In this recent Forbes article:
the Centers for Medicare & Medicaid Services (CMS) is finally acknowledging the crucial role that family members play in caring for frail older adults and younger people with disabilities. The agency is taking important steps to help them by paying doctors and other providers to deliver critical support to the families of people with certain medical conditions.
The agency plans to pay Medicare providers, including physicians, some nurses, and therapists, to train family caregivers. They will also pay for a social needs assessment and care navigation for people with certain conditions and create an integrated care model for people with dementia and their families.
The new payment model should allow doctors to outsource caregiver training to community-based organizations, such as adult day and senior centers. However, these organizations are generally not Medicare providers. Hopefully, CMS will find a way to make this work.
The second initiative would allow Medicare to pay for a health-related social needs assessment and assistance with care navigation. This new payment rule would allow physicians to partner with non-medical providers, including community-based social service organizations and community health workers.
Comprehensive Dementia Care The third proposed reform focuses on providing dedicated support to families caring for individuals with dementia. Named the "Guiding an Enhanced Dementia Experience" (GUIDE) initiative, this eight-year program is designed to offer a comprehensive range of services. It includes care coordination and management, caregiver education and assistance, as well as respite services.
Scheduled to commence in a year's time, this program represents an ideal model of fully coordinated care for individuals dealing with chronic conditions. As I previously mentioned, innovative integrated care programs for individuals with dementia have faced challenges due to Medicare (and Medicaid) not covering them. However, this initiative has the potential to change that situation.
While the dementia care model appears promising, it raises the question: why is CMS restricting its scope to individuals with dementia alone? Medicare should contemplate implementing a similar model for all individuals dealing with severe chronic conditions.
Overall, these proposals represent a significant step forward in recognizing the vital role that family caregivers play in our healthcare system. While some proposals will provide valuable support, others may be less effective. However, the key takeaway is that traditional Medicare will finally pay to support family caregivers.
The Significant Role of Family Caregivers
There are still many unanswered questions, such as how much Medicare will pay for these services, how often they can be provided, who qualifies as a family caregiver, and whether medical practices will be willing to participate. Despite these uncertainties, the Biden administration’s initiatives represent a significant step forward. They aim to remove some of the biggest obstacles to effective family caregiving and may help individuals with chronic conditions to age at home for longer. Most importantly, they demonstrate that family caregivers are valued and essential members of our healthcare system.