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A Pandemic Lesson: The Importance of Person-Centered Care

An Influencer in Aging reflects on people with complex care needs


Part of the The Coronavirus Outbreak: What You Need to Know Special Report

(Across caregiving and community, business and intergenerational attitudes, the pandemic and how we respond to it could change us forever. Next Avenue turned to some of our Influencers in Aging, a diverse group of thought leaders, for their insights, counsel and opinions of what could lie ahead — if we choose.)

Older adults are at high risk of contracting COVID-19 and those with complex care needs are particularly vulnerable. So, we at The SCAN Foundation — a public charity devoted to transforming care for older adults — are working closely with California leaders dealing with the immediate effects of the pandemic. But we’re also thinking long term.

I’m contemplating the learnings that come out of this experience and how the expeditious policy adaptations allowing health systems to respond to the COVID-19 crisis can create lasting change for people with complex care needs.

Person-Centered Care: Vitally Important Now

Experts predict, and I suspect, we’ll be dealing with different phases of this crisis for several years. It’s definitely not the time to forgo person-centered health care.

People with complex care needs are at the most risk during this pandemic, and federal, person-centered health policies are, thankfully evolving daily to respond to the current environment.

When a person’s values and preferences are elicited and a plan of care is put in place based on those values and preferences, health plans and their medical providers are better positioned to serve that person’s needs, particularly during crises.

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Person-centered care was always meant to be iterative — poised to address challenges brought on by a change in someone’s medical condition, a health professional or caregiver transitioning out of their care team and, yes, even a shift in how to provide care within pandemic public health protocols.

The rhythm of the care plan will certainly change and addressing a person’s worries related to their care is essential. But I’m confident that care teams can find ways to still honor people’s preferences and tackle what matters most tomorrow, next week and next month.

Use the Crisis Response to Drive Lasting Transformation

People with complex care needs are at the most risk during this pandemic, and federal, person-centered health policies are, thankfully evolving daily to respond to the current environment.

In the last few weeks, the Centers for Medicare & Medicaid Services (CMS) has issued an array of waivers and rules, creating new flexibilities that allow health systems to respond to the growing challenges brought forth by COVID-19.

These flexibilities let health systems build off current capacities and implement strategies that have never been done.

Three examples:

1. Before the pandemic, telehealth — the ability to confer with your doctor through a video call rather than in person — was slowly being tested and implemented for Medicare beneficiaries with a restricted set of providers. Now, it’s being used in new ways with CMS funding telehealth coverage for 80 additional services.

Medicare beneficiaries may now receive telehealth visits in any health care facility as well as in their home. Medicare is now also funding phone-based therapy for mental health services, which wasn’t the case even a month ago. And home health providers are using telecommunications to monitor people remotely in ways that align with their preferences and plan of care.

2. Home- and community-based services now can assess and deliver services in new ways to support social distancing and reduce risk of exposure for older adults.

To make this possible, nurse practitioners, clinical nurse specialists and physician assistants are now allowed to order home health and this regulatory change is intended to remain in place after the pandemic passes.

Home health providers can now also assess needs, and provide support, remotely. This will require processes for determining who needs a home visit and which types of visits are considered essential.

Also, physicians can now order home-based services such as home-delivered meals, preventive services and caregiver support services under the relaxed definition of “homebound.” Under the new rules, homebound includes people staying home due to COVID-19.

3. CMS has also approved Medicaid waivers to give states new emergency flexibilities. For instance, states can enroll out-of-state or new providers more quickly to be responsive to workforce demands. And some states are allowing Medicaid care coordination to be provided remotely.

Looking Ahead

The next few months will undoubtedly be really difficult for all of us. But I’m seeing elements of short-term COVID-19 crisis solutions that can, and absolutely should be, leveraged for true transformation.

Health systems that have focused in recent years on things like care coordination are the ones that will be most ready to engage these new flexibilities. They’ll also be the ones that will best serve older adults and people with complex care needs, while calling on person-centered care principles and keeping the person at the forefront to guide us through these uncharted waters.

 

By Dr. Bruce Chernof
Dr. Chernof is president and CEO of The SCAN Foundation. In that role, he advances a goal for the country that many Americans recognize as their own personal hope for their older years: that they can hold onto their independence and dignity, and that good-quality health care and other supports will be available to them in a way that respects their individual needs.@DrBruce_TSF

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