Long-Term Care at Home
Contributed by Lindsay Dymowski Constantino, President & CoFounder of Centennial Pharmacy Services
Q. What exactly is “long-term care at home” and how is it different from traditional retail or
LTC pharmacy models?
Long-term care pharmacy at home refers to the services and supports that a pharmacy provides specific patients residing in their own homes that is equal to or greater than the level of care that they would receive if they were residing in a long-term care facility. Unlike traditional retail models that focus on point-of-sale transactions, LTC at home pharmacies provide comprehensive medication management including adherence packaging, 24/7/365 availability, cyclical medication reviews, delivery coordination, and care coordination with other community providers and caregivers. In traditional LTC pharmacy, pharmacies are providing medications to facilities; LTC at home is rooted in the community, serving patients who may never enter a facility but still require high-touch, ongoing clinical support.
Q. Who qualifies for long-term care at home pharmacy services? Is it only for patients receiving home health?
Not at all. While patients receiving home health services may qualify, the LTC at home model is designed for any individual who requires a skilled level of care, regardless of whether they are enrolled in a formal home care program. This includes patients with chronic conditions, cognitive impairment, mobility limitations, polypharmacy, or frequent hospitalizations. Eligible populations may range from medically complex children to adults living in private residences. In fact, many patients receiving Medicaid home and community-based services or those who are dually eligible for Medicare and Medicaid often meet the criteria, even if they are not actively receiving in-home nursing support. It’s important to note that there is a formal qualification process. Pharmacies are responsible for identifying, qualifying, and continually re-qualifying patients to ensure they meet the criteria for LTC-level pharmacy services. This must be clearly documented and maintained at the pharmacy to support compliance, payer expectations, and patient safety.
Q. What services must a pharmacy provide to be considered compliant with LTC at home?
First and foremost, any pharmacy operating under their LTC NPI must meet the CMS requirements for LTC-level of pharmacy care. The CMS requirements include comprehensive inventory, adherence packaging requirements, pharmacist on call service, IV and compounding access, medication delivery, and emergency medication supplies.
In addition to meeting CMS requirements, pharmacies must recognize that LTC at home patients are often living independently or supported by non-clinical caregivers. This reality demands that the pharmacy elevate its role, delivering a level of care equivalent to what the patient would receive in a facility setting. That means stepping beyond dispensing and into true medication management. Pharmacies must provide comprehensive care coordination, including medication synchronization, up-to-date clinical documentation and qualification forms, and most importantly, perform a complete Medication Dispensing Review (a combination of medication reconciliation and drug utilization review) every time medications are dispensed. By doing so, the pharmacy ensures patients are not only receiving the right medications but are also being actively monitored and clinically managed in the home. This model moves beyond simple delivery and becomes a robust, patient-centered system of care, supporting both safety and better health outcomes.
Q. Why is LTC at home becoming more important in today’s healthcare landscape?
A shift towards aging in place, combined with rising facility costs and a sever shortage of LTC beds, has created a growing demand for LTC-level services delivered at home. By 2030 — five short years — nearly one in five Americans will be65 or older. Meanwhile, more than 70% of individuals who need long-term care reside in the community, not in institutions.The LTC pharmacy at home model fills a critical gap by offering continuity or care, improving medication adherence, and reducing hospitalizations … all while also supporting caregivers, community providers, and reducing health care costs.
Q. How are payers and PBMs responding to LTC at home?Are they recognizing it as a distinct service model?
Yes, but it’s a work in progress. Forward-thinking industry leaders are beginning to recognize that LTC pharmacy at home is not just retail or LTC pharmacy, it’s a hybrid model that requires its own compliance structure, reimbursement model, and credentialing process. This year we are seeing some payers and plans have already begun carving out service sets and are requiring proof of service standards. Although this can be frustrating for pharmacy owners and operators, it’s exciting! This evolution opens the door for contracting opportunities for pharmacies that can help them better support their at home patient populations, and even provides space for value-based opportunities for pharmacies that can demonstrate outcomes.
Q. What does the future of LTC at home look like and how can independent pharmacies position themselves to lead?
The future of LTC pharmacy at home is both urgent and promising. As health plans, ACOs, and regulatory bodies continue to prioritize aging-in-place initiatives, the demand for qualified LTC pharmacy at home partners will grow. Independent pharmacies are uniquely positioned to lead because of their community relationships, agility, and ability to provide personalized care. To lead in this space, pharmacies must ensure compliance with CMS standards for long-term care, implement dedicated LTC at home workflows, and actively engage with local providers, MCOs, and community partners to build trust and demonstrate that independent pharmacies are capable of delivering high-touch, clinical care, not just filling prescriptions.
Q. What are some of the biggest misconceptions about LTC at home pharmacy services?
The biggest misconception is that LTC pharmacy at home is just “retail with delivery.” Many assume it’s simply a matter of putting prescriptions in a bag and dropping them off at a patient’s home. In reality, the LTC at home model is a clinical, outcomes-driven model that mirrors the level of pharmacy services traditionally provided in a skilled nursing facility. In a retail model, the interaction often ends at the point of sale. In contrast, LTC at home pharmacy care involves ongoing clinical oversight, robust documentation, proactive medication management, and close coordination with healthcare providers, caregivers, and home-based services. Pharmacies are responsible not only for dispensing but also for ensuring that the medications are administered correctly, safely, and consistently, often to medically complex or cognitively impaired patients.
Other common misconceptions include:
• “It’s only for hospice or home health patients.”— LTC at home services are not limited to patients in those programs. Patients do need to qualify for this level of service, but any individual who requires a skilled level of medication management, typically due to chronic illness, polypharmacy, or functional impairment, may qualify, even if they’re not receiving formal in home care.
• “Only big LTC pharmacies can do this.” — In fact, independent, community-based pharmacies are leading the charge in LTC at home. With the right infrastructure and training, smaller pharmacies can provide these services with greater flexibility and personalization than many larger operations.
• “There’s no formal framework or regulation.” — This model must meet CMS’s long-term care pharmacy requirements, including medication regimen reviews, 24/7 pharmacist access, adherence packaging, and timely delivery. It also requires pharmacies to meet minimum care standards, including qualifying patients, providing care coordination, clinical documentation, and cycle medication reviews. It is not a gray area; it’s a regulated level of care that is being audited for service support and even now has accreditation pathways.
Ultimately, LTC pharmacy at home is about bringing the institutional pharmacy model into the community … with all the clinical rigor, patient safety measures, and outcome tracking required to support high-risk populations aging in place. My favorite aspect of the model is that pharmacy is no longer just a dispenser … it becomes a central player in the care team, exactly what it should be.
Lindsay Dymowski Constantino, President & CoFounder of Centennial Pharmacy Services
Lindsay Dymowski Constantino is the president and cofounder of Centennial Pharmacy Services, one of the first pharmacies in the country exclusively focused on long-term care at home. She also serves as the cofounder and president of the Long Term Care at Home Pharmacy Quality Commission, which partners with payers, health plans, and other industry leaders to develop compliance frameworks and operational standards that allow pharmacies and other healthcare providers to confidently and compliantly deliver long-term care pharmacy services in the home setting. A nationally recognized leader in community-based pharmacy innovation, Lindsay is passionate about building scalable, sustainable models that support aging and medically complex patients where they want to be — at home.
