Sent Home Too Soon — The Hidden Dangers Behind Medicare Discharge - Episode 89

In this powerful and eye-opening episode, host Diane Carbo teams up with Arya Rashidian from Aria Home Healthcare to expose the truth behind premature discharges in the Medicare and Medicaid systems.

💬 What happens when your loved one is sent home too soon from the hospital or rehab?
💸 Why are families being pressured—and sometimes tricked—into accepting unsafe discharges?
📉 How have government policies, greedy insurance practices, and failing reimbursement rates brought our healthcare system to the brink?

🎙️ Episode Highlights:

• 💔 The emotional and physical toll on caregivers after premature discharge
• 🚨 Broken promises: Why the "100 days of Medicare" is often just a myth
• 📉 The collapse of community hospitals and skilled nursing facilities
• 🧾 The appeal system loopholes—and how families are being misled
• 🔍 How Medicare Advantage plans manipulate assessments to cut care hours
• 💡 Real-life advice for families who feel unprepared when a loved one is sent home
• 🙋‍♂️ Why Arya’s agency continues to take Medicaid clients (a rare and selfless act)

🗣️ Your Story Matters

Have you or a loved one experienced an unsafe or early discharge? Were you misled by Medicare Advantage promises?
👉 We want to hear from you. Visit the "My Caregiver Story" section at Caregiver Relief to share your experience. Let’s make our voices heard!

👵 Caregivers are the backbone of long-term care.
You deserve to be heard. You deserve support. And you are not alone. 💚

Podcast Episode Transcript

Diane: Welcome to the Caregiver Relief podcast, where we shine a light on the challenges and solutions facing today's family caregivers.

I'm your host Diane Carbo, a registered nurse with over 50 years of experience in helping families navigate the complexities of aging and caregiving.

Diane: Today I'm joined by Aria Rashidian from Aria Home Healthcare for a critically important conversation.

While Aria and his agency provide compassionate care for older adults, he's here today to help me uncover what's really happening behind the scenes in Medicare and Medicaid. Stories of families being forced to bring loved ones home too soon under pressure and with little support, all due to changes in reimbursement rates and flawed policies.

Aria will share his frontline experiences while I speak up about the uncomfortable truths that he can expose, because this isn't about red tape, it's about lives. So let's dive in. Aria, thank you so much for taking time out of your very busy day. I'm excited to have you here.

Arya: It's a pleasure to be here. I love, talking about this as a very critical issue and, let's get into it.

Thank you. Thank you.

Diane: Well, can you tell us a little bit, aria Home Healthcare and what inspired you to work with a home care agency that feels like family?

Arya: Of course, again, we had very humble beginnings, and we're very recent, we were founded in 2019 and we wanted to open because our owner, Mojang Akbar, she was, has been a nurse for over 36 years.

first in Iran and then now in the United States. She has worked in all sectors of, whether it's in skilled, non-skilled, hospice as well as different hospital settings. And she wanted to create a kind of, delivery home care service where it gives, the seniors reliable services with experience and supportive caregivers who generally feel like family.

And I know that's a word being tossed around a lot these days. But we feel that if we can get to know our patients and get to know our caregivers, it really helps build a comforting environment to make sure that the home as always, should be a client's, peace of mind. So incorporating a very experienced and compassionate caregiver in that setting will allow the patient to just feel more at ease and so will the family.

we want to build that trust and really our home care services throughout prioritize the wellbeing and comfort of really everyone that we serve. And that just, makes us a trusted partner in healthcare.

Diane: Absolutely. And we need more of that because of what's happening. Skilled nursing facilities are closing.

We have a shortage of doctors, we have a shortage of specialists, we have a small community hospitals are closing. And it's because of government regulations that make this kind of service unsustainable. Aria, how would you describe the emotional and physical toll you see family caregivers experiencing, especially when patients are sent home way too soon from rehab or skilled nursing.

Arya: they're unprepared. they're truly unprepared. I mean, they, come to us very worried and they say, my dad's gonna get discharged. I don't know. Or, my mother's gonna get discharged, and I don't think they're truly ready for it. because for a lot of families it's very surprising and it's very always done last minute.

Diane: yes,

Arya: you can really have enough time to just take that, especially with the busyness of everyone's lives. It's never a good time to really bring that kind of, a conversation forward, but especially when they're done within that time period that you mentioned. It's just awful because it's happened to us as well, where, we tell them that, and it's back and forth with the facilities that we say, listen, the client doesn't feel well, and we tell the families, we actually advise the families mm-hmm.

that tell the patient, tell your father, tell your mother that you feel very bad. You don't want to leave. Tell them you don't want to. 'cause usually it's the patient or in some instances they're designated caregivers, that they have to literally say they have to stay because we don't want them to go home because we know that as much as our caregivers are there to support them, it's not going to yield them.

the desired, care that they need. They need very intensive medical care. They don't really need a exactly. Compan care. So that's why we tell them or some other personal care needs. We tell them that you have to do whatever is in necessary for the family to tell them to, calm down, be assured, and tell them to please tell your mother or your father to let, to tell them that you can't release my parents, and to tell them and make sure they themselves.

Are capable to say that, express that to the doctor. And so far they've been successful because, they cannot legally discharge somebody who themselves say, I don't want to go, I need help. I don't wanna leave. I'm in a lot of pain. Yes. because we are in the business of providing care, we are in the business of providing really supportive care.

And we cannot let members willingly get discharged. if they can't, if they can't or if they don't want to or if they need that medical attention right away.

