The agency issued an informational bulletin last month reminding states of federal renewal requirements and available flexibilities to ensure continued coverage for individuals eligible for HCBS through Medicaid. This bulletin continues CMS’ efforts to minimize coverage gaps, particularly during and after the public health emergency unwinding process, and to ensure eligible individuals retain or are re-enrolled in Medicaid.

For home care providers, a renewed government effort to clean up HCBS protocols – like in the Medicaid Access Rule – helps keep patients on census and enables better care geared toward value.

Following the end of the COVID-19 public health emergency in 2023, states restarted regular eligibility renewals for those enrolled in Medicaid and Children’s Health Insurance Program (CHIP) coverage, a process often called “Medicaid unwinding.” This included renewals for individuals who needed assistance with daily living activities.

As states restarted renewals, many individuals faced challenges renewing their coverage because of administrative barriers. States experienced unprecedented renewals, resulting in backlogs in some areas, according to CMS. Many states also experienced system and compliance issues, which the agency directed them to address.

Throughout unwinding, CMS has strongly urged states to adopt federal strategies that make it easier for eligible individuals to renew Medicaid. On Aug. 19, CMS issued guidance outlining strategies states can adopt to help eligible individuals receiving HCBS retain their coverage.

These strategies are designed to simplify eligibility and enrollment processes, maximize the use of available and accurate information, and reduce the burden on individuals and state Medicaid agencies, allowing eligible individuals receiving HCBS to maintain their coverage, independence and engagement in community life.

In accordance with the guidelines, states are required to regularly review Medicaid eligibility, in line with federal regulations, to ensure continued access to HCBS for those who are still eligible. Some of the current flexibilities that help maintain coverage and access to HCBS include collaborating with local agencies to improve “no wrong door” systems for assisting individuals in maintaining Medicaid enrollment. States can also choose to exclude some or all countable income or resources when renewing coverage for individuals receiving HCBS for a specific period of time.

No wrong door means consumers can enter any service with the expectation that if it is not appropriate for them, they will receive assistance in accessing the most relevant services.

“During the COVID-19 pandemic, the Families First Coronavirus Response Act mandated that states maintain continuous enrollment in Medicaid for people,” Home Assist Health President and CEO Sara Wilson told Home Health Care News. “However, this continuous eligibility requirement ended with the public health emergency, leading to various challenges for states transitioning out of it. These challenges included staffing shortages, training needs, outdated operating systems and communication issues. As a result, procedural errors occurred, leading to wrongful termination of participants and creating gaps in care. These gaps can pose increased financial and health risks for the individuals affected.”

Phoenix-based Home Assist Health is a nonprofit home care provider.

“HCBS enables individuals to age and recover in the comfort of their homes,” Wilson said. “Continuity in these programs is crucial in upholding this right, guaranteeing access to care, and safeguarding the health and well-being of participants.”

During the renewal process, eligibility must first be confirmed using the state’s asset verification system without requiring additional information from the individual (ex parte). Ex parte renewals are one of the most vital tools for states to keep eligible people covered and prevent terminations due to red tape, as demonstrated by CMS data last year.

“Ensuring people have access to comprehensive, high-quality health coverage is a top priority for the Biden-Harris Administration,” a CMS spokesperson told HHCN. “That is why we have urged states to take up every tool CMS made available to help eligible people renew coverage and to protect them from becoming disenrolled due to red tape as states conducted Medicaid and CHIP renewals following the end of the Medicaid continuous enrollment condition in 2023, a process often called ‘Medicaid unwinding.’

As the unwinding process demonstrated, states’ choices have real consequences for eligible people’ ability to maintain coverage during Medicaid and CHIP renewals. While states must follow federal Medicaid and CHIP requirements, they have broad flexibility within these requirements when administering their programs. States can take steps to help eligible people, including people who receive HCBS, stay covered. These steps include improving ex parte rates, taking up CMS’ strategies that make renewals easier to navigate (including strategies outlined in our recent guidance), and addressing other barriers to coverage.”

CMS issued guidance to help states adopt strategies to improve ex parte rates. With these efforts, Medicaid and CHIP ex parte rates doubled nationwide from about 25% in April 2023 to 50% of renewals due in May 2024.

The agency also recently finalized a rule that builds on critical lessons learned during Medicaid unwinding by streamlining and simplifying how people enroll in and renew Medicaid and CHIP from now on. These improvements will reportedly help millions of eligible people with HCBS enroll in and maintain Medicaid coverage moving forward.

For example, for those eligible for Medicaid based on disability, the rule prohibits states from requiring in-person interviews, requires states to provide a reasonable period for applicants to return information and documentation, and requires states to accept renewals in multiple ways, such as online, by phone, mail or in person.

Regarding compliance with renewal requirements, the guidance issued on Sept. 20 details steps that all states must take to ensure their compliance with federal renewal requirements for Medicaid and CHIP and avoid further action by CMS.

States must assess their compliance with federal requirements, submit the results to CMS, and submit a plan to resolve any issues. Building on insights from the unwinding period, this action will help ensure state compliance with key federal renewal requirements, safeguarding individuals’ ability to renew their health coverage and strengthening the integrity of the Medicaid program, according to CMS.

“HCBS is crucial for long-term care services, allowing participants to choose home-based care while promoting individual choice and control,” Wilson said. “Home care providers should work with their state Medicaid authorities to support this transition process for members.”

The post CMS Releases HCBS Continuity Of Coverage Requirements appeared first on Home Health Care News.

In a crowded home care ecosystem, companies are constantly looking for ways to stand out.

For some that means putting innovative solutions in practice that will enhance operations and care services. For others, that means developing deep local roots to strengthen services in various communities.

On top of this, home care companies are rolling out services that will help differentiate their care delivery model from that of competitors.

