Can Medicare Certified Home Health Evolve to Meet the Surge in Demand?

With the very sudden and rapid increase in patients requiring and requesting home health care following a hospital stay or in lieu of choosing other care options (assisted living, nursing homes, inpatient rehab, etc.), home health care providers need to be prepared to deliver to a new and broader audience than before COVID-19.

The home health industry is fragmented in the mind of the typical consumer. Most older clients see home care typically as a VNA that is covered indefinitely by Medicare or Medicaid. Most adult children share this view, but have a bit more awareness of longer-term home health options that are either funded by Medicaid, self-pay, or long-term care insurance. The industry has not done a good job of educating the public regarding what care is covered at what time. As a result, in most consumer's mind, all home healthcare is the same. One exception being informal care provided by a family member or friend or other caregiver who is hired through word of mouth or through other channels.

Most senior care analysts and researchers have been reporting on the home care boom secondary to the bad press nursing homes and other senior living providers have received in the wake of the Coronavirus pandemic. Some estimates are showing a nearly 50% decline in adult caregivers’ interest in nursing homes or assisted living in favor or home care due to the negative attention these providers have garnered recently.

But home health providers need to understand that if they want to convince the public that patients are better suited for home care, the care and service must be better than other options available. There are several areas home health can improve upon if they are to compete in the healthcare continuum. There are many challenges to delivering exceptional service and care in home health, I have outlined a few potential roadblocks to success below and some suggestions on how providers should be thinking about how to address them.

Communication: Communication is the first challenge. Many older adults are cared for in their homes with no adult children or other relatives on hand to observe or learn the status of their loved one's condition or treatment plan. Care management and care update meetings and frequent communication are essential and should include family members and other practitioners associated with each patient's care. My experience is that many providers fall short in truly "owning" the care coordination aspect of their patients and gaps in care and communication that can lead to adverse events. Coordinating updates on issues such as medication changes with family members, physicians, the pharmacy, etc. as well as communicating with others on their own team (wound care specialist, therapists, etc.) often get overlooked.

Information conveyed to an older patient is understandably not always fully digested, and family members can be left in the dark if communication is only to the patient. Providing updates, caregiver education, and instructions for family members and other's involved in the patient's care is paramount to success for the patient during their episode of care. The home health providers who succeed at looking at the patient in holistic terms - their medical history, social situation, resources, self-care goals, etc. will be the most successful. As I learned from coordinating home health for many family members, there are a lot of moving parts, a strong care coordination with fluid communication can make or break the outcome.

Care Management and Coordination: Another focus area that most Medicare home health agencies miss is that their clients should be their clients for more than just a few weeks - rather, they should view them as clients for life. If their patient goes to the hospital, someone should be on top of that at the agency, visit the patient, check in with the patient's physician, etc. If the patient will need more care after their Medicare time is up, the agency should work to coordinate the extended care they need in the home (in and outside of their network) and help the patient and family understand their options. Develop a longer-term plan for checking in on patients and their families after they are discharged from Medicare and for educating them and their caregivers as their needs change and progress overtime.

Accessibility: Many agencies still struggle “filling” new cases timely. As most research indicates, the longer sick patients must wait to access care, the higher the risk for an adverse event. It is crucial that new cases be seen within 24 hours of discharge from the hospital and that weekends are not a barrier to opening new cases. This applies not only to the initial nursing visit and assessment, but for physical therapists, home health aides, social work, etc. An advantage that post-acute care facilities have is that care is accessed, and assessments are made immediately – if home health is to compete, they must deliver in this area.

Technology: Telehealth/Telemedicine have grown by leaps and bounds over the past few months due to the pandemic. But there are other technologies and products home health providers should be offering clients, some of these include: Sensors to detect falls, interactive programs that address social isolation, emergency alert devices and online communication and educational tools for patients and families to assist them in understanding treatments and preventative health for diseases and also to keep communication flowing and open. And of course, offering telemedicine to assist in monitoring important clinical indicators is key in managing patients with chronic diseases and keeping them safe at home.

Collaboration: Home health cannot be an island. Providers need to have solid relationships in place with other medical and social agencies that go beyond meeting the primary medical needs of their patients in an episode of care. For example, partnerships with skilled nursing and assisted living facilities should be prioritized so there are relationships in place when a patient’s care needs exceed what home care can provide. Many times, patients can bypass an acute care or ER stay in lieu of a respite or longer-term admission to a senior living or post-acute care facility. I have found that home health agencies do not do a good job in educating their front-line care providers about these options which limits maximizing their patient’s choices and care. 

Additionally, Home Health providers should go the extra mile and develop relationships with pharmacies that offer delivery, grocery stores that offer delivery, hospice and palliative care providers, visiting physicians and nurse practitioners, home DME/Respiratory companies, meals on wheels and other nutritional support services, medical transport companies etc. so their clients can access these services when needed. There is a great opportunity to look beyond the episode of care and collaborate with other care and service providers to enhance each patient’s experience and outcome. Home health agencies should also be aware of spiritual services the patient may need or desire and work with their place of worship to arrange home visits or at least establish a connection for them. These are all things that are offered in a post-acute or assisted living facility – it would be wise to assess how your agency can deliver on these services and if you have the right (and enough) collaborative services in place.

Finally, one area that is extremely difficult for home health providers is addressing many of their elderly clients feeling of social isolation. Too often, the world of an elderly patient grows smaller and smaller by the day. Addressing the mental health of home health clients has always been an Achilles heel. If you have not already, the time has come to explore some of the collaborations and services I have mentioned on their behalf to assist in better managing client’s loneliness, depression and other mental health conditions that too often go unaddressed. Training and education of front-line nurses and caregivers to recognize and care plan for these issues should also take priority. This is another area that post-acute care and assisted living facilities have become well versed in collaborating with consulting psychologists, social workers, and psychiatrists – another opportunity for home health to improve.

With the right leadership and culture, home health agencies can evolve and meet the increasing needs of the clients who are increasingly choosing home care instead of other care options. But home health providers must routinely assess how they are meeting the needs of their expanded clientele base or patients will seek out other agencies and/or other options. Stay ahead of the curve and differentiate your agency through expanded service offerings, partnerships, and innovation – your clients will benefit greatly as will your agency’s future.