Diane: I'm gonna, as we go along, I'm gonna explain this, but we only had the illusion of healthcare. Right now we don't really have quality healthcare and its government involvement has just brought healthcare to its knees.

And I wanna address this. I wanna uncover what Medicare says, verse what's happening. Medicare promises a hundred days of coverage for a skilled care, but what we're see actually seeing is patients on traditional Medicare are being discharged after just 18 to 20 days. And on Medicare Advantage, the patients are often sent home only after 11 to 14 days.

Have you seen this trend as well?

Arya: I have. And generally We don't work at all with Medicare, but Right. I have worked with a lot of national, agencies that specialize in skilled nursing care, and they tell me all the time that, these members, they cannot be discharged so quickly.

And, I just feel like it's now it's a formulary that they're using to purposely, discharge members that are very sick. But because they want to attain their, they want to receive the highest, stars or accreditation standards, they wanna keep their accreditations. Yes.

Or they want to maintain high patient surveys, somehow, even though, usually doing that will yield the exact opposite. that it's just become Almost fast food. where they exactly do the transactions, they wanna just help through the drive through and get them going.

Whether they're okay or not is not their concern, only their, to receive the highest reviews, also to maintain better reimbursement. I know you don't know about this

Diane: for not providing continued care, so why you may not be able to confirm that directly. can you speak to how reimbursement re pressures affect discharge planning?

Arya: how it really affects, in my own opinion is that, if in a way, if. Reimbursement rates don't go up. But inflation does, that means inflation goes up, it affects their vendors. Yes. Vendors increase the company's operating costs. Operating costs also include payroll. If minimum wage continues to increase and reimbursements do not, or they fail to reach the higher the minimum wages go.

And in certain states it's a lot. and again, that's a totally separate discussion, but in certain states it's a lot. And, and if they don't yield that same amount, then it makes it really pressure some for these agencies to really go through and come and really. Maintain the fee for service.

And while fee for service has gotten a lot of, controversies around it, rightfully for a lot of providers, very small providers, fee for service is the only way they can maintain a float by providing care in a volume setting. Yeah. and that means just providing care to as many people as they can so they can receive the reimbursements and still maintain their payroll, their inventory, their operating costs and not go broke.

Diane: Yes.

Arya: So that's my really opinion about this matter.

Diane: That is the reason why we haven't doc a doctor shortage. a nursing shortage. We have a therapist shortage. We have a specialist shortage because the government's gotten involved in cut costs so much that did, I don't know, I'm sure you don't know this 'cause you haven't been in nursing enough, long enough.

But, doctors are getting paid less than they were 20 years ago and they have to hire triple the staff they used to have because of all the government regulations, the hoops they have to go through. And it's really a challenging time and we are gonna see home care agencies close. We're already seeing skilled care facilities closed.

Yeah. and I have all kinds of, I have all kinds of issues happening with, I wanna talk about the broken appeal system. Many families believe they have the right to an appeal, an unsafe discharge. And you were explaining that a little bit earlier. But, when they file for the appeals, 'cause I've talked several families through this, when they say, oh, they're, and I said, they can't go home.

it's doesn't make sense to go home. And this is from the acute rehab or skilled facilities. And, when they file, the facilities are telling the appeal reps that, when they call that no discharge has even been written yet. To delay the process. And I have told my families every time they tell you, and it would be three and four days in a row, they would do the same sys.

It's awful. so I feel that, we see a lot of this and they're also using another scare tactic and I just recently had a client this week do it. Families are told if they lose the appeal, they'll have to pay out of pocket. Yes. and, it could be thousands per day. what kind of fear or confusion do these me messages create for the families we serve?

It's just, I want people to know that Medicare Advantage plans, if you have one, you really need to do your research because Medicare Advantage plans are actually charging 200 to $300 a day copay if they're in a skilled facility.

Arya: Exactly.

Diane: and that's where you come in because when they're coming home, they're coming home really early and they're wanting to see people like your agency to help them.

Arya: Exactly. And, what you were alluding to, filial responsibility. it's just, horrible of what they're even intending on doing. certain states as you Yes. Have alluded to, have started, going, through court proceedings, allowing that. It's still rare, but it's becoming more and more common.

And I'm just afraid that during my time, as I get older, it's going to be more and more of a reality unless we start working on legislation that can prevent this from becoming a reality, I've spoken to Humana, some Medicare Advantage plans, and they have said that no, we don't have that.

we don't allow our providers to carry that, including our facilities. Now, I don't know to what degree, they were, explaining that. 'cause again, this was with a licensed Humana sales agent, so they're only limited to what they can, provide to me. But, I was able to obtain that information.

But it does get me concerned a lot because, no family should be allowed to bear the cost of their parent for medical attention. if they've worked,

Diane: and it's gonna occur more and more. I worked for. Two of the largest Medicaid driven, long-term care faci companies in the country. And I can tell you right now that they put liens against people's homes.

Yeah. And the home care agencies are gonna have to do the same thing if they can't get the proper care. So that's a whole nother ball game. But

Arya: yeah. and it's very, very unfortunate. I will share that in the time that I've actually had to read about this and study about this, which was still new to me and still is new to me.

'cause I'm learning more every day, is that, families. Can't pay these high amounts, that, hospitals are asking for. Because contrary popular belief, if you go to a hospital without insurance, the cost of treatment is actually less than if you do have insurance.

Diane: Exactly.

Arya: For me, that creates a paradox and that's why.