Ari Medoff — CEO of the home care company Arosa — recently touched on the greater need for ingenuity in home care.

“I am constantly amazed at how big and vast our market is, and how few points of differentiation most of us in the industry have,” he previously told Home Health Care News. “We need more creativity around business models. We need more companies to try different things.”

HHCN recently heard back from six home care leaders on the aspects of their companies that they believe separate them from the crowd.

***

Home care faces significant market pressures typical of its growth shakeout phase, where market differentiation is necessary for survival. At Home Assist Health, our strategic response focuses on deepening community commitment through a person-first approach, evident in our person-centered care planning and employee-centric programming that prioritizes clients and staff.

We’ve integrated innovative solutions like Automation Edge’s bot for streamlined back-office tasks and Tap Root Ella’s AI for dementia care, enhancing care quality and efficiency. Recognizing increasing rates of chronic disease, we’re prioritizing health independence by expanding community health worker services and promoting self-management of health skills. Partnering with an Arizona non-profit, we’re providing diabetic-compliant meals to eligible members.

Our focus on workforce centers around students who are not only experts in what attracts them to a profession but are also our primary target for growth. We’ve expanded partnerships with high schools, community colleges, and Arizona State University, offering internships, apprenticeships, scholarships, and student-led HR consulting to nurture talent and enhance capacity.

We operate in the human services industry, where placing people at the center of everything we do is fundamental. Our goal is to promote and enhance human potential at every level. This guides our operations and ensures resilience during industry shakeouts.

— Sara Wilson, president and CEO of Home Assist Health

***

To differentiate ourselves in the home care market, we leverage advanced technology and maintain strong human connections. Our primary competition isn’t other agencies, but private caregivers. Since leaving the Honor Care Network, we’ve partnered with Hellohire and Homecare Pro to streamline our hiring process. This automation reduces onboarding time, ensures thorough vetting and maintains high-quality care. According to the 2024 Home Care Pulse annual benchmarking report, our hiring conversion rate outperforms the top 5% of agencies.

Our innovative approach improves efficiency, reduces costs and allows us to deliver top-notch care while considering our clients’ fixed incomes. By integrating technology into our operations, we enhance accountability and remain competitive. Despite our technological advancements, we emphasize the human element by conducting in-person interviews and orientations to build trust and ensure we hire the best caregivers. This blend of technology and personal interaction sets us apart in a parity market.

By embracing innovation and prioritizing human connections, we remain efficient, relevant and committed to serving our community effectively. And, at the same time, the bonus for Cypress is the reduction of the costs of human capital, and the bonus for caregivers is the speed to hire increases exponentially. Our approach ensures our clients receive the best possible care. As our business manager has said for over 20 years, ‘He or she who has the caregivers wins.’ Having quality caregivers available is how we differentiate ourselves.

— Bob Roth, managing partner at Cypress HomeCare Solutions

***

We believe that deep local roots are essential for home care companies to differentiate themselves from competitors. In practical terms, this means leveraging our community knowledge to provide clients with the resources they need at any time of day. If you require a reliable and trustworthy caregiver to spend that very night with an anxious, hospitalized loved one, we are the answer. Hand-in-hand with local knowledge is a strong base of exceptional caregivers. Their dedication and expertise will establish and maintain our reputation for quality, compassion, professionalism and reliability while building trust with the people we serve. These qualities matter most to those seeking home care services and can make or break an agency. Plus, they are a big part of our quest to reshape the meaning of personalized caregiving. Unlike large companies that struggle with local knowledge and small agencies that lack resources, we are unwaveringly focused on our communities and caregivers. This unique approach, tailored to the specific needs of the people we serve, sets us apart and helps us break the parity barrier.

— Doug Markham, CEO of Avenues Home Care

***

At Senior Helpers, we differentiate from other home care companies by looking at outcome data for the families we serve. We utilize a proprietary LIFE Profile Assessment app with our clients that applies more than 18 years of data to create a customized care plan for each client. We then measure our client’s improvements and track any hospital readmissions or ER visits. We believe our services are non-clinical and highly skilled. Our caregivers are trained to care for clients with chronic illnesses such as Alzheimer’s, Parkinson’s and much more.

Most home care companies focus on private pay, or government payers such as Medicaid. At Senior Helpers, we excel in both these markets along with the underserved middle market. The middle market has the largest number of seniors, but it is very difficult to service. The seniors in the middle market don’t have the financial resources to afford traditional home care and they have too much money to have the government help pay for home care. Senior Helpers has developed customized fractional care programs called flexHOME, utilizing home care and technology to meet the needs of this growing market. We want to serve as many clients and families as possible and we need to be resourceful on how we serve them now and in the future.

— Peter Ross, CEO and co-founder of Senior Helpers

***

Family & Nursing Care Select stands out with our expertise navigating all aspects of long-term care insurance (LTCI) for our clients. Our LTCI management team provides unparalleled, comprehensive, hands-on support and advocacy ensuring each and every client maximizes their LTCI benefits. We provide guidance and support with all the paperwork, troubleshoot issues and uncover potential additional policy benefits, thereby maximizing the value of each policy. We consistently receive raving feedback from our clients about our proactive communication, and how supportive our LTCI team is from the first discussion when initially setting up care through the entire life cycle of a client.

— Neal Kursban, CEO of Family & Nursing Care

***

I believe that to differentiate yourself in the home care industry, organizations need to prioritize humanized experiences over transactional ones. At Nurse Next Door, our Happier Aging philosophy embodies this belief by delivering personalized and connected care. By nurturing relationships and empowering seniors to pursue their passions, we enhance their emotional, mental and physical well-being, celebrating aging as a vibrant stage of life. Our focus extends beyond our clients to our caregivers through our Caregiving as a Career initiative, aimed at industry transformation. We provide growth opportunities, guaranteed hours, and foster a supportive culture that attracts compassionate professionals. Valuing our caregivers ensures they feel fulfilled and appreciated, establishing Nurse Next Door as a caregiving career destination in home care.

