Escalating Energy Costs Threaten Health Care for Critically Ill and Homebound Seniors:  Home Care Nurses, Aides and Therapists Drive 4.8 Billion Miles per Year
To Reach Shut-in Patients

Washington, D.C. June 25, 2008 -- A new study released today by the National Association for Home Care & Hospice’s (NAHC) Foundation for Hospice and Homecare has documented that nurses, therapists and home care aides who serve chronically ill elderly and disabled patients drive nearly 5 billion miles each year and that escalating gasoline prices are threatening their ability to reach patients, particularly in rural areas.

"The sheer volume of miles driven by the employees of the nation's home care and hospice agencies to reach shut-ins with complex medical problems is astonishing," said Val J. Halamandaris, President of NAHC. "Our data shows they traveled 4.8 billion miles in 2006 to provide medical and nursing care to 12 million people who are so disabled that they cannot leave home without assistance."

Halamandaris added that the "angels of home care cross all types of terrain, from crowded metropolitan streets to the dirt roads of frontier America, in all types of weather to provide care for the patients who depend on them -- many of whom suffer from congestive heart failure, stroke, chronic obstructive pulmonary disease, diabetes, cancer, Alzheimer's disease and other life threatening conditions." The nation's home care organizations provided more than 428 million medical and nursing visits in 2006.

According to the study, which is based on Medicare cost reports required to be filed with the Federal government augmented by responses to a nationwide industry survey, the 4.8 billion miles driven in 2006 is the equivalent of:

• 1,386,458 trips across the U.S. at its widest point
• 192,920 times around the earth
• 10,017 roundtrips to the moon
• 52 trips to the sun
• More than double the 2 billion miles driven globally by UPS, the international delivery service

"Neither rain nor snow, hail or floods keep these intrepid caregivers from reaching their patients and treating them like they were their own parents and loved ones," said Tim Rogers, Executive Director of  both the Association for Home Care and Hospice of North Carolina and the South Carolina Home Care Association. “In North Carolina, our nurses and therapists drove over 232 million miles (232,116,150) in 2006 and made more than 15 million visits (15,677,638) to critically ill homebound patients.  In South Carolina, our caregivers drove more than 75 million miles (75,079,713) and made almost 5 million visits (4,715,621).”

Both Halamandaris and Rogers, who serves as Chairman of NAHC’s Forum of State Associations, stressed that the rapidly increasing cost of gasoline is threatening the ability of home care agencies to reach shut-ins. "The sad part is that there is no other way to reach these patients -- particularly those in rural areas -- and no other practical way to care for them," said Rogers.  "Home care is the best -- the only -- way to care for them, but increased costs all tied to the rising price of oil are making it harder and harder to keep families together and maintain these patients at home where they prefer to be."

The Foundation's study does much to buttress recent reports that have surfaced in the national and local media describing the impact that rising gasoline prices have had on the elderly and disabled in their own homes. In a June 5, 2008 Wall Street Journal article, accelerating gas prices are blamed for creating a "high risk and largely invisible population" who will suffer as home support services experience rapidly increasing costs of transportation. Similarly, the New York Times of June 9, 2008 reported that the pain of high gasoline cost is not being felt equally. Nation-wide Americans are spending about 4 percent of their take home pay on gas while in rural areas the figure has surpassed 13 percent.  According to the Times, people are giving up meat in order to buy fuel.  As always, the elderly, ill and disabled who live in rural areas endure a disproportionate share of the pain.

According to the Foundation's study, home health agencies located in rural areas (one fourth of all U.S. citizens live in such areas) experience higher costs across-the-board and especially when it comes to fuel. Many of them operate at break-even, while 44 percent of them reported losing money last year.  While some subsidization might be found for a year, two years of losses is enough to force most agencies out of business. The report indicates that the state of Montana provides a good example.  While the number of home health agencies has grown nationwide over the past 10 years the number in that state has dropped from 65 in 1996 to 36 licensed agencies today. In Montana, there are 29 counties that do not have a home health agency and residents of 14 of these counties (as many as 30 percent of the state's population) have no type of home care services available. The problem of making home care available in rural area was exacerbated in 2006 by the elimination of a 5 percent differential or "add-on" that has been part of the Medicare program since 2000. This bonus payment to support rural homebound patients with acute and complex medical problems often spelled the difference between survival and bankruptcy. Halamandaris praised Senator Max Baucus (D-Mont.), the Chairman of the Senate Finance Committee, and Senator Charles Grassley (R-Iowa), the ranking member, for their efforts to preserve the inflation update for Medicare-participating home health and hospice providers (No. 1 below) and for their efforts to reinstitute the 5 percent differential for services to home health patients in rural areas (No. 2 below).

Among the study's recommendations are those listed below.  The Congress should:

1. Preserve the annual inflation updates for home health and hospice as provided in Medicare law.
2. Reinstate the 5 percent rural add on for home health services delivered to patients in rural areas.
3. Exempt home health agencies, hospices and their nurses and therapists from paying Federal gasoline taxes.
4. Recognize home telehealth between trained nurses and patients as the equivalent of in-home visits.
5. Retract the Medicare regulatory cuts of nearly 12% facing home health care in 2008-2011.
6. Withdraw the Medicare regulatory proposal to eliminate the Budget Neutrality Factor in the hospice wage index.
7. Grant home health providers priority status to fuel and supplies through “first responder” status in cases of public health emergencies and disaster situations.

Selected mileage data from the survey follows below:

Total Visits Made in Miles Driven by Home Care Providers in 2006 by State.

Source of Data and Statistical Assumptions:

The data above were calculated from over 4,200 Medicare cost reports, as well as through an online survey of 1200 home care providers. From the cost reports and survey responses, NAHC calculated the average miles per visit on a state specific basis by dividing mileage costs by the IRS per mile set reimbursement rate. Data from the 2006 Healthcare Information Set (HCIS) from the Centers for Medicare and Medicaid Services (CMS) and the CMS National Health Expenditures (NHE) survey data (2004) were used to calculate the home care and hospice visits made by agencies. The number of visits was provided for home health, and the number of covered days was provided for hospice, which was converted to “visits” based on an assumption of a 1:1 ratio. Non Medicare home care visits were calculated based on spending data for such care compared to average spending per visit. Total visits were then multiplied by the state estimates for miles per visit. These were added together for a national estimate.

For additional information contact:
Amanda Thomas, William A. Dombi,
Theresa M. Forster, or Val J. Halamandaris
at (202) 547-7424