I feel that it's not really the fact that this is what it costs to provide healthcare. This is the cost because of insurance. Yeah. And this is the cost because of some other unrelated expenses also built in. Because I feel like we can have affordable healthcare, and it doesn't have to be a European model or some other ambiguous model or new model.

It can still be the same model, but just. Basic enough and itemized enough that it makes sense because I feel that our billing has gotten completely out of control. And these providers feel like because without adequate legislation, they can kind of bill for whatever services we want. And as an aspiring nurse, I'm appalled because of a few things.

One of them being that nurses are bundled up with room and board. That doesn't make any sense to me. And and I feel like that demoralizes nurses and, it doesn't give them kind of any discretion of any kind of having anything, but the doctor gets to bill like his own rates and then, but they have to still follow their kind of billing codes and billing mechanisms.

And also the diagnoses codes have gotten outta control because they are taking and. For the purposes of reimbursement, they're billing them as giving them worser, diagnosis or much more intensive diagnosis code. Yes. Previously diagnosed with before. it is, and all of that, it's adding to the failure responsibility that,the children are going to have to undertake it.

That exactly is not fair because that's not how their parents were when they first came in. And it's not fair that we have to treat them like that because, we don't have regulation. And I just feel like it's an unfortunate part, for us is that we need to have regulation to just stop ourselves for a little bit.

We can't demonstrate humanity or we can't common sense in our own rules that we just need to always have something to tell us. Don't do this for us to say. Yes. So it's very unfortunate.

Diane: Aria, I, Did a course. I actually took a course on how to become an insurance agent, and one of the things that shocked me, I suspected, but I wasn't sure I had it verified or validated.

the government policy makers have made it so that they not, didn't cut costs or change the way care was. Perceived or given, or delivered, they are actually making the high deductibles, the high copays and the high lifetime out-of-pocket expenses to deter the use of benefits. So you have the benefits, but nothing has changed in our healthcare system.

In fact, the rich will pay. If they, because they can afford it, the middle class will take out second mortgages. They will sell their assets to get the care and treatment recommended. But the poor, and I've dealt with this for forever. They do without, and I am so impressed because you, are an agency, and this is rare 'cause I worked for a home care agency.

They wouldn't touch Medicaid at all. Medicaid patients didn't get any care. and that shocked me 'cause it was a visiting nurses association, which they're supposed to be altruistic and you are seeing that, but you're also experiencing through your Medicaid, their, your reimbursement rates are shrinking.

Arya: It is. And, we right now through the passage of the so-called one big, beautiful bill, it has now allowed in my states affected in Virginia primarily, is that our, reimbursement rates may soon stay the same, or, and then eventually be cut because, they, because the passage of the bill primarily outlined that, states, cannot raise their own, form of taxes to help with the, federal reimbursement rates.

And right now in Virginia, that's desperately needed because as the minimum wage of the state continues to climb, which right now stands at $12 and 41 cents. But as that continues to climb, yes, it's going to hit that minimum reimbursement rate. and if that doesn't grow or gets lowered. Our, with our vendor associated with our vendor's cost and our payroll and our different kinds of insurances.

And with all these, expenses, home cares will have to be either forced to change courses in terms of seeing what kind of care they provide. And I've seen this happen in my area. Two of the home cares that were skilled and non-skilled. Now they just went to private pay. Yep. Now they're doing private.

they're saying that we don't, please don't refer us anymore. Clients. We're not working with insurance companies anymore. And that's now, yes. I can't imagine how that will be in the next four and a half years when the bill finally sets into place and all of these reimbursements will be determined to be, you

Diane: weren't around when Obamacare became

Arya: I was very young.

I was, yes.

Diane: Yes. Yeah. I'll tell you, Obamacare brought healthcare to our knees. And the plan is such that it's supposed to offer all preventative services, and it was supposed to be for a good price and it's no longer sustainable. And the thing is, they use. I worked for the, one of the very first review organizations in the private review organizations in the country.

They were trying to get healthcare costs under control. So they use what they call the Medicare guidelines, which are DRGs, that's a diagnostic related group. Like if you have pneumonia, you get, so many days length of stay, LOS, length of stay. And they've used that to tell these hospitals that had private insurance companies say, you get this much.

That's where we came in with the Preau and all this and that, and, In those days, in the beginning, it was really necessary because there was an abuse. I can tell you right now, 50 years or 45 years ago, I would call a hospital in New York City and they would put somebody in the hospital two days prior to surgery to have all their outpatients done.

And now, everything's done. So it's really frightening to me because, Medicare, here's what they've done. Medicare in the past has been cutting, cutting, cutting. And it's all about money and not considering the human condition. And what we are seeing right now is, with Medicare. Is, there was a period in the last 10 years, our healthcare has been going down for a long time in the past 10 years.

with, since Obamacare has been in too, Medicare has cut. So that, if you, here's what they did. They said, they told the hospitals, you have this pot of money to work with for this diagnosis, and if you keep them in this length of stay, you keep the pot. But if you cut it short, you make more money.

Yeah. So they incentivize the hospitals or the facilities to discharge patients home earlier. And what's happened is, they were having patients come back, you can't put a cookie cutter, approach to seniors. their bodies just are different. So what we have now is they have cut and cut so much that,

the facilities were then told, if you, if a patient comes back within the first 30 days after discharge, you don't get paid. So it's ridiculous. Right. You don't get any extra money. So what the facilities did to make money is they put people in what they call an observational status.

It looks like a hospital room. Everything seems like a hospital room, but you're not actually admitted to the hospital. And this happened for many years. And what was happening is Medicare has a three day overnight rule. And if you have three nights overnight, you qualify for skilled care and home care.

