Home Care

A bipartisan group of congressmen yesterday proposed a $500 million expansion in home care for the elderly, and accused the Reagan administration of unfairly denying some Medicare benefits as a way of cutting back federal spending, contrary to the will of Congress. The proposed legislation, drafted by Sen. Bill Bradley (D., N.J.), would increase the maximum length of home nursing care from 20 days to 60 days and add a new benefit of three weeks of help, after a hospital stay, from unskilled personnel such as a housekeeping aide.

The House yesterday defeated a $28 billion Medicare bill that would have given long-term home care to about 1.4 million chronically ill Americans, even as representatives applauded the bill's author, Rep. Claude Pepper (D., Fla.). The House voted 243-169 to block the bill from coming up after a passionate debate that pitted Pepper, at age 87 the oldest member of Congress, against powerful chairmen whose committees had been bypassed when the bill was written. They said Pepper's bill was too broad and too costly.

The federal government increasingly is refusing to pay for home health-care services to the elderly under Medicare, contrary to the intent of federal legislation, private agencies that provide such services complained yesterday. The National Association for Home Care said that federal officials last year rejected five times as many bills for home health services as they did in 1983, leaving thousands of ailing Medicare recipients without adequate care. Representatives of the Washington-based group joined three congressmen, two home-care executives and a physician at a news conference to announce that they would file suit today in Washington against the Department of Health and Human Services.

At age 79, Ralph DueWhite of Twin Oaks, Delaware County, had all he could handle taking care of his wife, Thelma, who was invalid and beginning to show signs of dementia. Then it got worse. Thelma DueWhite, 78, was diagnosed with brain cancer in June, and Ralph DueWhite's physician warned him that the stress of his protracted caregiving was taking a toll. The doctor advised him to get help for himself as well as for his wife. That's when DueWhite called the Delaware County Office of Services for the Aging, which administers the state-funded Waiver program for older adults who qualify for subsidized at-home care.

I am a baby boomer who, like many others, is confronted with issues related to growing older. I also have an 81-year-old mother who lives three hours away from me, in Westmoreland County. She is in good health and enjoying her senior years. Together, we talk a lot about the "what ifs" when it comes to her health and future, and she has made very clear that a nursing home is not in the picture. She wants to remain at home. Pennsylvania government spends nearly all of its Medicaid long-term care budget, 93.2 percent, on nursing homes.

A 65-year-old Aliquippa stroke victim with cancer of the throat, a feeding tube in his stomach and draining wounds had his home-care benefits cut in half last winter by Medicare officials. A 62-year-old woman living alone in Philadelphia, suffering from heart disease and battling cancer, waited six months for the first visit of a homemaker this spring because of a massive backlog in demand for homemakers' services at the Philadelphia Corporation for Aging. A 76-year-old New Jersey woman is caring for her 86-year-old husband, bedridden and the victim of four strokes, after the couple's Medicare home health-care benefits were all but eliminated last fall.

All across the nation, the insurance company and HMO executives who are busily ejecting acutely ill patients from their hospital beds are singing the praises of home health care. Taking care of sick patients at home, they proclaim, saves money; reduces the risk of hospital-born infections, and spares the sick the experience of an often cold and impersonal hospital setting. Visions of mom serving up hot tea and chicken soup to a child with a bad case of the flu immediately come to mind.

An official with the Pennsylvania Department of Public Welfare said yesterday that muscular dystrophy patient Andrew Vizuete had been granted medical-insurance coverage to live the remainder of his young life at his Bucks County home, and that his family was told of the ruling on Friday. Vizuete, crippled by fatal Duchenne muscular dystrophy and the subject of an article in yesterday's Inquirer, said he was battling with his insurance company to provide a full-time in-home nurse so he would not have to die in a nursing home.

Senior citizens ages 65 and older make up the fastest-growing demographic group in the country, one that is projected to swell to about 74 million people when the baby boomers come of age in 2030. Not only is that a relatively large segment of the overall population, but it also represents a burgeoning market for businesses and agencies seeking to provide goods and services for the elderly, especially home care. Home care is described as a wide range of health and social services delivered to seniors who wish to remain independent in their own homes for as long as possible.

Stephen Thompson can't forget the 52-year-old patient whose bones were so brittle from breast cancer that they would literally break on the way to chemotherapy in the hospital. The solution was to treat her at home. Thompson, an executive for the Visiting Nurse Association of Greater Philadelphia, was able to give the woman the treatment she needed inside her Center City apartment, which overlooked the Benjamin Franklin Bridge. For more than a year before she died, she could lie down amid her collection of stuffed animals and take intravenous medicine for her cancer.