— Cathy Thorpe, president and CEO of Nurse Next Door

The post ‘We Need To Try Different Things’: How 6 Home Care Providers Stand Out In A Crowded Market appeared first on Home Health Care News.

As the nation faces a debt ceiling of $34 trillion and climbing, it’s no surprise that the federal government is under pressure to find ways to cut program costs and crack down on overspending.

What is surprising is that the program they continually target in budget cutbacks has an impressive record of saving the government billions: Medicare-certified home health care.

Though home health care helps nearly 36 million 65+ and permanently disabled Americans recover at home and avoid costlier placements in institutions, the Centers for Medicare & Medicaid Services (CMS) has initiated deep cuts to the Medicare home health industry, totaling $25 billion in cuts over the next decade.

Government-funded health care programs like Medicare, Medicaid and Medicare Advantage (MA) home health are closely connected in how they are financed.

This is because Medicaid and Medicare Advantage have such insufficient funding to begin with, forcing providers to rely on Medicare to cover the shortfall to offset the costs incurred in treating patients under Medicaid and Medicare Advantage – a decade-old system that is severely flawed and requires all three programs to ride on the backs of one another for financial stability.

The solution is two-fold: First, CMS must stop cutting Medicare home health care funding. Cutting funding year after year has only created turmoil in the very industry that is essential in providing stable, in-home care for vulnerable Americans.

Second, CMS and the Medicare Payment Advisory Council (MedPAC) must seek to develop new policy approaches that account for Medicare’s cost-savings and support a sustainable funding model for Medicare, Medicaid and MA. This two-fold solution will ensure that purported federal efforts to save money and cut programs are not done so to the detriment of millions of seniors and adults with permanent disabilities.

As funding cuts continue, the costs of business and operations increase, leaving home health providers forced to either cut wages, services and coverage areas or shut their doors altogether. This ultimately costs Medicare more money by pushing patients into costlier institutional settings while simultaneously risking health outcomes.

Medicare home health patients have better health outcomes and are at less risk for rehospitalization. Since COVID, we have seen a substantial shift in America’s future of health care as more evidence has shown home to be the safer and more comfortable setting. Without fixing the flawed system, vulnerable Americans won’t be able to access this option of care and our government will be forced to spend even more money.

To put it into perspective:

It costs $2,010 per month to care for a patient at home for 30 days under home health care.

A skilled nursing facility costs an astronomical $16,500 for that same care.

That’s a cost savings of approximately 88% for every patient diverted from a skilled nursing facility and cared for at home. Put another way, we can care for eight people at home for the cost of caring for one person in an institution.

Why does the federal government continue to put a target on the back of an industry that has shown to be a win-win for both patients and the federal budget?

Year after year, these seemingly baseless funding cuts destabilize the nation’s ability to move health care into the home, and further our growing debt. The federal government should be fixing this broken system by taking the money Medicare home health care saves and reinvesting it into a practical funding model that supports providers’ ability to expand access to these essential services.

In its Strategic Framework plan, CMS claims to have a “commitment to ensuring all American people have access to the highest quality health care.” The home health industry undeniably operates within that commitment, keeping America’s vulnerable populations cared for in the patient-preferred, cost-effective setting. We are finding it increasingly difficult to see how the federal government has lived up to that same promise.

The post Contradictory Policymaking Has Led To Costlier Care: The Future of Health Care Is In The Home appeared first on Home Health Care News.

At the start of the week, the “Ensuring Access to Medicaid Services” rule was finalized. The 80-20 provision is, arguably, the most controversial component of the Medicaid rule. In summary, the provision calls for 80% of Medicaid payments for home- and community-based services (HCBS) to be earmarked for direct care workers’ compensation.

On Thursday, Congresswoman Kat Cammack (R-Fla.) introduced a bill to block the U.S. Department of Health and Human Services (HHS) from finalizing the 80-20 provision.

Additionally, the legislation would also block HHS from implementing any similar rules that place a minimum requirement for how much of Medicaid spending on HCBS goes towards direct workers’ wages.

Cammack’s reason for introducing this legislation is her belief that the 80-20 provision will severely limit access to care at a time when providers are already struggling to serve patients.

“The Biden administration’s proposed ’80/20′ rule would require states to spend billions in new unfunded mandates or force HCBS providers to reduce access to care for those who need it most,” Cammack said in a press statement. “Because of top-down demands from the Biden administration, home care agencies can’t keep up with staffing levels and overall care levels while complying with this rule. It’s putting millions of Americans at a sharp disadvantage and only exacerbating the challenging issues we already face.”

Cammack isn’t the only person that has expressed similar concern about providers’ ability to deliver services under the 80-20 rule.

Leaders at organizations like Home Assist Health, the National Association for Home Care & Hospice (NAHC) and Addus HomeCare Corp. (Nasdaq: ADUS) have spoken out against the rule for similar reasons.

“It compromises our network integrity for care at home,” Sara Wilson, president and CEO of Home Assist Health, previously told Home Health Care News. “It makes me nervous, because it could affect our ability to care for the people who we are here to serve.”

NAHC President William A. Dombi took aim at what he believed to be a contradictory rule.

“At its core, the rule is a fundamental contradiction,” Dombi previously told HHCN. “It’s saying, we have all of these things we need to do to improve the quality of care, to improve the lives and the health and safety of individuals. All of those things require administrative expenses to achieve. Yet at the same time, the rule is saying, ‘We’re cutting the available funding for you to implement those same activities we’re requiring.’”