Well, all of a sudden people were not qualifying for skilled care.

Arya: Yeah. Just kind of like Obamacare, they came out and then first it crashed 'cause a lot of people were trying to sign up. And then when it kind of substance settled down, a lot of, limited doctor access.

a lot of doctors didn't accept it.

Diane: Yeah.

Arya: and a lot of people couldn't keep their preferred doctors.

Diane: Yes.

Arya: And fewer people started joining. And then there was mandate that people didn't like. And then, it got really expensive because, they didn't get enough help paying for it. And their premiums rose and their deductibles were even worse.

And to deter the

Diane: use of benefits. That's how our government responded to that. Exactly.

Arya: And that's why it's really synonymous. And I feel like now with seniors and Medicare, especially Medicare Advantage plans,

Diane: yes. It's

Arya: becoming the same thing. And the funny thing, funny enough is that it didn't even need a legislation.

This one, this one just happened on its own.

Diane: Yes.

Arya: So it's, even back to my legislation question, it's just like, is that even. Two less of what we're doing. Is that not even enough? Because if, even if legislation is not gonna work, fix an issue, then really, truly what will Yes. so it's,

Diane: I'll tell you what they're doing now.

And this is, I giggle about this 'cause it's a misnomer. They're, they've created Medicare's moving toan a CO an accountability care organization. And that means that not only are the, we cost sharing with the government now on, on our Medicare, but they're trying to get everybody that's a solo pro practitioner out.

If they're not in a, hospital setting or in a hospital network, they're gonna be left out in the cold and we're gonna lose a lot of good doctors. Yeah. it's really sad. So what challenge does this create for you, hiring and retaining qualified care?

Arya: Big challenges. as I mentioned and alluded to earlier, higher, rising and raising inflation equals raising costs equals raising costs for our vendors.

And that therefore equates to higher operating costs for our company. And, making sure that we're following the Department of Labor regulations, making sure, especially that's for our state. when you meet certain amount of employees, you have to offer certain benefits and you have to do all of that all while, which you have to compete and receive that reimbursement right from the government.

'cause, again, when we work exclusively with Medicaid, members pay either very little or nothing at all. Yeah. that means you are responsible with retaining the employees, providing them benefits, healthcare coverage, 4 0 1 Ks, and also maintaining your other company expenses, all of which you also have to complete, try monthly, reviews on members and their conditions.

Yep. And you have to complete paperwork that's associated with and obtaining prior auth, all of which is not reimbursed. By the way. Any work that is performed by the nurses in Medicaid is non-reimbursed. And that's what I want.

Diane: So facilities aren't gonna be able to have that oversight? No. good oversight.

And that's when quality of care and. So unsavory things happen in Exactly.

Arya: And exactly. And what we make sure, because we have to get our reimbursement, basically our payments for our nurses on the same pots that we get from the payments that we give to the caregiver. So our dollars really being stretched thin.

And I feel like this is a common theme across a lot of Medicaid, based, agencies, not only in Virginia, but around the United States, and a lot of them are closing or selling their business because they cannot compete with a lot of these leaner, different skilled oriented a CO or new types of, large.

based, hospital chains that are growing. and now, John Hopkins, for instance, John Hopkins now offers, Medicaid based, in home care. a lot of these bigger chains are now opening up home cares as well. And it's harder because they have higher capital, they have higher, staff members and they can, be able to provide a higher service area radius, than probably a smaller agency cans.

Diane: They may be able to provide service in a larger area, but I can tell you now from decades of nursing, the Medicaid programs, when the budget goes, when the budget is are used up or they've ex taken care of too many people, the benefits go away. Yeah. And I've seen that for. In California, I was there one year doing a consulting and they have family caregivers get paid by the Medi-Cal system.

And July, they already had told people we could no longer sustain this pro, this system because we ran outta money. Oh, and here's the thing, I will tell you what, where the money's going. greedy CEOs. Administrative, administrations, it's going to the nurses salaries, the a and the buildings. It's going to everything.

We're paying for their benefits. So we are not getting to use our benefits. The money that we have put in our pot for, to get these benefits, we're not able to use them because they're being utilized. The government made a mistake when they create, started managed care the way they did because, the big CEOs and all of those administration, people, they get bonus.

I actually have hospitals that I've worked in where the case managers got a bonus if they got their patient out early or than expected. What the heck? What does that, why that money should be for that patient's care? And this is the kind of thing that's been going on for decades. So they are just putting another nail in the coffin.

Arya: Exactly, and we're doing this to ourselves, and that's really the unfortunate part is we know what we're doing. Those that have the power, those that are, that serve in those higher positions, we are intentionally making decisions that are going to cost and affect millions of people in the coming years, and even presently.

And I just feel like we're not really thinking about our decision. We're only thinking about the today. Yes. We're only thinking about the budget. Even if we are considering the budget, we're thinking about the budget for today. We're not thinking about it in the future. Five years from now, 10 years from now.

Well, Oreo,

Diane: I can tell you, there is a, in Medicare Part DI know this is Off Helm Care, but I wanna share this with you. Yeah. Medicare Part D is for medicines and your prescription drugs, Medicare. And I will tell you there's a, what they call a donut hole. That donut hole when seniors. Hit it. It's the, they have to start privately paying for their medicine.

And I will tell you there for the last 20 years and our long-term politicians know this and they've ignored it. And instead, grease the hand of big pharma. Exactly, but there are literally 125,000 unpreventable deaths a year to, because of seniors that have stopped taking their lifesaving me medications because they couldn't afford it.

