Focus on Caregiving: Innovative Approaches to Respite Care

November is National Caregivers Month, and we continue our focus on this topic with our second article in the Fall Focus on Caregiving Series. This month we will examine innovative approaches to increasing access to and utilization of respite care services across the country.

The definition of respite care is broad, but most commonly it refers to emergency or planned temporary care relief for primary caregivers. Respite care has evolved to mainly ensure the assistance needs of a primary caregiver are met, though less commonly thought of respite services could include assistance with house cleaning, grocery shopping, medical caregiving, or a couple hours a week of drop off childcare for a child with complex medical needs in a day facility suited to care for the child. State-level approaches include programs that attract waiver participants to respite care, boost utilization of services, communicate the importance of respite care, and increase flexibility in the spending of respite care funds. Additionally, respite services could be medical or non-medical, and challenges ensuring access to both kinds of services have been exacerbated by provider shortages. This article highlights innovative policy and programmatic approaches to respite care to increase utilization, access, and equity in services and care delivery.  

Kentucky 

Rate Increase: 

In the spring of 2022, the Kentucky Legislature approved a state budget that included a rate increase for 1915(c) Home and Community-Based Services (HCBS) waiver programs to better align HCBS provider payment rates with the current economic landscape and the costs incurred by providers who serve waiver participants, as well as to reflect the federal quality of care standards. All services (excluding some residential services) covered under Kentucky’s five HCBS waivers received a 10% rate increase in fiscal year 2022-2023, and another 10% increase in 2023-2024. This rate increase covers respite care, which is included as a covered service under Kentucky’s five HCBS waivers, so both specialized and non-specialized respite providers will see higher payment rates. Rate increases are an important step in addressing the workforce shortages in respite care providers and attracting new providers to the field.  

 Spending Flexibility:  

In Kentucky, there is a cap on spending for respite services under the state’s HCBS waivers. However, if an HCBS waiver participant exceeds the maximum allotted amount for respite care, Kentucky allows participants to use “personal care,” another covered service, as their source of respite if they exceed their limit. This is an important policy innovation for participant flexibility and utilization of allocated funds. It also ensures participants do not experience a disruption in care delivery – many respite care providers are also personal care attendants or nurses, so the same provider would be able to provide care, just under a different covered service.  

 Utah 

Medicaid Respite Care Pilot Program:  

In 2021, the Utah General Assembly passed House Bill 34, which allows for the Utah Department of Health to apply for a Medicaid waiver or state plan amendment for medical respite care for individuals experiencing homelessness. This bill is a Medicaid Respite Care Pilot Program that reimburses facilities providing residential medical respite care to individuals experiencing homelessness covered under the Adult Expansion Medicaid Program. The aim of the program is to improve health outcomes for this population and address the challenges of cycling in and out of care settings by creating a stable, accessible environment in which to receive continuous treatment and recovery services after discharge from an emergency department.   

 Respite Provider Training Program  

This past summer, ten states (Arkansas, Illinois, Kansas, Massachusetts, Montana, Nevada, New Mexico, New York, South Caroline, and Wisconsin) completed a 12-month pilot of the Respite Care Provider Training online program, which is a part of the Respite Provider Recruitment and Training Project launched by ARCH National Respite Network and the Respite Care Association of Wisconsin, in collaboration with the National Academy of State Health Policy (NASHP). The program is a free online training course that consists of ten modules for individuals interested in entering the respite care field. Each module focuses on at least one of the ten Respite Care Professional Core Competencies, which are used as standardized benchmarks to ensure a high quality of care.  

A training program that is free and accessible and is adaptable for state-specific needs and requirements is an important step in addressing the respite provider shortage and establishing a widespread standard of care. It is critical to direct state resources to develop a baseline for professionalism and success in the field. This will ensure patients and families feel comfortable accessing care and can find trustworthy providers, and it will help recruit more providers to the field to address severe staffing challenges. Investing in these two areas can lead to a higher utilization of services and increased accessibility of respite care for diverse communities and populations. 

Health Policy News will continue to track developments in innovative approaches to respite care across the country and will bring more information about caregiving and respite as the fall Focus on Caregiving series concludes.