Gratitude and Courage

For many of us, this time of year serves as an opportunity to reflect on what we are thankful for; the company of our loved ones, our personal health and safety, or the resiliency of our communities. This year at VNAs of Vermont we are thankful for the dedicated nurses, therapists and other staff who provide compassionate home health and hospice care to our families, friends and neighbors. Because of the care provided by VNAs of Vermont member agencies, many Vermonters will be able to spend the Thanksgiving holiday in their homes, with their families.

The month of November is also recognized annually as National Hospice and Palliative Care Month (HAPCM). The theme of HAPCM this year is ‘Courageous Conversations,’ and we are encouraging you to join us in discussing the benefits of advanced planning, hospice, and palliative care.

HAPCM was first announced in 1978 by then President Jimmy Carter to recognize the efforts of those who provide end-of-life care, and to help raise awareness of the growing hospice movement. Days ago, former first lady Rosalynn Carter, who was in hospice care, died peacefully in her home with family by her side. In 1987, Rosalyn Carter founded the Rosalynn Carter Institute for Caregivers to support the unique needs of the caregivers who selflessly care for family and friends. She was an exceptional advocate for care at home, and we are deeply thankful for her commitment to sick or aging Americans, and the people who care for them.

Former President Carter, also a long-time champion for care at home, announced in February of this year that he was entering hospice care, and recently celebrated his 99^th birthday.

Conversations about death can be difficult for many but having these difficult conversations early go a long way towards ensuring that we can all live our best lives until the end, and that we have a plan in place for when we’re no longer able to make medical decisions for ourselves.

It is never too early to start having courageous conversations about hospice and palliative care!

In the coming months we will continue to share information about hospice and palliative care options available to Vermonters. Reach out to your local home health and hospice agency to discuss available hospice services. More information on HAPCM can be found on the National Hospice and Palliative Care Organization’s website.

Federal Update: Permanent Medicare Home Health Rate Cut in Final Rule

In early November the Centers for Medicare and Medicaid Services (CMS) issued the Final Rule regarding Medicare home health services payment rates for CY 2024. The permanent cuts contained in the final rule present a significant threat to the home health and hospice services that thousands of Vermonters depend on to heal or age at home.

CMS implemented a new payment methodology on January 1, 2020. It is to this new standard rate schedule that CMS is applying cuts. In the proposed rule, CMS called for a total permanent cut of 9.48% to this new standard rate. CMS already started phasing in the cut, beginning with a 3.925% reduction on January 1, 2023, leaving 5.779% for 2024.

Following substantial advocacy highlighting the disastrous impact the rate cut will have on home health agencies, the final 2024 rule contains an additional 2.890%; half the cut it initially proposed for 2024. We have every expectation they will implement the rest of the cut in 2025. In addition, a “clawback” of reimbursements paid at the higher rate going back to 2020 is still on the table.

Companion bills known as the Preserving Access to Home Health Act would postpone the cuts to 2026, allowing time to develop a more thoughtful approach to home health reimbursement. Senator Welch and Congresswoman Balint have already pledged their support for these companion bills. We are working with our partners at the National Association for Home Care & Hospice to advance this critical legislation and protect access to the Medicare home health benefit that thousands of Vermonters depend on.

In Memory of Joyce Grayson

As the entire home health community continues to reel from the tragic and senseless death of visiting nurse Joyce Grayson, murdered during a patient visit in Connecticut, we continue to keep Joyce, her family, friends, and home health colleagues in our minds and hearts.

Nationally, and in Vermont, we have seen an increase in violence against health care workers. The bravery of home health and hospice workers is a topic that is not discussed nearly enough. They routinely enter unknown environments and situations to deliver care to those who need it.

No person should have to fear for their life while providing compassionate health care to our communities. Safety is a top priority for our home health and hospice agencies. Each are re-examining the actions they take every day to protect their staff and as an association we are evaluating whether there are policy actions Vermont can take to better protect home health care workers from violence in the homes they serve.

Joyce Grayson will remain in our thoughts as the home health community at-large comes together to heal from this horrific event.