Now, I had that experience, I have chronic pain years of nursing and, I can't take pain medicine. It's not that they're gonna give us to 'em now. Anyway, that's another whole story. But I hurt so I can't take gabapentin. it makes me wobbly. Thank goodness I can't take it. It now has a chance to cause dementia, 40% chance of causing dementia in patients.

So it's not a good drug. So they put me on duloxetine. It's Cymbalta, it was the only drug that worked. Now, this drug dioxin has been around for a long time. It's in generic form. Do you know? I was told that it would be $700 a month. For me for the next two months to pay out of my pocket for this little pill.

Arya: 700.

Diane: I'm a stubborn Irish girl and I know, and I was not. And what I know is pharmacy benefits managers are greedy and they have taken advantage of the American public way too long. And Duloxetine is an SSRI and serotonin, re reuptake. Anyway, it's an antidepressant, but it also works as a painkiller.

And it was the only medicine that really relieved my pain. I want you to know that it causes withdrawal and I had terrible withdrawal and I've never had a reason to withdraw from a drug, but I couldn't even get a doctor to give me a script for just a few pills so that I could wean myself off. And it was horrific and people are, have been going through that for decades, and it makes me sick.

So I just won't take that damn drug. I'm sorry. even though it helps me, I will not. Be held hostage to a drug. I just won't, and I'm not gonna let them do that to me. Yeah,

Arya: so it's very unfortunate, but God bless, at least you, you know that you're a fighter and that you really wanna speak out for what's right.

And really about your other point about these lawmakers, they forget that seniors are their biggest base. Yes. And, it's important that they feel like they have to be reminded that if you really don't serve us. You don't serve your primary base.

Diane: Yes.

Arya: Because in this country, majority rules, then you are not going to retain your seats.

Now, as much as I like to believe that it's slowly becoming a fable, because somehow they can do feel like, lawmakers can do these things and still retain their seats. there is an, it's crazy trend. It's crazy phenomenon going on. Yeah. But I still want them to know that we are still the voice, that seniors are very much the, still the voice of this country.

Yes. And members like yourself and others in your community, they don't have to really stand for this. And when we see things like Medicare and God forbid their social securities get cut, then that means that those politicians aren't doing their jobs. And it's funny because everyone grows old.

Yes. Everyone's gonna have to go through this. So in a way goes back alludes to my, the, my, my previous point that. They don't know the consequences of their decisions because they're only thinking in the, today. They're not thinking 10, 20, 30 years when they become the same age of these seniors to see how life is gonna turn out for them.

and what the

Diane: policy makers are doing is putting their hand out and taking cash. From the, big pharma or, and allowing this pharmacy benefits manager system to continue. I'm hoping that it's going, that's going to change, but,

Arya: but even the cash with today, with the adjusted rate of inflation, it's gonna be minuscule for them by the time they reach that.

But it's not only that I don't really think about themselves, but they also have extended family members that cash isn't gonna be sustainable to give it to this family member, to that family member. Honestly, one of those family members is gonna be really sick and they're gonna require a lot of medical care and attention and a lot of cause and all that's really going to be part of their conscious because they were one of the members of the voting committee who voted.

To have that cut in favor in lieu of whether we wanna say cash or other kinds of maybe financial benefits or political gain. And it's really, and that's what I mean is at the end of the day, we have to think as humans, we have to think even if we're religious, we have to think as Christians, as Muslims and all of those sects that, do we really want to do these?

Is this thing going to be in our best interest, God forbid, let's say it's my family or so one of my loved one's, close ones. how is that going to affect me? No money in the world can replace good health, no money in the world. And I just feel like we're not taking that into consideration. And even these regulations that are designed to protect the consumers.

are really not being adhered to because we just wanna find a kind of a gap or an open spot and say, or maybe hire a very fancy lawyer who can read outside of the lines and say, that's not specific enough. And hopefully contest that in a court of law. And I just feel like that's not how really care is supposed to be done.

and my last point is that. These MCOs, a lot of them, I know that's a statewide term, but like these insurance companies like Anthem United, Humana, these are publicly traded companies.

Diane: Yes.

Arya: And I just feel like they're under a lot of pressure because the way they're in Wall Street is comparing them to the nasdaq, comparing them, they're actually not comparing them, excuse me.

But they are putting them in the same threshold as data companies. And if they don't hit their earnings or they don't project a growth, then they're going to be punished either by CEO replacement, by the stock falling. And because the accountants of that company are so weary, it causes all of these things and a lot of pressures to politics.

Everyone is to blame the whole system, is to blame everyone. Oh, absolutely. Things and it's just, it's very unfortunate because that's not how it was designed, Yes. Back in your time, and I'm sure you can agree, a pharmacist would get their drugs, like the drug that you mentioned, put it in the pharmacy and probably mark it up 10 to 15% to make sure their company's up and running.

Yes. And it was very affordable. People didn't need to trade an arm and a leg for my dad's heart medication or my dad's. I guess even when the drug, penicillin came out, people didn't need to trade an arm and a leg for it.

Diane: Yes.

Arya: Like today with a lot of vaccines being almost, not readily accessible.

And also some of them being, in some of the blood work that you do, like vitamin D especially now, are trying to restrict that. They're trying to say, no, just get it over the counter. You don't need 50,000 milligram, but if you're vitamin deficient and you need that, it's very curt for a doctor. If you're saying, I'm not going to write a prescription or me, your insurance thing, I'm not gonna cover that because I think you could do well just over the counter.

it's very unfortunate. and it's only gonna get worse unless we start acting like human beings with values with

Diane: Exactly. I will tell you right now that. we have agreed the pharmacy benefits managers are greedy. That's why we have notrans, openness about the drug prices.