Despite Addus’ pushback against the 80-20 provision, the company believes that it is well-positioned to push for rate increases to combat the rule’s impact. 

“The conclusion is that you have to be big,” Addus CEO Dirk Allison said at the Raymond James conference last month. “That’s not just big nationally, you have to be big in a state. If you look in the states where we are very large, we have a great deal of access to the state government, and can work with them on the reasons why we need increases in rates, which is what it will take for certain state programs to remain competitive, if this goes through. We’re working on that.”

The post Congresswoman Kat Cammack Introduces Legislation To Block 80-20 Rule appeared first on Home Health Care News.

After the release of the proposed “80-20 rule” last year for home- and community-based services (HCBS), providers had plenty of time to digest. Now, they’re formulating their plans of action ahead of the proposal’s potential finalization.

Broadly, the U.S. Centers for Medicare & Medicaid Services’ (CMS) proposed rule had several components, but the most controversial would result in roughly 80% of Medicaid payments for HCBS being put aside for payment for direct care workers.

The proposal has since received an unfavorable reception from many industry stakeholders, with the final rule expected sometime this Spring.

One of the most common objections is the belief that the rule would wreak havoc on smaller companies providing care. Many also believe that the rule doesn’t account for the different operating dynamics across all 50 states, nor does it account for other workforce investments like training.

Sara Wilson, president and CEO of Home Assist Health, believes that the proposal – if finalized – could impede care.

“I’m of the position that it was moving forward too fast, without research, or a state-by-state cost analysis,” she told Home Health Care News. “It compromises our network integrity for care at home. It makes me nervous, because it could affect our ability to care for the people who we are here to serve.”

Home Assist Health is a Phoenix-based home-based care provider that provides a variety of care services, such as personal care, housekeeping and respite care.

Care Advantage CEO Tim Hanold thinks that CMS has good intentions, but disagrees with the federal agency’s approach to what he considers a shared goal.

“Access to care is a shared goal, and so is increasing compensation for our caregivers,” he told HHCN. “I think we’re all aligned around that. The CMS rule started with good intentions, but certainly there’s going to be some unintended consequences if it comes out as written. Rate adequacy really continues to be the main driver for providing appropriate wages, and that is what I believe the administration should focus on to improve access to care.”

Richmond, Virginia-based Care Advantage is a home-based care company that has more than 45 locations throughout Virginia, Maryland, Delaware, Washington, D.C., and North Carolina. The company offers both personal care and home health care services.

Despite the largely negative response to the 80-20 proposed rule, there are some components of the rule that haven’t received any pushback.

“There are components of the 80-20 rule that we’re in agreement with — the timeliness of access, HCBS quality measures and the standardization of wait list reporting requirements,” Hanold said. “Those are all things that are necessary to keep the entire ecosystem responsible for delivering high-quality and timely care to the Medicaid population.”

While Hanold believes the rule will be finalized, he is less sure about what the final rule will look like.

“It’s not clear to me yet if it will be finalized as originally written, or how many variations of it will come across,” he said. “There are a number of components that will probably be pure play and work all the way through. Then there are others, like the 80-20 threshold, that created quite a bit of response from numerous states and from numerous organizations.”

Planning for the rule

Though providers are unsure of what the finalized rule will look like, this hasn’t stopped companies from being proactive. Many leaders have come up with a plan for the proposal, in its current form, being finalized.

At Home Assist Health, the plan is to work closely with the company’s state Medicaid management authority and lean into partnership strategies.

“We are staying close with our peers, and our Medicaid management authority to monitor progress, possible discussions on when the time comes on operationalizing it, so that we can adapt accordingly to preserve this very important vital service for those who rely on it,” Wilson said.

As a non-profit organization, Home Assist Health is also positioned to pursue grants and fundraising. Though Wilson notes that this is currently much more difficult than it has been in the past.

Additionally, the company plans to work closely with its state home-based care trade associations.

For Care Advantage, the plan is to be cognizant of how the company serves its different markets.

“It’s about resource allocation,” Hanold said. “We have to be smart about how we think about all of the regions and areas that we serve. We have to ensure that it still makes economic sense. In other words — no margin, no mission.”

In general, the company has spent a lot of time modeling out different scenarios when it comes to the 80-20 rule.

Hanold believes that there are three things here that will hold true for all businesses in the space.

“The first one is that you need to build volume and scale, possibly in a material way,” he said. “You have to think large, you have to think at scale for a business in a 80-20 world to really work. The second point is consistent healthy rate reimbursement. It’s critical that we’re voicing the case for rate adequacy. Our joint advocacy now is more important than ever. The third point is that you need to be really selective on how to deploy resources.”

The post Inside Home-Based Care Provider Strategies For Surviving Under The Looming 80-20 Rule appeared first on Home Health Care News.

Among the grant recipients is Phoenix-based Home Assist Health. The CVS Health Foundation has earmarked $2.1 million over three years between Home Assist Health, Valleywise Health and Advance.

“We are so grateful and honored,” Sara Wilson, president and CEO of Home Assist Health, told Home Health Care News. “It’s very humbling to have, what we see as these giants, wanting to partner with us, and recognizing the power that people have in improving the health and well-being of other people.”

Home Assist Health is a home-based care provider that provides a variety of care services, such as personal care, housekeeping and respite care.

The company has been working closely with Valleywise Health for the past few years, as part of a food pharmacy project that was partially funded by CVS. The project helped individuals who had an uncontrolled diabetic status, and who experienced food insecurity, get access to healthy diabetic compliant foods.

Last year, when Valleywise Health pursued the CVS grant, the health system invited Home Assist Health to be one of its partners for this endeavor.

