily living spend down their assets paying for care until they qualify for Medicaid, which does cover long-term care in skilled nursing facilities.
A bill re-introduced earlier this year by Sens. Ben Cardin (D-MD) and Chuck Grassley (R-IA) seeks to create a Medicare demonstration program that would pay for in-home personal care services. The idea is to help people stay out of nursing homes—settings that seniors prefer to avoid and that are more costly than home care.
As this is under consideration at the federal level, even more action is happening in the states, Fleming said.
“From a government relations standpoint, we’re seeing repeated efforts at the state level to implement a home-first strategy,” he said. “States are laboratories of innovation.”
Using strictly state dollars, for example, Ohio expanded eligibility for home care coverage and dramatically reduced its amount of institutional care. Almost Family also is seeing managed care organizations (MCOs) driving toward more coverage of personal care in people’s homes. MCOs are grasping the potential for home care to improve outcomes while lowering costs, such as by reducing hospitalizations of seniors insured by managed care plans.
There’s no telling when and how home care might become a political flashpoint in the United States as it just did overseas, but Fleming believes that it’s increasingly coming to the forefront in the health care policy debate here.
“We’re approaching an inflection point in terms of the value of home care and the recognition of policymakers as to what it can contribute,” he said.
Written by Tim Mullaney