We have places like GoodRx and SingleCare that have different prices and that are even lower than the insurance company. And that you're paying for. Yeah. And why that is, is because. Each pharmacy benefits manager determines what the amount's gonna be. So that is, all wrong. But we also have hospital CEOs making several million dollars and if they don't make it, they have an umbrella that they'll still get that money and leave with a lot of money.

But okay. I've heard a large Medicare Advantage plans are actually calling the seniors directly and asking things like, how long does it take you to shower or get dressed? And then using that data to reduce the amount of home care hours approved. Have you seen this kind of time-based rationing?

Arya: Oh, of course. they're doing that actually right now. Anthem Health Keepers Plus, one of the MCOs under the umbrella, ance Health. they are doing this, they are employing third parties to call, although it has scaled down recently and they've made the calls optional. at the time when they first came out, they were putting a lot of pressures with the case managers that, help those members make sure that they're receiving consistent care.

And also their providers, such as myself and others, not directly myself, but my organization and others to make sure that they're receiving the care that they need. And really, Diane, what they're doing is that they're saying that. does it take you this many minutes? they get very intense, almost questionably, interrogation Yes.

Stuff or questioning, that it becomes very uneasy for the members and they can be very long. I've heard from members that some calls last around 45 minutes

Diane: Oh my Lord.

Arya: And being in a call like that and getting these intensive questions asked because members are Scared because they don't want to, qualify themselves on the verge of being institutionalized.

Yeah. 'cause they don't want to then be referred to nursing homes.

Diane: Yes.

Arya: They feel that they have to show themselves as Okay. because they don't know, they haven't had any exposure to this kind of call before. And oftentimes the care managers are never notified when they're going to call. And when they don't call, they will notify the care managers to tell the member to call us immediately.

We have these series of questions, so they don't know what kind of data they're collecting from the members. And when the care managers complete their reports, when it's sent to the insurance company, usually, the former is always accepted rather than the latter, which is the care manager's information.

And we also have to send our information as well. So they usually just determine by the third parties that they're working with that they, do a better job. But it's scaled back. But I feel that, I don't know if it's in a testing stage or whether they're doing that in lieu, just to maybe decrease the coverages because now that's exactly what they're doing, being cut.

and they're doing this just to make sure to see if they're prepared, if they can even do something, which is start cutting benefits. 'cause again, we're on a timetable now. Yeah. That in the next almost less than four years, all of this stuff is going to be the next generation that they're doing this just to keep their auditing systems off, which is again, essential.

But I feel that if they're directly cutting it and the member is very worse off without care. And they are just saying that, well, and it's beneficial for the insurance companies too, because I think El Ance Health is last earning calls or two earning calls before. I'm a little bit of a stock market enthusiast myself.

They told the, they said that, oh. We couldn't, our Medicaid business was the reason why we couldn't project a higher earnings like Medicaid. Medicaid, Medicaid. It always comes down to them. And that's why again, they lobbied, they didn't lobby against this just like they fought very fiercely towards Obamacare, if you recall.

Yeah. They didn't fight a lot with this as well because they actually wanted it to be cut down because they felt like they were being burdened with this because they weren't willing to make a profit. They couldn't make a profit off of this kind of, long-term services and really business with Medicaid.

So that's why it was beneficial for them to have this cut, so maybe reduce the burden and the operating cost they had to set for this type of program. and that to me is very unfortunate because it's going to affect millions of people in the coming years. if it already hasn't already.

Diane: It's, when, Nancy Pelosi stood in front of Congress and said, pass the bill and fi figure out what's in it later because she's so powerful.

They all signed it. Shame on 'em, every single one of them, Democrats and Republicans, because there was no discussion on the policy. And then all of a sudden they're looking at it. And I will tell you right now, there are 13 million people on Obamacare that don't use their benefits 'cause they can't afford to use them.

And that's the, that's what they're trying to do. But now I wanna talk about your team. What signs of burnout or stress do you commonly in, observe in your care?

Arya: definitely it's, rising costs, in their daily lives, the stress in their daily lives. And this is, this hasn't been changed.

This is endemic. This is endemic. it's been for decades, but I feel like now, ever since post COVID, OVID. A lot of families just have been really struggling. because, they are working days and nights and members are, and it's both sides. they have their own life that's going on, but also the members have really been, a little bit non-cooperative.

and really, and we try and come in, try to ease tensions on both sides because we generally care about both sides. we don't really prefer one over the other. We wanna make sure our employee's, mental, wellbeing is taken into consideration as well as the patient's care. but, as their medical destabilization, increases, sometimes the stress of that caregiver goes higher and higher.

And then compare that also with rising gas costs.

and the fact that they have to commute or use their vehicles to, go to a client's homes, which again, we pride ourselves as an agency to make sure that they are very close to the members they work with and that we work with the patient's family and also let them know about the benefits their insurance provides in terms That's impressive.

Medical transportation because that's impressive. You believe that. it's not, the caregiver's responsibility to use of, 'cause again, we only get one reimbursement. We don't get a gas reimbursement from Medicaid. We don't get exactly sure things from me. We just get one flat rate. Now it doesn't matter if it's a holiday, it doesn't matter if it's the night, it doesn't matter if it's a weekend.

