That’s according to a recent report from the Medicaid and CHIP Payment and Access Commission (MACPAC). MACPAC makes recommendations to Congress, the U.S. Department of Health and Human Services (HHS) and states on issues affecting Medicaid.

“Variability in payment rate assumptions can incentivize workers to switch to higher-paying services, creating access challenges” Robert Nelb, principal analyst with MACPAC, wrote in the report.

Medicaid payment policies significantly impact the HCBS workforce. Much like other corners of the home-based care industry, there’s a growing shortage of HCBS workers due to high demand and headwinds exacerbated by the COVID-19 pandemic.

States have a wide variety of ways that they can pay for HCBS services.

In order to address workforce shortages, states will adjust Medicaid rates to supplement more funding for HCBS caregivers. Most states base their payment rates on wage data from sources like the Bureau of Labor Statistics.

Many stakeholders who were interviewed for the MACPAC report said that while short-term funding from the American Rescue Plan Act (ARPA) has helped to stabilize the workforce, these gains may be lost if funding is not sustained in the long term.

“Because of growing inflationary pressures, some stakeholders also expressed concern that simply sustaining ARPA rate increases may not be enough to address current HCBS workforce challenges,” Gabby Ballweg, a research assistant with MACPAC, said during a commission meeting in March.

However, increases in HCBS funding and payment rates do not always translate into equivalent wage increases for HCBS workers, Ballweg explained.

“Many states in our study used wage pass-through policies as a strategy to require providers to pay a direct share of the provider rate increases to workers,” Ballweg said.

The report also found that many states don’t regularly update HCBS payment rates.

“There is substantial variance in the frequency of HCBS rate updates across waiver programs ranging from annually to every five years,” Nelb wrote. “Public documentation of rate studies, processes and results is also highly variable. Some states publish formal rate study reports on their websites and others have very little external rate study reporting.”

One potential solution to this issue is self-directed care when a patient or client will select their own caregiver, often a family member or close friend.

In 2022, there were approximately 3.5 million HCBS workers. Of those, 2.8 million were home care workers – and about 40% of those workers are employed through self-direction.

MACPAC leaders believe that with more research and data, self-directed care could be an effective way to curb some of the workforce issues in HCBS.

“I really appreciate your attention to self-direction and looking more closely at family members as paid caregivers,” MACPAC Commissioner Jami Snyder said during the commission meeting.
“Many states, understanding the tremendous workforce challenges, decided to extend paid care to parents of minor children during the pandemic. That’s just one facet of the equation that we should definitely include in our study of this area.”

The post Report: Medicaid Payment Variability Hinders Access To Home- and Community-Based Services appeared first on Home Health Care News.

Every home-based care provider wants to recruit and retain better this year than they did last year. But that’s easier said than done.

Companies are constantly tinkering with their approaches to attract and retain skilled professionals, and are doing so in 2024 yet again.

Between new recruiting processes, career advancement opportunities and more technology, there’s a lot to learn from some of the more forward-thinking organizations in home-based care.

“There’s lots of data that shows the importance of the purpose of an organization,” Amedisys Inc. (Nasdaq: AMED) Chief People Officer Adam Holton told Home Health Care News. “I’ve never worked in an organization before where people care this much about taking care of other people. Our leaders have that same mindset with our caregivers as our caregivers do with their patients. That cultural piece is something that we don’t take for granted.”

Investments made at Amedisys

Amedisys had one of its strongest years in 2023, when it comes to organic growth within its nurse hiring program.

At the same time, it has struggled to hold onto its nurses. When clinicians leave Amedisys, over 50% of the time it is in the first year.

“There are two big levers in this space,” Holton said. “You either bring in more clinicians at a faster rate or retain them at a better clip. Obviously it sounds simple, but it’s not.”

Based in Baton Rouge, Louisiana, Amedisys is one of the largest home health and hospice companies in the country. It has over 520 care centers and about 19,000 employees across 37 states and the District of Columbia.

In order to keep the momentum strong from 2023 to 2024, Holton and his team have doubled down on a number of initiatives that have worked incredibly well over the past 15 months. Those ventures include widening the aperture of where Amedisys looks for talent and implementing sourcing capabilities to its job posting program.

“Once upon a time in our industry, and in our company as well, we could get away with only hiring primarily — and almost exclusively — individuals who had past backgrounds and home health,” Holton said. Those days are over.”