“[Valleywise Health] invited us to be one of the partners to help focus on those social determinants of health, and put in place interventions from the home environment, and provide health coaching, education and navigation,” Wilson said.

The grant funding will go toward driving integrated diabetes management services. This includes things like home care and monitoring, as well as medically tailored food boxes and educational resources.

In other words, the funds allow the company to further build on the work it has been doing in this area. It will also empower individuals to take their health into their own hands, Wilson noted.

“At the end of the day, that patient we’re there to support is doing the work,” she said. “We’re not doing it for them. We’re giving them the information, the resources, the education, the accountability, so that they’re successful in their own health independence.”

As part of the collaboration, eligible patients that are referred to Home Assist Health through CVS Health Zone and Valleywise Health will receive a home visit from the company’s care staff. These patients will receive culturally aligned education and coaching, according to Wilson.

“For instance, if they’re primarily Spanish speaking, we’ll use their language and then we work with them to improve their health independence,” she said. “When we’ve done this in the past, we’ve seen their emergency department visits drop. They’re making proper use of their primary care doctors and specialty appointments. We reduce avoidable admissions, as well as readmissions, and then we see pretty consistent improvements in their health vitals labs and overall quality of life.”

Overall, Wilson believes that the awarded grant speaks to CVS’ enthusiasm when it comes to care in the home.

“What I understand is that CVS was very excited about the opportunity of bringing in a home care partner, where we can actually help address these issues from the home space,” she said. “That was something they were excited about doing here in Arizona. For us, it’s a wonderful opportunity to really demonstrate, with the spotlight of CVS, the power that home care has. There’s not been as much attention on how home care has these very real positive impacts on individual health and well-being.”

The post CVS Health Grants Home Assist Health $2.1M To Support Home-Based Care Initiative appeared first on Home Health Care News.

Personal home care providers have begun to ditch blanket approaches, instead opting for more patient-by-patient specificity.

Going further to meet individual client needs enables home care to make a greater impact, while also increasing client satisfaction.

“One of my favorite geriatricians once said, ‘If you’ve seen one senior patient, you’ve seen one senior patient,’” Senior Helpers CEO Peter Ross told Home Health Care News. “It’s really important that we customize the care plans for each of the individuals, because everybody has a different situation they’re dealing with.”

Personalized home care

Patient-centric care is not a new idea. However, it may look different these days in comparison to a decade ago when technological advancements weren’t there yet in the home care industry.

Today, providers like the Maryland-based Senior Helpers are tailoring their service offerings with a more personalized philosophy using apps and other data-centric tools.

Senior Helpers is a home care company that operates over 380 franchise locations in the U.S., Canada and Australia. It’s one of the largest franchise companies in the home care space and was recently bought by Waud Capital.

A few years back, Senior Helpers launched its Life Profile assessment tool, an app that uses 20 years of data to assess the individualized needs of a senior.

“It’s an app we use with the family that provides a score — almost like a fuel gauge — and that score will basically dictate the chance of that person being readmitted into a hospital,” Ross said. “We’ve done almost 30,000 assessments with this tool and have learned we can create customized care plans while leveraging our care management, our care services, as well as our technology, to provide the best level of care.”

Advocate Health – Senior Helpers former owner – and the U.S. Veterans Administration (VA) have been strong advocates for the app.

“It’s something that’s very unique to Senior Helpers. There’s nothing like it out there in the marketplace,” Ross said. “It truly gives us a leg up on creating a customized care plan that goes right into our software center and allows the caregiver to understand exactly what we need to do for any given member.”

Technology, Ross added, has taken a lot longer to take hold in the home care industry than it should have. Now that seniors are getting more comfortable with wearables and smartphones, that allows providers the ability to leverage that technology to curate a more personalized care plan.

Curating a person-centered care plan

Every person’s care needs are different. With that in mind, a person-centered care plan is often based on an individual’s group of needs.

For many providers, compiling an exhaustive list of needs has become part of the home care process.

“With a common patient panel with diabetes or COPD, treatment is tailored uniquely to those characteristics or demographics,” Home Assist Health CEO Sara Wilson told HHCN. “We also look at a lot of interventions that target social determinants of health based on where somebody lives. Considerations such as food deserts, transportation, environmental surroundings — I would liken it more to a thumbprint versus a blueprint.”

There are so many factors that play into our general health, Wilson said, that it would be insufficient not to take all of it into consideration.

Educational limitations, literacy issues, language barriers are all lifestyle factors that mean more to an overall care plan than most would think.

Creating individualized care plans also creates buy-in from the members and patients.

“We ask, ‘What’s going to get you motivated to control your health?’” Wilson said. “Once a member identifies their wishes and aspirations, then you have buy-in. Now you get a client or patient who’s more motivated to participate in healthy habits.”

Another tactic Home Assist Health and its caregivers use is something called motivational interviewing.

“There are so many factors that you can’t simply resolve with a food pharmacy,” Wilson said. “In home care, sometimes we are the best entity to get into the home, listen to understand and build those authentic relationships using motivational interviewing to understand what does this person ultimately want out of their life. How are we going to use that one wish for themselves to be what motivates them to take control over their current health status?”

Moving care forward

In order to properly assess a home care client, there has to be a foundation built on trust and good data. Sometimes the first part of that equation is even harder to build.

“Our clients often exaggerate their abilities,” Griswold Home Care CEO Michael Slupecki told HHCN. “They understate their challenges. By having something like a wearable or other technology in the home when we’re not there, you can get a baseline for how folks are actually doing today versus last week. It allows us to address issues in a more personalized way.”

With more than 160 locations, the Blue Bell, Pennsylvania-based Griswold provides home care services in 30 states.