We get the same medical reimburse Medicaid reimbursement rate for that state. And that's it. No extras, nothing. So that's why we have to make do with what we have. But we also have a fiduciary responsibility as an agency to become very informed of our surroundings and really of the members' coverage. And find out maybe some of those extra benefits.

A lot of, MCOs include that maybe members don't know, is that they include a wheelchair. They can get stair lifts. In certain cases, they can get special help with stair lifts, installations, and pricings. Wow. If they have Medicaid. We have helped a lot of, some of our members who were interested in that, get those, get work with their case managers to get those requests put in.

It does take a little bit, it is one of those red tape things because stairlift installations are very expensive and prohibitively so sometimes. But they do help as long, they do have regulated, they have some, exceptions in place, but most of the time if you do have Medicaid and or you have, what's called the, the Medicaid, Medicare, or Medicaid, they call it Medicare expansion.

they do help with the financing and the costs of those plans, which reduces the burdens on their families. But yeah, it's our responsibility that we find out because insurance, Diane is a horrible mess. It will continue to be a horrible mess. But we as the provider have the opportunity to try and work with as many MCOs as we can, insurance companies as we can.

And also within that same time, understand what's in those insurance companies. So when members come in, we don't have to tell 'em exactly where to go, but we can point 'em out to resources and things that can be made available to them, even if it's just turning the back of their insurance card and finding out, oh wow, all these services are right in behind.

So it can be as simple as that. Or just pointing them in the right direction. and that requires something that I feel that a lot of agencies and a lot of people just need to know, and is that you do it out of the kindness of your heart. You're not doing it for a reimbursement or money. And I feel like that, I want that to be the biggest lesson or the biggest takeaway at all from, at least your question, that you've asked me because.

if it's all transactional, it's not about assisting people anymore, it's not really about providing care anymore. And at the end of the day, why are we doing it if it's not to provide the care that we need for our members? Yes.

Diane: I want my listeners to know that direct care workers are usually poorly treated.

They get paid very little money and most of them have two or three jobs. And because of their, they don't get reimbursement for the gas or their transportation. Many of them don't have benefits. Many of them don't get, vacation pay and stuff. They have left healthcare and moved into other food service or retail because, and it's really caused an issue because we do have a shortage of people that are providing care.

Arya: And we absolutely do.

Diane: Yeah. Ariel, what changes would you like to see at the state or federal Level to better support caregiver agencies like yours? So you can deliver care without being strangled by unsustainable policies.

Arya: I think one of the biggest things that we can do is just, certainly have some free government programs that can basically point providers, new providers or small providers in the right direction of what things they can already implement in their workplace that are either relatively low cost or no cost.

these can start simply through newsletters and, updates. some of them, can be done hopefully at the state level just to see, if providers that are really starting out and what kind of scope of care that they need, mental health resources for their employees, what they can, institute, in there to help, employees just manage everything.

And at the end of the day, I guess consider the fact that. Minimum wage is going up and as much as we want to make sure that our employees are being paid a fair wage, we want to also, because that's the biggest thing, not everyone who works in home healthcare. Wants to also work in home healthcare.

And that's not in a bad way, it's just some people just look at it as a job. they don't look at it as a career. Yes. No one wants to become a caregiver for the rest of their life. but they need to have a more of a livable wage. And it feels like we can't really provide that as much unless the reimbursement rate increases.

'cause it has a direct correlation. that's why a lot of these resources are unable to be provided. Because of the fact that, the reimbursement rate and also the fact that the employer's responsible for, half the employee's taxes. 'cause if they're the All W twos, and they're responsible for, their licenses professional, getting them on their professional liability, getting them on workers' comp, getting them on, the different licenses that are relevant for their specialties, like H-H-A-P-C-A, and CNA and they also have to pay for their, refresher courses that they also have to maintain.

So all that's a big cost for the company if it's all coming out from the same pot, that's a very small pot. yes, I feel like it needs to be revisited and I feel that. legislation should not be on a timetable, especially for something as critical as this. there should be some, concession.

Sure, there should be, concession. Sure. But and I guess if they want to make some cuts for the time being, sure. But they have to really take these things into consideration because agencies can't sustain itself and for that long of a time. And that's gonna really leave seniors without care and overburden families even more.

Because now then they have to take off time for work to be the family caregivers because. Of the fact that these agencies are gonna be going away, and that's not what we want at all. And that just stress. And that's

Diane: exactly what's happening with the skilled facilities and the small community hospitals.

They have cut reimbursement. It's not sustainable. And I want you to know, I'm not sure if you're aware of this, but 63% of family caregivers become seriously ill or die before the person they're caring for. When I started my first website, aging Home healthcare.com 20, 25 years ago, I actually, it was 50% and I was shocked.

now it's gonna, I'm afraid it's gonna go to a hundred percent because the family caregiver is the largest pillar in the long-term care continuum and they supply provide $650 million a year of unpaid care. That's astonishing. We are expecting family caregivers to provide care once provided by professional healthcare profession.

Pros?

Arya: Yeah. Isn't that scary? It is scary because New York's doing that too. I think New York said that, you know what, we're not, we're just gonna pay families a flat rate, for taking care of their families. And I think what that rate was like $30,000 or something like that. Yeah. Something very minuscule, very small.

and that's just not sustainable at all. the emotional stress, the physical toll they undergo, especially given like their loved ones, destabilizing medical condition is just so unfair because putting all that burden on the family and then limiting the providers because they don't want to pay their reimbursement rates or payouts or anything like that, will create a bigger crisis than ever known.

and as this country continues to age, and it's an aging country,

Diane: we have a silver tsunami here.

