Wednesday, October 9, 2013

Continuing Care at Home (CCaH): New Players in Long-Term Care

Last week, Scott Townsley, Esq., of the business consulting firm CliftonLarsonAllen, was a guest speaker at Penn State Law's Elder Law class.  Scott has often shared his deep experience with law students and practicing lawyers, speaking from the care providers' perspective, including drawing upon his work with CCRC operations. I always learn something new when I hear him! This year, his presentation included the latest on a developing concept, "Continuing Care at Home."  And of course, in the tradition of long-term care, we have a new acronym, CCaH.  Financing on this type of option is different than merely hiring individuals to work as caregivers in the home on an hourly basis, and involves (from my understanding) a two-part fee structure that contemplates an ongoing relationship.

For details on this interesting concept, including FAQs, see the white paper by Scott and his colleague Sarah Spellman, "Continuing Care at Home: Evolution, Innovation, and Opportunity."

I'd love to see an example of the type of contract used for CCaH. Of course, that might be because I also teach Contracts courses!

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I admittedly just scanned the white paper. I have a few questions. Is it not true that custodial and Home Health in traditional Type A communities are on a fee-for-service basis? (In other words, that kind of care is NOT part of the traditional Type A commitment.) If the CCaH is associated with a traditional CCRC, wouldn’t the independent residents who paid to live on campus think, “Why can’t we receive home help as part of the contract, too?” I wonder if the CCRCs that decided to branch out into CCaH modified their traditional Type A contracts to include assistance in the independent campus units as part of their Type A "deal."
Is there a case of a CCaH NOT being affiliated with a traditional CCRC? Where do those “customers” go when they do need institutionalization? To a traditional AL/SNF facility? I can see these non-CCRC, long term health care facilities (AL, Memory, SNF) branching into CCaH. If they jump on the bandwagon, I think they would be major competitors to the CCRC that wants to branch out to CCaH.
One huge aspect of CCRC living is the socialization, so an unaffiliated CCaH wouldn’t have that. Ask any surveyor of Resident Satisfaction. It would say that “my fellow residents” plays a very positive role in the degree of satisfaction. How would an unaffiliated CCaH participant receive this socialization? If affiliated with a traditional CCRC, would the CCaH contractees be transported to a campus for activities and programs? If a couple enrolls and one needs to be institutionalized, say, for Medicare rehab, would the CCaH contract include transport of the well spouse to visit the one who is infirm? Transport to the campus dining room for meals? Wouldn’t traveling all over town for these pick ups be costly?
Non-profit CCRCs have Benevolent Funds that permit them to say, “If you run out of money through no fault of your own, we will not kick you out.” What is the similar commitment (if any) of a non-profit CCRC to a “resident” who is part of its CCaH arrangement?
I would think the financial qualification to sign on to a CCaH would be considerable, given the one-on-one nature of the possible custodial care, fuel costs/automobile allowances for the health care workers, and bus or van transportation (pick up for community activities, meals, visiting the infirm partner in Health Care). If a CCRC is Non-Profit and is already feeling the pressure to lighten up on financial screening of potential residents because of concern about jeopardizing its “non profit” status, would a non-profit CCRC be willing to take such a financial chance on contracts with these in-their-own-home participants?

Posted by: Jennifer | Oct 11, 2013 6:16:49 AM

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