In the Realm of Haunting Ghosts: Denying the Existence of Substance Abuse in Medicare Home Health

ABSTRACT

Purpose: There is extensive literature on the significance of substance use, misuse, and abuse among the elderly in the United States. A literature review indicates no studies on the nature, significance, or impacts of the lack of substance use and abuse coverage in Medicare home health.

Method: The current study is an initial, exploratory study to address the literature gap, based on interviews of a convenience sample of 37 home care nurses between January 2013 and May 2014 in the New York City metropolitan area.

Results: Nurses believe substance use and abuse occurs frequently among Medicare home health patients; substance use and abuse is not assessed and treated professionally in Medicare home health; the lack of coverage in Medicare home health results in exacerbation of existing patient physical and mental health conditions, which, in turn, worsen substance use and abuse conditions; the homebound requirement and lack of coverage of transportation and personal care assistants limits home care patients ability to obtain outpatient substance use and abuse treatment; and lack of home-based assessment and treatment contributes to increased home care readmissions, re-hospitalizations, and increased caregiver burden.

Discussion: The new PDGM system, which begins January 2020, provides an ideal opportunity for representatives of the home care, social work, and substance use professional associations to assert the need to change coverage and reimbursement requirements to allow for a more evidence-based approach to assess and treat Medicare home health patients with substance use challenges.

KEYWORDS:

• Medicare
• nurses
• home health
• substance use
• substance abuse