Pediatric home health is a vital service. But while the need for this type of care continues to grow, longstanding recruitment challenges remain, making the space tricky for providers to navigate.
Roughly 13.3 million, or 18% of children in the U.S., have special health care needs. As of 2017, about half of these children received support services that were provided by Medicaid.
Additionally, more than 500,000 children in the U.S. utilize home health services, according to statistics from a recent Axxess webinar.
Pediatric home health services can include ventilator management, airway management, gastrostomy tube management, seizure management, respiratory management and other nursing services for people who are under the age of 18.
“These patients … require a unique skill set from clinicians,” Lisa Malone, clinical product manager at Axxess, said during the webinar. “Children receiving home health care have a diverse array of diagnoses, severity levels and complications.”
The global pediatric home health care market is valued at $30.9 billion and is expected to grow to roughly $56 billion by 2026, according to a 2020 study conducted by Acumen Research.
Indeed, for providers looking to expand their service lines, pediatric home health care can be promising in terms of financial numbers and margins. However, a firm foundation must be built in order to have a successful program, according to Malone.
One company that has found success in the pediatric space is in-home care giant Bayada Home Health Care.
“The pediatric business represents about a third of Bayada’s overall revenue,” Melinda Phillips, president of skilled nursing services at Bayada, told Home Health Care News.
For context, the company brought in $1.5 billion in overall annual revenue in 2019, according to a spokesperson.
Moorestown, New Jersey-based Bayada provides home-based nursing, rehabilitative, therapeutic, hospice and assistive care services across more than 300 U.S. locations, with additional locations in Germany, India, Ireland, New Zealand and South Korea.
Bayada’s pediatric business encompasses 98 offices, 7,000 nurses and home health aides, and 4,000 clients, according to Phillips.
Despite establishing a major foothold in the space, Bayada still faces challenges around recruiting qualified caregivers. It is a struggle that is all too common for home health providers in working in the market.
A medically complex patient population and the fact that this care involves children often can create workforce challenges within the space.
“There is home equipment that many nurses haven’t used before,” Malone of Axxess said. “There are emergency situations that will occur, and they may be the only adult in the home.”
Furthermore, it is also more difficult to recruit new graduates into pediatric home health care, according to Malone.
“New graduates are typically less desirable for home care since they will basically be unsupervised the majority of the time,” she said.
For Bayada, a lack of qualified caregivers has meant a slight disruption in business, according to Phillips.
“It leads to our inability to say ‘yes’ as quickly as we’d like,” she said.
One thing that helped with building a staff of qualified caregivers was Bayada’s creation of its pediatric simulation lab in 2012. The lab allowed the company to provide advanced training to its staff prior to an actual home visit.
“Bayada pediatrics implemented the first home care-based clinical simulation lab in the nation,” Phillips said. “It’s similar to what nurses would receive in a top children’s hospital. We are providing that simulation in our state-of-the-art lab. They learn and refresh their clinical skills as needed.”
Interim HealthCare, another company that has found success within the pediatric home health space, is no stranger to recruitment challenges.
“We grew 10% to 15% for decades,” Delia Glaser, vice president at Interim HealthCare of Pittsburgh, told HHCN. “However, about four years ago, the workforce shortage greatly impacted all of health care — particularly our pediatric focus. The No. 1, 2 and 3 challenges here are the recruitment of qualified staff.”
Interim is a Sunrise, Florida-based in-home care franchise with more than 300 locations across the U.S.
The company’s Pittsburgh franchise location is its largest pediatric services provider.
While the pediatric side of the business has been lucrative for Interim, recruitment challenges have delayed its growth, according to Jane Hinton, the chief clinical officer at Interim.
“It has slowed our growth of the pediatric service line,” Hinton said. “However, we have instituted quite a few things in the last year, and we are now seeing growth in that segment again.”
One of these things was investing in a more robust pediatric education process for clinicians. Similar to Bayada, Interim now operates a simulation lab.
The continuing education element that the labs provide can also help with retention, which is critical, as hiring new nurses can be costly. Specifically, nurse turnover can cost an agency $38,000 to $58,000 per lost clinician, according to a 2016 National Healthcare Retention & RN Staffing Report.
To ensure retention, Interim implemented a perk-based rewards program for its caregivers in 2018.
“Our [Appreciation for Valued Associates] reward program is similar to Southwest’s points system,” Glaser said. “It is designed to give thanks to our caregivers. They get points and ultimately gift cards if they collect enough points, working holidays and weekends. They can get up to $200 a year in gift cards, and it has done tremendous things for our staff retention.”
Interim has also invested heavily — $1.5 million to be exact — in talent acquisition programs to ensure effective hiring and onboarding.
“We’ve had franchisees tell us over the last three to five years that if they could find more nurses and caregivers, they could take more patients home,” Hinton said. “The bottom line is that we have invested quite a bit in what we call Interim careers, a recruitment platform.”
While companies like Bayada and Interim have thrived in pediatric home health care, there still needs to be more reimbursement for these services to encourage more providers to enter the market, according to Glaser.
“These services are generally paid for by Medicaid or Medicaid HMO,” she said. “It’s generally more cost-effective and the right thing to do for these kids to be at home rather than the hospital. These agencies need to get more politically involved and speak to their legislators, as well as the managed care organizations.”
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