Arya: Yeah. Yeah, exactly. We have, we are very much aging and I feel like this is just gonna get worse and worse unless it gets addressed responsibly,

Diane: Yes, I agree. I agree. Aria, thank you for your honesty and compassion today.

I'm so excited and glad we had this conversation. What advice would you give families right now who are about to bring someone home from the hospital or rehab and don't feel ready?

Arya: obviously you don't want to, you don't want to make sure that your loved one's being discharged prematurely. please, consciously coach yourself into your options, which is that if your family members are not feeling well and you are the designated contact, make sure you are the designated contact for your parents, if not already,

Diane: good point.

Arya: Make sure your family's being well educated in his or her options. Please don't let them know because a lot of seniors, because they're already sick, they're too scared to speak out. Okay? Yes, speak for them. Don't be afraid. Don't take the simple appeal process. Make sure to fight when you can when you're in there.

I know that's considered a direct approach, but that's what I'm advocating for. We are in a new state of healthcare where the appeals process that we spoke of is not working. So please, please fight for your parents when you're in those facilities. Don't let them discharge you too quickly. And if you are, and if you've exhausted that, please mentally prepare yourself that it is going to be a hard journey.

and it is not going to be an easy one for them, but just know that, you thankfully, are in, we are, we all live in a country where we have a lot of resources, at least at our hands. And unfortunately, while those, some of those resources may be very hard to tap into when we need them the most, it's very important to know about our options and to just know that we are not alone and that when we want to provide that kind of care, hopefully.

Agencies like myself and agencies, like others will still be there to support you in the future. because no really family should just go about it alone. We feel that a patient education is such a integral part of our what care that we deliver, and the best thing about that is that it doesn't cost a penny.

And you can tap into that or ask, and it is your absolute right to know. And you shouldn't ever have to be afraid to get a bill from getting advice like that or

Diane: Exactly. Now, finally, how can people reach out and learn more about Aria Home Healthcare?

Arya: we always love, speaking with them. I have the privilege of speaking to.

Diane to a lot of people today. Ms. Mohan does too. You can reach us at our direct cell number is 7 0 3 9 5 3 7 2 0 2. That's again 7 0 3 9 5 3 7 2 0 2 or at our email at info at aria A-R-Y-A-H hc.com. Or you can just visit our website, which is aria hhc.com, and you can see about our different services and what we provide and how we can be the best of care.

And just know at the end of the day, regardless whether you just want to call in or just say hey, or just ask a question about your current health needs or your coverage status, I will always be there. Mohan will always be there to answer your questions because we deserve, you have the right to know what you have and what the kind of coverages you can receive.

And if we will be the best fit for you, then we would love to serve you.

Diane: We're creating a page in our home care directory for Northern Virginia, and I wanted, I want my listeners to know out there, you're a rare gem in the home care continuum. You really are because you take Medicaid. Oh my lord, that's a rarity.

And, you're trying to provide care with love and a challenging, very challenging time. So I appreciate you helping me today with, addressing some of the issues. I wanna make our listeners out there aware that, of what's happening and how we need to start to affect change.

Arya: again, it was a real pleasure speaking to you and really hopefully, your listeners, can really understand that it's really just not all that simple,

And definitely getting a new perspective in that's great for them to hear and hopefully they can just take all this information little by little because when I speak to all the members that called and they're just calling, they're just calling because they don't know. They told us, oh, my commercial plan referred, me to you.

I need this kind of care. And I really talk to them about the process. Sure. It's, it takes about three to five minutes of my time, sometimes 10 minutes of my time, but I wanna make sure that the members understand if I can't provide that services, why I can't provide that services. Yeah. Or if they can't get access to our particular type of service, not because we don't offer them, but because their plan prohibits them.

I want them to know why, because a lot of times it's not 'cause members. Don't ask about them, it's because they don't know. It's always meddled in that big paperwork called their plan of care or their plan of care agreement or whatever new fancy term they've called their new agreements, for the members.

And it's always 70 plus pages long and no one has time for that, unfortunately.

Diane: Oh, and it doesn't even in real, it's legalese. It's not even in understandable legal English. It's not even in English. And that's intentional.

Arya: Exactly. So that's why I always take the time to speak to members. So even if you're a listener and you don't really know what's what, but you wanna know if you qualify for our type of care or our type of services.

If you've searched us up or if you looked at us, or even if you haven't, you just wanna call us. Feel free to do so. We'll be more than happy to answer your questions.

Diane: For my listeners out there, I wanna thank you so much for joining us for this deeply important conversation. What we've discuss today is far more than just policy.

It's personal. Families are being forced into impossible situations. Seniors are being sent home too soon, and caregivers, both professional and family, are being pushed to their limits. So if you're listening right now and you or someone you love has experienced an unsafe or premature discharge from rehab, skilled care, or home healthcare, we want to hear from you.

Your stories matter. Your voice could be one that helps create change. So please share your experience, with us in my caregiver story area on the caregiver relief website. And if we get enough stories, maybe we can start to make a difference. Whether it's about confusing discharge instructions, denied appeals, or not getting the care your loved one was promised or expected.

We are going to collect these stories to shine a light on what's really happening behind the scenes. And if you're a caregiver who's felt abandoned or unsupported, because of these broken systems, we see you, you're not alone and you do deserve better. for my family caregivers out there, remember, you are the most important part of the caregiver equation.

Without you, it all falls apart. So please learn to be gentle with yourself. Practice self-care every day because you are worth it.