Slupecki has thought about the intersection of home care and home health a lot over the last few years. His experience as the former COO of Interim Healthcare has given him a unique perspective in how to better personalize home care.

“Today, I would say about 90% of the industry still does what it was doing 30 years ago,” Slupecki said. “That is assisting a person with activities of daily living. Which isn’t a bad thing. What we’re trying to do is be a little bit in between traditional home care with the intent of actually addressing the social determinants and all these other factors that we’ve now realized have a big impact on people’s health.”

One example at Griswold is the addition of virtual nurse visits.

After a traditional home care assessment, clients with Griswold will then meet virtually with a nurse to set up a clinical assessment.

“Depending on the client’s needs and chronic conditions, this nurse can deploy cuffs, scales, and odometers at virtually no cost to the client,” Slupecki said. “We’ve had interventions with these virtual nurses who may notice somebody’s blood sugar has gotten out of control. Those nurses will then tell a family member or a primary care physician who then mitigate likely disasters.”

The future of a more personalized home care environment is tied to innovative technology, a well-rounded caregiver support system and strategic partnerships with a shared vision.

“It’s all about collaboration,” Ross said. “It’s all about working with health care providers that continue to make adjustments and improvements to the care management and care coordination for these members.”

The post How Personalized Health Care Is Changing The Role Of Home Care Providers appeared first on Home Health Care News.

As the cost for home care rises, some providers are finding that clients have more of a zero-tolerance policy when it comes to mistakes or mishaps in care delivery or care planning. 

With the stakes for client satisfaction arguably higher than ever, leaders of home care companies are leaning into client retention strategies.

Generally, Sara Wilson — president and CEO of Home Assist Health — has found that home care clients and their families are taking more of a dealmaking mindset to the vetting process when they’re looking for a care services provider.

“[They want to know] if this is a trusted brand,” she told Home Health Care News. “Is it distinguishing itself from other competition in the market? They know their buying power. They’re sensitive to price, and want to know if this price will bring the value that they’re looking for. We had a meeting with a client, just recently, who was vetting our services and said, ‘Well, what am I going to get out of this?’”

The Phoenix-based Home Assist Health is a home-based care provider that provides a variety of care services, such as personal care, housekeeping and respite care.

Over the years, caregiver retention and recruitment has been top of mind for leaders of home care companies. Wilson believes that leaders should add client retention to their top priorities.

Still, she noted that this gives home care leaders the opportunity to fully evaluate the value their companies are bringing to clients.

“What’s the added value — it’s quality care, innovation, uniqueness, personalized services and educational resources,” she said.

On its end, Home Assist Health has expanded its services to include health coaching support and disease education for the entire family. This can include things like proper diet habits, meal provision and menu planning.

It can also include counseling recommendations for clients who are struggling with big life changes.

The company has also incorporated telehealth into its care delivery model to offer a more layered experience.

“How do we give you immediate, in-the-moment support to deal with these challenges of aging or disability, so that you’re successful while still working through a positive life quality at home?” Wilson said.

On the flip side, Family & Nursing Care CEO Neal Kursban doesn’t believe that clients are more willing to walk away from a home care company now, compared to any other point in time.

Based in Maryland, Family & Nursing Care is one of the largest private-pay home care companies in the Washington, D.C., area. Currently, the company provides just under 41,000 hours of care per week.

Though Kursban sees the cost of care increasing, he also believes that clients’ expectations have always been high, and remain so.

However, similar to Home Assist Health, client retention strategies are important at Family & Nursing Care.

“There’s only so many ways you can differentiate yourself in private-pay home care,” Kursban said. “In my view, the importance of agencies is to create a ‘Wow’ experience all the time. It’s hard to do.”

One of the ways Kursban believes companies can achieve this is by examining every touchpoint, and identifying the areas where the organization is failing to create that experience.

At Family & Nursing Care, this means having an infrastructure that allows the company’s coordinators to have meaningful and emotionally bonding conversations with clients and their family members, according to Kursban.

“When the intake comes in, you have to work with a family to help them identify their needs,” he said. “They don’t always know what their needs are, and it takes a pretty involved conversation to really identify their true needs and balance that with their financial position, and then appropriately guide them to a schedule that addresses their needs, but also works for your company.”

The company’s client services managers are not only responsible for communicating with clients and their families, they also help determine the best mode of communication. That means figuring out if text messaging, calls or emails work better for a client.

“It’s about meeting the clients where they are at,” Kursban said. “What’s going to work best for them? Not how your company prefers to communicate.”

Additionally, the company always wants to know when its own caregivers may be falling short, in terms of care delivery.

“[I want to know] where we are falling short, and if we are, let’s revisit,” Kursban said. “Let’s get a different caregiver. You’re paying a lot of money for this as a client. We tell them, ‘Make sure you have what you want. Don’t be shy, don’t accept complacency. It’s not going to work in the long-run.’ Hitting those conversations head-on is vitally important.”

The post As Home Care Billing Rates Rise, Client Retention Becomes A Larger Priority For Providers appeared first on Home Health Care News.

As 2024 approaches, home care leaders are embracing AI, alternative payer sources, employee-centric solutions and much more.

Home Health Care News heard from nine home care industry leaders, who shared their views on the biggest trends, challenges and opportunities that will define home care in 2024 and beyond. Some also noted where their organizations’ efforts will be focused next year.

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The home care market continues to expand due to growth in an aging population, increased prevalence of chronic conditions, and a continued consumer preference for the comfort and familiarity of home over institutions. While elder care is growing more quickly, I predict in the next 2-3 years, we will see an increase in home care utilization among a more diverse group of demographics — mainly helping support those with chronic conditions.

