‘We have to fix this’ Sens. Casey, Collins hear rural home healthcare concerns

The home health care system in rural America needs a facelift. 

This was the consensus of both lawmakers and a panel of witnesses who testified Wednesday before the U.S. Senate Special Committee on Aging.

The panel’s chairwoman, U.S. Sen. Susan Collins, R-Maine., and U.S. Sen. Bob Casey, D-Pa., the panel’s ranking Democrat, heard the experiences of health care workers, program directors and healthcare industry experts on what could be done to improve home healthcare in rural parts of America. 

Casey invited former steel worker Francis Adams from Washington, Pa. to share his experiences and insights with the special committee. 

Adams, who is in his seventies, testified that he has to work two jobs, one as a home healthcare worker and another in retail —  to make ends meet. 

But Adams’ day doesn’t end there. He told the panel that he’s also a caregiver to his blind brother. 

Adams said he was concerned about the shortage of home healthcare workers in the United States. 

More than 1 million more home healthcare workers will be needed by 2026 to support demand in the industry, he said. 

That statistic seemed to rattle Casey who replied, “We’re not anywhere near meeting the obligation” of the home healthcare industry, adding that “We’re failing as a country.”

Casey, who’s sponsoring a bill to improve and invest in home and community-based healthcare services, said Pennsylvania’s rural nature is a hurdle for the industry. 

“When people think of Pennsylvania they tend to think of Philadelphia and Pittsburgh,” Casey said. But 48 of the state’s 67 counties are rural, he noted. 

Casey’s bill would award seven-year grants to states following recommendations from state-based development and implementation councils to expand affordable housing, create better access to transportation, increase wages for direct care professionals and build more job opportunities for those with disabilities. 

William Dombi, president of the National Association for Home Care and Hospice offered his support and his organizations support for Casey’s bill saying that he was “impressed.”

The hearing also shed light on issues with telemedicine access in rural areas.

Leighann Howard, director of home health and specialty programs at Northern Lights Home Care and Hospice in Waterboro, Maine,  testified that broadband and cell signals in rural areas are hurdles to telemedicine not only for patients, but for provides as well.

Howard said that “it isn’t far off I-95” that cell phone reception and broadband connections start to fizzle out in the New England state’s rural interior. 

Collins, who’s sponsoring legislation that would expand rural broadband, said she’s heard from young veterans with mental health needs who have utilized telemedicine as an alternative to physically seeing a therapist or psychologist. 

“We must do everything we can,” to support home healthcare in rural areas, Collins said.

Eager to find solutions, the committee asked witnesses what could be done to improve home healthcare services. 

Dombi, the son of Eastern European immigrants, suggested immigrants as a potential source of the much-needed home healthcare workforce, but added, “There’s no one silver bullet solution.”

Dombi also suggested that a change in the curriculum was needed to better support rural healthcare, creating an industry that isn’t hospital or physician-centric.

Pointing to Washington and Oregon, Adams praised healthcare worker unions as a way to build interest in the industry. 

A union member, Adams said that unions were able to “get home healthcare workers reasonable wages” and training. 

Warren Hebert, an assistant professor at Loyola University and CEO of the Home Health Care Association of Louisiana said finding incentives to attract and keep residents of rural areas in place are crucial to building a sustainable workforce for the industry. 

Changes to Medicare were also discussed as options to eliminate home healthcare obstacles. 

Dombi called a Medicare provision blocking doctors from prescribing home healthcare to patients “antiquated.”

Collins agreed, saying changes to Medicare were only “commonsense.”

Casey mentioned the federal government’s proposed cap on Medicaid spending and its effect on access to healthcare. Casey said he believes this cap will disproportionately affect rural Americans. 

Adams called the caps “devastating,” adding that recipients would have to cut corners to make up for the losses. 

The caps would limit government spending on the Medicaid program, establishing a ceiling on how much money the federal government is willing to spend on the program in favor of block grants or finite confers that states would need to apply for to fund their Medicaid services. 

“We have to prioritize the healthcare needs of rural Americans,” Casey said. “One of the best places to validate that we care deeply for the people who live in these communities is to not cut funding for those services like Medicaid.”