Midland Care Connection, a nonprofit in Topeka, KS, offers the spectrum of senior care to people over 55 in 40 counties in Kansas and Missouri. Its services include home health, hospice, palliative care and the Program of All-Inclusive Care for the Elderly (PACE). It also is the owner of an Accountable Care Organization. Dual eligibles make up about 85-90% of Midland Care’s PACE clients. PACE, which provides a range of services to keep people in their homes and out of nursing homes, helps to improve the quality of life and lower healthcare costs of dual eligibles within the first 90 days, Wiltz said. Preventive care, he emphasized, is the key to treating this group. One of the biggest changes that has taken place since the organization started PACE in 2007 has been Kansas’ growing understanding and acceptance of PACE. This bodes well with the recent passage of the One Big Beautiful Bill Act, which contained federal Medicaid reductions. Midland Care’s diversified revenue streams also help to shoulder the organization from Medicare home health and Medicaid reimbursement cuts. With the continuing reductions to home health payment, Wiltz believes home health is reaching a crisis point. Agencies are going to have to pivot away from Medicare fee-for-service and move to models such as Medicare Advantage’s Dual Eligible Special Needs Plans (D-SNPs).

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McKnight’s Home Care Editor Liza Berger; Jeremy Wiltz, Vice President of Strategic Initiatives, Midland Care Connection

There are serious ramifications for the continued payment reductions in the Medicare home health regulations, Steven Landers, MD, MPH, CEO of the National Alliance for Care at Home, said. Beyond the lack of access to home health services, the whole payment structure has been decimated, he said. This year, the home health payment program will total just over $15 billion, down from $17.8 billion in 2019. The cuts are making it harder for agencies to have the purchasing power to staff agencies. Another negative development for home care is the passage of the “Big Beautiful” bill, which will place pressure on states to reduce home- and community-based services. The Medicaid work requirements in the law may hurt personal care workers who use Medicaid as their health insurance, he noted. While home care is not the most powerful lobbying contingent in Washington, “sometimes right beats might,” Landers said. Landers’ past positions, which included his role as director of home care at the Cleveland Clinic, helped him see the value of home care and how policy making in Washington affected the care regular people receive. As part of his tenure, he would like to see home care providers be able to deploy new care models such as the Medicare Care Choices Model. Landers sees the Alliance being a partner with the Centers for Medicare & Medicaid Services to combat rampant hospice fraud.

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McKnight’s Home Care Editor Liza Berger; Steven Landers, MD, MPH, CEO, National Alliance for Care at Home 

Americans plan their vacations in more painstaking detail than they plan for aging, even though the aging stage of life lasts much longer, said Peter Ross, CEO of Senior Helpers. After meeting Richard Wexler, host of the podcast Caring in America about a year and a half ago, they decided to launch a nonprofit foundation to help Americans plan their aging journeys and be proactive. The result is APlan2Age.org. Unlike other sites that provide resources, APlan2Age is noncommercial and does not seek to profit off the site, Ross said, noting that Senior Helpers is an advisory council member. He encourages other home care firms to reach out and help support the site. One of the site's signature aspects is a care plan that visitors can fill out and modify over time. Ross noted that the purpose of APlan2Age is to try to prepare for the aging process as a way to head off a catastrophic life event. Families, for example, might talk about installing grab bars in loved ones’ showers to help prevent falls. Wexler learned about the importance of planning the hard way — when he and his wife were thrust into caregiving roles for their parents in their 80s. One of the big reasons to prepare for aging is to take pressure off family caregivers who shoulder most of the burden of caring for aging family members, Ross said. The next big development for APlan2Age will be Tuesday, July 29, at 1 pm ET, when Ross and Wexler hold a webinar entitled “The National Conversation on Aging.”

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McKnight’s Home Care Editor Liza Berger; Peter Ross, CEO of Senior Helpers and Co-founder of APlan2Age;  Richard Wexler, CEO and Co-founder of APlan2Age