In 2024, I expect to see continued advancement in the integration of health care and home care fueled by technology and data collection. Remote monitoring for vitals and fall risks will help provide a more complete picture of patient health. Patient touch points will expand, furthering the collection of patient data. Increased capacity for predictive modeling through AI will empower home care leaders to enhance service offerings to improve the quality of care, patient health, comfort and independence.

Home care companies positioned to provide an integrated and individualized care plan leveraging new technologies will see the most significant consumer interest and build revenues through enhanced partnerships with referral sources.

— Emma Dickison, CEO and President at Home Helpers

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Due to the increased cost of private-pay home care and economic uncertainty around a recession, we believe 2024 will be marked by shorter length of stay than we saw pre-pandemic. Like 2023, this will be driven by consumers delaying the start of care and/or ending services in favor of more cost-effective options such as family-provided care. This may be a challenging time for some operators, especially those without a mature sales funnel.

Outside of scaled operators, which are the minority in private-pay home care, M&A may continue to be slightly challenging for sellers. There may be less buyers for the average home care agency than in years past, meaning fewer LOI’s and softer offers. While Family Tree Private Care is still an active buyer, we expect that challenging debt markets in the first half of 2024 will compress most buyers’ ability to finance deals or support a purchase price that the average seller has come to expect.

These challenges, we believe, bring opportunity for any high-quality agency with strong referrals to survive uncertainty, but more importantly to capitalize on rebounding demand driven by positive consumer sentiment and willingness to spend as early as the second half of 2024.

— Daniel Gottschalk​​​​, Co‑CEO of Family Tree Private Care

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Balancing the need for appropriate home care regulations while preventing overregulation is crucial for the industry. Baseline regulations that set forth good business practices to keep clients and caregivers safe are essential. Now, each state licenses private-duty home care, but if nationwide licensure is implemented it would create basic, minimum standards and would also give the industry more recognition as a legitimate player in the health care continuum.

It’s important that the home care industry supports fair and achievable licensing standards to prevent states from implementing overly burdensome regulations. This will also create a trusting relationship with regulators and show that everyone has the same goals — the best quality of, and access to, care. Appropriate regulations also help maintain the public’s trust in the industry.

Excessive regulations can stifle growth and innovation, create distrust by home care companies, and impose excessive operational and financial costs, which will ultimately have a negative impact on clients and caregivers. For example, excessive paperwork, reporting, and documentation demands diverting resources away from direct client care, increasing administrative burdens and the cost of care for clients.

I look forward to the future when each state’s private duty home care license is consistent nationwide.

— Neal Kursban, CEO of Family & Nursing Care

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The industry can anticipate a rise in instant pay options for caregivers, such as platforms like Daily Pay or Tapcheck. Moreover, social media-like applications for interacting with caregivers and employees, such as CoachUp Care, are likely to gain prominence, ensuring seamless communication and coordination.

Recruiting caregivers will remain a significant challenge for home care agencies. Additionally, the industry will witness a shift towards dominance by big franchises and private equity-backed agencies, posing a threat to the competitiveness of independent agencies. Moreover, factors like inflation and recession will contribute to the growing cost of labor, leading to increased prices for services. This may make home care unaffordable for many seniors, potentially forcing them to consider less desirable alternatives like nursing homes.

The aging population, particularly the increasing number of baby boomers, presents a substantial opportunity for the home care sector. As this segment continues to age, the demand for home care services will surge, creating a significant market for providers who can cater to the unique needs of this demographic.

In summary, the home care and senior care industry in 2024 will witness a shifting landscape defined by emerging trends such as instant pay options and social media-like applications, alongside challenges in recruiting, industry consolidation, and affordability. However, the growing market of aging individuals presents an opportunity for providers to tailor services to meet the rising demand. Adaptation and innovation will be key for players in the industry to navigate and thrive amidst these defining trends, challenges and opportunities.

— Qiana James, CEO and Founder of Friendly Faces Senior Care

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Home care in 2024 will experience another year of rapid demand and increasing complexities. Competition among home care agencies will intensify, leading to higher levels of innovation. Businesses will need to navigate the changing market using adaptive strategies, market differentiation and strategic partnerships. Businesses will set themselves apart by proactively addressing today’s community health challenges.

There will be a rise in businesses employing people-first strategies ranging from employee-centric solutions to person-centered care plans. Success will be further defined by a business’ ability to demonstrate positive health outcomes, employee satisfaction and community partnering.

The need for home care workers will continue to vastly outpace the workforce. Because of that, home care agencies, community members and our government must – and will – work together on solutions for sustainability. I see sustainability coming from health promoting strategies. My vision extends to a world where health independence serves as a strategic prescription for prosperity and enduring well-being for generations to come.

— Sara Wilson, President and CEO of Home Assist Health

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The rising cost of care is a trend I see most prevalent in the home care space and an area personal care providers need to prioritize in order to prevent challenges for their operations in 2024. Margin compression and reductions in reimbursement rates along with current unfavorable macroeconomic conditions for consumers means providers must find strategic ways to drive efficiency, reduce costs, and deliver quality care and successful patient outcomes. To address these challenges, home care and personal care providers will need to continue investing in processes to strengthen and streamline their operations while reducing costs without compromising the quality of their services. I expect a continued trend of centralization of functions to achieve scale that can support a business case for the adaptation of automation and eventual AI augmentation.

In 2023, my network initiated the development of multi-unit operating models that leverage the centralization and scaling of functions, which were piloted across our BrightStar-owned agencies. We have already had success introducing automation into the revenue cycle with robotic process automation that dramatically decreases the amount of human intervention in recurring administrative functions including payroll, billing, and revenue-cycle-management optimization.