New Jersey is being asked to pay back $61 million in federal Medicaid reimbursements because the state has not documented whether some services claimed for disabled people were provided, U.S. government auditors said. The overbilling happened from 2005 to 2007 in a program that provides home care for mentally and physically disabled people, auditors at the Health and Human Services Department's Office of Inspector General said in a report today. The state billed the federal government $1.4 billion for the program during the period.

JoAnn Splon Downes, 81, of Center City, a social worker who was one of the pioneers of hospital-affiliated hospice care in Philadelphia, died of Parkinson's disease on Easter, April 8, at home. "She was comforted by the presence and spirit of family gathered for the holiday," her children wrote in a tribute to their mother. In 1978, Mrs. Downes had been a social worker in Philadelphia for two decades when she was asked by a friend, Dr. Jeffrey Hartzell, to be administrator for a new program he was establishing at Pennsylvania Hospital - the first hospital-based hospice service in Philadelphia.

Gary Alexander, secretary of Pennsylvania's Department of Public Welfare, is determined to cut spending for programs run by the agency that has the biggest chunk of the state's budget. The reduction of Medicaid rolls by more than 80,000 children since August and plans to institute an asset test for food stamps in May have gotten widespread attention. But more subtle moves are roiling the mostly nonprofit world that serves disabled and elderly Pennsylvanians who live at home - instead of being institutionalized - with the help of attendants hired and supervised by the disabled person but paid by Medicaid under an inscrutable system of waivers.

Air Products & Chemicals Inc. is selling its Continental Europe home care business to the Linde Groupe of Germany for 590 million euros ($749.9 million), the Pennsylvania-based company said Monday. The business being sold provides oxygen therapy, sleep therapy, and infusions, and it operates in Germany, France, Spain, Portugal and Belgium. The operations have a base of about 260,000 patients and reported revenue of about 210 million euros ($266.9 million) in 2011, the Allentown-based company said.

Last week, the Obama administration announced plans to abandon a key part of the health-care reform law, known as the CLASS Act. Although most Americans hadn't heard of the provision, it was meant to fix our broken long-term care system. Abandoning it was a mistake. A few days ago, I took care of a lively, 86-year-old woman in the emergency room. Let's call her "Mrs. T. " Mrs. T lives alone, and she came to the ER hours after a fall. "No one was around to help me up, so I stayed there until my neighbor stopped by," she told me. She was lucky: If her neighbor hadn't stopped by, she might have died there on her own floor.

ALLENTOWN - A Lehigh County jury has awarded more than $23 million to a woman who lost parts of both legs to infection almost three years ago. Attorneys for the 55-year-old Lehighton woman argued that a home-care nurse failed to report a bacterial infection in the feeding catheter of the patient, who was being treated for complications from Crohn's disease, and that the delay resulted in a near-fatal bloodstream infection in October 2008. A Lehigh County jury on Friday found the nurse and St. Luke's Miners Memorial Home Care liable, awarding $23.1 million for medical expenses, lost earnings, and pain and suffering.

FLORENCE - As we head for a tour of the Tuscan countryside, our guide announces that we will be making an unscheduled stop. "I think you will appreciate it," is all Paolo Santioli will say. Soon, our bus pulls into the Florence American Cemetery, proceeding up the wooded hillside to the memorial pylon towering over countless rows of pristine white grave markers. We get off the bus and walk the grounds where 4,402 American men and women killed in World War II are buried. Some of us quietly make our way around the reflecting pools and marble maps indicating the battles fought, while others wander silently among the manicured graves.

RE ELLEN Kadransky's March 3 letter on home care: Does she really have an issue with a business owner having the nerve to want to make a profit? I work for a home-care agency, and Ms. Kadransky needs to be aware that every home-care employee consumes more than an hour of unbillable time between the interview, completion of paperwork and introduction to the client for whom he or she will care. Every employee requires a $40 national background check and a $20 tuberculosis test, which the employer/business owner pays for. The employer also contributes to the employee's Social Security obligation as well as the state unemployment fund, even if he never has a single claim.

Heidi Azar of Cherry Hill knew her mother needed help. Caring for Azar's 91-year-old grandfather, who has Alzheimer's disease, had become a 24-hour-a-day job as his condition worsened over the last two years. "My mom's the one that suffers to some degree," Azar said. "She doesn't want to put him in a home but . . . everyone needs some time away in these situations. " Azar suspected her mother would be reluctant to have a stranger come into her home to help. Then she heard of a new product offered by TLC HomeCare Services of Moorestown: respite packaged as pampering.

DAN Geringer's story about people with disabilities struggling to live independently really hit home ("Freeing People Who are Trapped in Nursing Homes," Feb. 25). My son has been able to live independently with the love of his family, and with reliable home-care aides coming in to support him. Tim Kinniry, Deborah Thomas and thousands of people in our state have the right to live in their homes and not in nursing homes. But it is having reliable home-care aides that make all the difference.