Verma: Older Adults Must Have a ‘More Robust’ Set of Home Care Options

The U.S. Centers for Medicare & Medicaid Services (CMS) on Monday touted several tools designed to help states rebalance their long-term care ecosystem toward home- and community-based services. 

The development is the latest in a series of CMS efforts aimed at strengthening home- and community-based services amid the COVID-19 pandemic, with the ultimate goal of decreasing America’s reliance on nursing home care.

“The COVID-19 crisis has shone a harsh light on the human costs of a long-term care system that relies too heavily on institutional services like nursing homes,” CMS Administrator Seema Verma said in a statement included in Monday’s announcement. “Too often, they are seen as the default option, even for those who may not require round-the-clock care.”


Broadly, Monday’s “toolkit” offers examples of innovative state models and best practices to rebalance long-term services and supports programs toward in-home care. Examples largely focus on Medicaid, the primary funder of long-term services and supports nationally.

One specific example highlighted in the toolkit is Pennsylvania’s managed care policy that requires plans to implement a home care workforce innovation component within their programs, utilizing person-centered planning principles to improve the recruitment, retention and skills of direct care workers.

Another is Vermont’s Medicaid section 1115 demonstration to increase access to home- and community-based services for adults at risk for nursing home admission who may not be eligible for Medicaid and who do not meet level-of-care criteria for a nursing home.


“While nursing homes will always be an important part of a complete care continuum, many elderly individuals and their families should have access to a more robust set of home care and community-based care options,” Verma’s statement continued.

In FY 2018, 79% of total Medicaid long-term care spending for individuals with intellectual and developmental disabilities (I/DD) was tied to home- and community-based services. Nearly half of long-term care spending for individuals with mental health and substance use disorders was tied to home-base care.

Meanwhile, just 33% of long-term care spending for older adults and individuals with physical disabilities was tied to home- and community-based services in FY 2018.

Contextually, CMS issued its toolkit on the same day The American Health Care Association (AHCA) and National Center for Assisted Living (NCAL) released a report revealing that new COVID-19 cases are increasing in nursing homes in the U.S., mostly due to the community spread among the general population.

Weekly new COVID-19 cases in the general population rose by 61% to 391,527 new cases the week of Oct. 18, according to data from Johns Hopkins University.

A correlating uptick in new cases in nursing homes occurred when cases in the surrounding community started rising back in mid-September.


“As we feared, the sheer volume of rising cases in communities across the U.S., combined with the asymptomatic and pre-symptomatic spread of this virus, has unfortunately led to an increase in new COVID cases in nursing homes.” Mark Parkinson, president and CEO of AHCA and NCAL, said in a press release. “It is incredibly frustrating as we had made tremendous progress to reduce COVID rates in nursing homes after the spike this summer in Sun Belt states. If everybody would wear a mask and social distance to reduce the level of COVID in the community, we know we would dramatically reduce these rates in long term care facilities.”

The full long-term services and supports rebalancing toolkit is available here.

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