— Shelly Sun, CEO and Founder of BrightStar Care

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As we approach 2024, Executive Home Care is poised to address the evolving landscape of home care, focusing on market differentiation, employee satisfaction, community partnerships, and data-driven insights. In an increasingly competitive market, consumers demand transparency and excellence in home care. They seek compelling reasons to trust providers with the care of their loved ones. This necessitates a clear articulation of our community commitments and unique service offerings. At the same time, the challenge of staffing shortages underscores the importance of fostering a work environment where caregivers feel valued and supported, a crucial factor in attracting and retaining talent.

Beyond basic referral networks, we are strengthening community partnerships through clear and effective communication, aligning our goals with those of our partners to enhance care quality. Additionally, our strategy heavily relies on data analytics. By analyzing client and caregiver data, along with key business metrics, we can swiftly address care needs and manage specific conditions such as Alzheimer’s and COPD. This not only improves our responsiveness, but also cements our position as specialists in senior care. These focused efforts in 2024 will ensure that we continue to provide exceptional care and support to seniors and their families.

— Kevin Porter, Brand President of Executive Home Care

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The biggest trend affecting not only the home care industry, but nearly every industry, is artificial intelligence.

There are a range of ways AI can be applied to caregiver recruitment and retention. From writing job postings, to chatting initially with applicants, to scheduling interviews, AI can eliminate several time-consuming steps in the hiring process. Once onboarded, AI can drive ongoing caregiver engagement to measure job satisfaction, provide rewards, give recognition, and even assign training.

Similarly, AI-enabled CRM technology can improve client acquisition and retention. In the home, AI powered passive monitoring technologies can help keep our clients safe, even if we aren’t present. The power of applying predictive analytics to client data captured by both caregivers and AI technology can warn us of fall risk, provide early detection of urinary tract infections, give medication reminders, and more. This can reduce avoidable rehospitalization and keep our clients healthy in the home longer.

AI technologies are changing and improving faster than we can implement and will impact the future of home care indefinitely.

— Michael Slupecki, CEO of Griswold

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The biggest opportunities in 2024 that will define home care will be around alternative government payer programs that now exist in home care. Home care has established itself as a positive impact to health outcomes when it comes to the cost of health care for our seniors.

Whether it is VA, Medicare Advantage, or Medicaid, there are significant upside to these programs for home care. In addition, there are several Medicaid specialty programs that are worth evaluating in markets across the country. To maximize these opportunities, home care providers need to focus on data that supports these better health outcomes. This data will go a long way in separating these providers from their competitors when these payers review their best partners to work with in their markets. Also, this data will help these providers get the best reimbursement rates, because you are lowering the total cost of care.

— Peter Ross, CEO and Co-Founder of Senior Helpers

The post 2024 Executive Forecast: What 9 Home Care Leaders Expect Next Year appeared first on Home Health Care News.

That was one key takeaway from a recent panel discussion that took place last month at the Home Care Association of America’s (HCAOA) annual conference.

When it comes to employee culture, there are a number of areas where the home care industry is performing well, according to research from Home Care Pulse and Great Places to Work.

“This is not just a job — that’s what your employees love most about where they work,” Home Care Pulse President Todd Austin said during the discussion. “It has meaning. The people here are treated fairly, regardless of their gender, and people are treated fairly regardless of their race. They’re proud to tell others where they work. These are the four areas that as an industry, we really excel in.”

Austin pointed out that it’s important for providers to emphasize these points when trying to attract people to the home care industry.

“How many of you are telling stories that align with those four categories — probably not a lot,” he said. “That’s our opportunity. This is what individuals are looking for when they are in the job market.”

On the flip side, the home care industry struggles with compensation, a lack of special recognition programs, as well as a tendency to play favorites with employees.

Generational demographics can also factor into what individual workers value most, according to the data.

In addition to findings around what attracts workers, the research also made the case for the importance of diverse workplaces.

At Senior Solutions Home Care, hiring based on the ability to excel at work has helped the company build a diverse workforce.

“Our baseline was that anyone can be an excellent caregiver, and let’s give them that opportunity to do so,” Kunu Kaushal, founder and CEO at Senior Solutions Home Care, said during the panel discussion. “We also listen and watch for what isn’t making them a great caregiver, and really define it based on the quality of the person’s work, not who they are as an individual, in any other way.”

For Friendly Faces Senior Care, ensuring that the company has a diverse workforce was intentional.

“I’m that person that as a young child, I remember that feeling of not being included, and I remember how horrible that felt,” Qiana James, founder and CEO of Friendly Faces Senior Care, said. “For me, it’s a mindset. I’m a person that always wants to make sure that everybody is included. When I’m designing my agency, I made sure it was very intentional, and it’s not just the caregivers, but also our office staff.”

James noted that this is the exact kind of workplace that many job seekers are looking for.

“So many job seekers are actually looking for organizations that are diverse, and it’s a higher turnover rat, if you have an organization that does not include diversity,” she said. “We all know the problems that we have with caregiver turnover. We want to make sure that we have a diverse organization. We cannot afford any more turnover.”

Sara Wilson, president and CEO of Home Assist Health, believes that representation is a strategy for an effective organization.

“It promotes good innovation, positive decision making, strong outcomes and recruiting and retention numbers,” she said. “We want market sensitivity and employee engagement with authentic representation.”

Ultimately, workers will be attracted to workplaces where they feel valued, according to Emma Dickison, CEO and president of Home Helpers, said.

“A couple of years ago, a Home Care Pulse benchmarking study highlighted why caregivers left their organizations, and the top five out of ten were because of the way they felt treated by the home office,” she said. “So start there. Look at those types of opportunities and the data to say, ‘How have we unintentionally excluded [people], and how can they be part of our innovative solutions, as we think about shaping the company going forward?’”

The post To Win At Recruiting, Home Care Providers Need To Better Understand Job Seekers appeared first on Home Health Care News.