Estimates vary, but the general consensus for how many home health nurses the industry is short ranges from 200,000 to 400,000. The nurse workforce contracted by 3.3% during the pandemic while the demand continues to rise every year between 5% and 7%, Holton said.

Because of that, home health providers have to get creative to find the right workers. Last year, Amedisys invested in a new applicant tracking system that has been a real needle mover, Holton said.

“That has been game changing for us as an organization,” Holton said. “Being able to take our great recruiters and focus less of their time on a lot of administrative, manual work and have them focus on the art and science of recruiting great clinicians to come into the organization has been hugely important.”

Another major investment Amedisys has made is in its preceptor program. Although expensive, Amedisys has dedicated nurses who are not operational in the field, but are solely there to train new hires.

“It’s not new to the industry, and we’ve done it in the past, but we’ve really started to see value from it,” Holton said. “It’s an investment where we have individuals now that have been hired to 100% work with new clinicians coming in to train them, answer all the questions, to follow up with them and to make sure that they’re comfortable and confident in what they’re going to be doing day in and day out.”

CenterWell’s investments

As is the case in all of health care, information is king.

Data can be used at every level of a business, particularly when hiring clinicians and attempting to maintain a highly qualified workforce.

“We take a multi-faceted approach to recruiting and retaining nurses and other clinicians that provide home-based care to our patients,” Jennifer Rose, CenterWell Home Health’s VP of Human Resources, told HHCN. “We have put systems and processes in place to continuously learn from our clinicians in the field. This daily information gathering provides a window into our clinicians’ mindset: their needs, pain points and what they’re asking for to enhance their experience.”

CenterWell Home Health — Humana’s (NYSE: HUM) home health provider arm — has over 350 locations, over 9,000 clinicians and serves more than 350,000 patients annually.

The simple process of actively listening to current clinicians about what they want out of their job has been a point of emphasis for CenterWell as staffing shortages persist.

Elevating the perception of the job and offering career paths for clinicians has proven to be a major boost in CenterWell’s retention efforts, Rose said.

“We’re helping grow the careers of our clinicians by investing in tuition reimbursement programs for college and university degree work, as well as RN to BSN advancement programs,” she said. “We also have programs in place for our clinicians to learn new skills and obtain technical certifications that allow them to care for patients with specialized needs.”

CenterWell has also made sure to work with its parent company when offering advancements and promotions throughout the company. The provider has made it easier for its employees to move from one part of the organization to another, in hopes that the flexibility offered to clinicians and nurses will be a boon to retention.

“For instance, moving from a care coordination role with our insurance business to home health or even our owned primary care centers,” Rose said. “This agile approach is a win-win for our clinicians as well as the business, providing additional flexibility.”

Investment in new technologies has also been an area of focus for CenterWell. Using AI and other capabilities to streamline scheduling and reduce on-call burden are just a couple of examples.

“We’re implementing advanced technologies like voice-to-text capability to simplify the task of documenting patient encounters,” Rose said. “That allows our clinicians to focus more of their time and energy on what they’re most passionate about – serving their patients.”

Amedisys has found success in its own newer investments in tech.

“We recently invested in a new listening platform,” Holton said. “There are lots of good listening platforms out there, but the one we’re now using collects all the feedback that we get from our clinicians and people in the field, and based off the science and the algorithms, it helps our leaders to pin down, ‘Here are the two action items you should take that are going to have the most impact on the caregiver experience.’”

The post How Amedisys, CenterWell Home Health Are Retaining Workers In 2024 appeared first on Home Health Care News.

“Our commitment to fostering a culture of continuous improvement and adaptability has been instrumental in our journey leading up to this pivotal point,” HomeWell Franchising CEO Crystal Franz told Home Health Care News in an email. “Recognizing the dynamic nature of the home care industry, we understood the necessity of remaining adaptable to sustain our growth — a goal that can only be accomplished by working together.”

HomeWell Care Services – which is franchised under HomeWell Franchising Inc. – provides personal care and homemakers services for seniors in over 50 locations across more than 100 markets in 33 states.

Over the past several years, HomeWell has been known as one of the fastest-growing home care companies in the country.

Since its rebrand in 2019, HomeWell has prioritized continuous improvement by integrating new systems and technologies into the fold, Franz said.

