Mileage Study Press Conference Expert Remarks: William A. Dombi, NAHC Vice President for Law, Explains Study Documenting Remarkable Growth in Home Care and Hospice
January 5, 2016 09:25 AM
On December 16, 2015, the Foundation for Hospice and Homecare and the National Association for Home Care & Hospice (NAHC) held a press conference (see previous NAHC Report article here) to present the findings of a study documenting that home care and hospice nurses, therapists and aides who serve chronically ill, elderly and disabled patients drive nearly 8 billion miles each year. The press conference included remarks from a number of experts, and NAHC Report will publish a series of articles providing in-depth coverage of their remarks and testimony.
William A. Dombi, Vice President for Law at NAHC, spoke at the press conference regarding the “remarkable” findings of the study, which documented that home care and hospice nurses traveled 7.88 billion miles in 2013 to deliver care and services all across the country. In introducing Dombi, NAHC President Val J. Halamandaris who presided over the press conference stated that Dombi “had the most to do with the computations and preparation of the study.” During his remarks, Dombi provided details about how the estimates in the study were calculated and explained the significant increase in the distance traveled since the previous study was completed in 2008.
In completing the previous mileage study in 2008 based on 2006 data, Dombi said the first thing he learned is that “driving is the wrong word to use” since nurses rely on a variety of modes of transportation, including float planes to islands off the coast of Alaska; boats to islands off the coast of Maine; snowmobiles in Montana and Wyoming; subways and train systems in Washington D.C.; bicycles; as well as primarily automobiles.
The most recent study’s estimated total of 7.88 billion miles traveled by home care in 2013 represents an increase of over 40 percent since the 2008 study documented that, in 2006, the estimated total was 4.76 billion miles. The biggest change in the data “is not so much the number of miles that they have driven, but really the extent to which home care has grown as a service,” Dombi said. “The primary growth in service comes from state Medicaid programs where there has been a rebalancing of spending from institutional care to home and community based services. Today, more than half of all long-term care spending in Medicaid is for home care. It took 20-some-odd years to get there after a Supreme Court decision, but it is heading in the right direction. We have now over 2 million individuals on a daily basis providing care across the country.”
“The other expansion,” Dombi said, “which contributes to the extensive growth in travel is actually in the hospice arena, where more and more people in the end of life are taking advantage of available hospice services in the home in order to have a smooth transition to whatever the next life may be for those individuals.”
Dombi further noted that “the estimates were really done in the most conservative way possible. For example, in the Medicaid realm where we are now seeing over $70 billion a year spent on home and community based services, we made an assumption that half of that is going towards family members and neighbors who are hired to provide services under Medicaid and that they would have no travel whatsoever. If we included them in the same sort of estimates we did in terms of outside organized delivery of services, the 7.88 billion would be in excess of 10 billion miles. So, a remarkable delivery of services all across the country.”
To read the final study, click here.
Video footage of the press conference is currently available on the NAHC website (www.nahc.org).