At the same time, getting feedback from its franchisees has also been a driving force behind its success.

“We’ve welcomed feedback from our franchisees, ensuring that we’re providing the tools they need to excel in their local markets,” Franz said. “This milestone underscores our dedication to ingenuity, collaboration and even a dash of boldness at times — all of which have helped reinforce our position as a growing leader in the industry.”

Earlier this year, HomeWell was one of a dozen home-based care companies that earned a spot on Entrepreneur’s 45th annual Franchise 500 rankings.

In 2022, HomeWell grabbed a spot on Inc. 5000’s annual ranking after it experienced 88% three-year growth.

One of the main drivers of that growth was the company decision to waive its initial franchise fee for new owners. In turn, those owners were able to reinvest this fee into the company, spurring even more growth.

In order to sustain that, Franz said that it’s important to stay rooted in the business principles that have allowed the company to get this far. That includes building on innovation, creating new partnerships and making sure its franchise owners believe in home care’s impact on families and the broader continuum of care.

HomeWell recently announced its Franchise Advisory Council (FAC), made up of elected representatives from its nationwide network of franchise owners, and will use that group to guide its path in the future.

“Looking ahead, we recognize the strength of our diverse franchise system and aim to leverage it to its fullest potential,” Franz said. “We eagerly anticipate tapping into the council’s insights to guide our future endeavors and ensure we continue to equip both new and veteran owners for success. With our brand’s momentum and the invaluable contributions of our owners, we are poised to lead the industry into the future.”

One of the standout programs that HomeWell credits its growth to is a bonus program that rewards franchise owners for longevity with the company and overall excellence.

As far as the future goes, Franz expects a lot of the same: expanding national presence while continuing to build relationships with national vendors.

“By maintaining its commitment to quality, innovation and collaboration, HomeWell is well-positioned to continue driving positive impact and setting new standards in the home care industry for years to come,” Franz said.

The post HomeWell Reaches 2 Landmarks: 100 Location Owners, $100 Million In Annual Revenue appeared first on Home Health Care News.

The franchise company is also launching Homewatch Connect, a smart camera system that aims to promote longer independence at home, reduce isolation and boost social engagement.

“This all-inclusive suite of services is designed to provide personalized care to clients, allowing the opportunity to get into care earlier and stay longer,” Homewatch CareGivers President Todd Houghton told Home Health Care News in an email. “Clients will benefit from increased independence, improved safety and a greater peace of mind while care providers are equipped with tools to deliver more efficient and tailored care.”

The Denver-based Homewatch CareGivers is a home care franchise company that operates in over 30 states and seven countries. The franchise employs over 4,500 caregivers at over 230 locations.

The services offered through Total Care Solutions will include daily social engagement and clinical expertise from Homewatch’s caregivers.

Houghton said the new program will enable clients to age in place with dignity on their own terms by offering “several flexible levels of service.”

Paired with the smart camera, Homewatch hopes to give its clients an improved communication system, while also addressing cost efficiency and flexibility when monitoring clients in their home.

“These cameras are integrated into clients’ homes to provide real-time connection, engagement and insights into their well being,” Houghton said. “Care providers can use this data to tailor care plans according to individual needs and preferences. The smart camera technology also allows for remote communication and collaboration with increased touchpoints through virtual care — in addition to having the caregiver in the home.”

Features of Homewatch Connect will include video calls with care professionals, remote monitoring, motion and sound detection as well as on-screen alerts for medication reminders, appointments and other scheduled tasks to keep clients active and engaged in their care plan.

“As the demand for technology-driven advancements continues to grow, Homewatch CareGivers remains at the forefront of innovation,” Houghton said. “This reimagined approach helps clients enable longer independence at home, reduce isolation and boost social engagement while helping to preserve privacy.”

The tools should also assist caregivers and providers by streamlining many of the work processes that come with a more tailored care plan.

“By combining advanced technology with personalized care, we are offering families a solution they have been looking for,” Houghton added. “It helps to ensure loved ones are well cared for through improved communication and interaction, while also offering care providers increased support, automation, cost efficiency and flexibility in monitoring and engagement.”

Both new programs are expected to officially launch this month.

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According to an analysis done by the private investment banking company Stephens, rates are expected to remain virtually unchanged, with a slight decrease of 0.16%. This marks the second consecutive year of a cut to real “core” MA rates.

Although expected, the news worried some post-acute stakeholders who believe plans will pass cost concerns down onto providers.

“These inadequate rates paid by the MA plans destabilize the financial health of provider organizations more broadly,” LeadingAge President and CEO Katie Smith Sloan said in a statement shared with Home Health Care News. “Policymakers must act before we find few providers remaining to serve the more than 65 million Medicare beneficiaries, including the nearly 33 million who now receive their Medicare benefits via an MA plan.”

Under the new guidance, payments from the government to MA plans are expected to increase, on average, by 3.7% — or over $16 billion — from 2024 to 2025.

In previous years, CMS has bumped up the rate by 3.32% for 2024 and 8.5% in 2023.

“The finalized policies in the rate announcement will make improvements to keep Medicare Advantage payments up-to-date and accurate, lower prescription drug costs and ensure that people with Medicare have access to robust and affordable health care options,” CMS Administrator Chiquita Brooks-LaSure said in a statement.

The federal government is projected to pay between $500 and $600 billion to private health plans in 2025.

The final core 2025 rate update is well below expectations, Scott Fidel, an analyst with Stephens, wrote in the report.

As a result, Stephens projects the potential for slower enrollment growth for the MA industry in 2025 as MA plans look to adjust member premiums and benefits to preserve margins.

“Bottom line, we see the final core 2025 MA rate update of -0.16% as reflecting a ‘highly adverse’ outcome for the industry, inclusive of the additional industry headwind of higher utilization trends currently observed,” Stephens wrote in its report. “The final 2025 rates largely reflect a continuation of the negative CMS rate cycle — now denoted as ’Year 2’ — of a much more constrained annual MA reimbursement trend as compared to the significantly more favorable rate outcomes in 2022 and 2023.”

Generally, home health agencies have expressed dissatisfaction with payment rates and reimbursement policies set by managed care companies.

For that reason, health care firms like ATI Advisory have encouraged providers to develop a value-based care strategy as a way to minimize the dependency on MCOs and other private payers.

“You don’t want a managed care strategy, you want a value-based care strategy,” Anne Tumlinson, founder and CEO of ATI Advisory, said during Aging Media Network’s Continuum conference. “Managed care is just a financial tool. But to move from delivering units of service to delivering value is really, really difficult. Changing what it is that you sell and how you get paid to do it is a huge undertaking.”

In her statement, Sloan mentioned the group of 46 U.S. House Representatives who sent a letter to CMS arguing the rate adjustments would result in a reduction to MA insurers’ reimbursement in 2025.

“Given the record of success, it is baffling that CMS has proposed a nearly 0.2% cut to the Medicare Advantage insurer reimbursement rate for 2025,” lawmakers wrote in March. “Insurers are already signaling that plan benefits may be cut, which will undermine the program and hurt seniors. These consecutive cuts raise questions about the future viability of the robust choices and options available to seniors in MA. Without necessary support, these options will wither and seniors will be left with fewer benefits, less access to affordable coverage and higher out-of-pocket costs.”

In MedPAC’s status report from January, it was found that CMS pays about 20% more for Medicare coverage provided to beneficiaries through MA plans compared to fee-for-service Medicare.

“Plans are viewing this as a cut,” Mollie Gurian, vice president of home-based and HCBS policy at LeadingAge, told HHCN in an email. “We are concerned that this perspective will trickle down and negatively impact our mission-driven, nonprofit home health members. If MA plans feel financially squeezed, they may cut rates paid to providers. Home health agencies already report inadequate reimbursement from Medicare Advantage plans so any downward pressure on rates is only going to put more strain on our members.”

The post CMS Finalizes Underwhelming Payment Adjustment For Medicare Advantage Plans appeared first on Home Health Care News.

One he has stuck with, however, is a constant commitment to searching for the next advancements in technology.

Between recruiting, onboarding and care management plans, Caring Senior Service have prided themselves on leveraging technology to stay ahead of the curve.

“Back in 2015, we recognized that most of the software providers out there were really forcing us to follow their way of doing business,” Salter told Home Health Care News. “We found that that wasn’t productive for the way that we wanted to assess and create service plans for our clients. We needed our software to be highly customizable, in a way that would allow us to be flexible.”

The San Antonio, Texas-based home care franchise company Caring Senior Service has more than 50 locations across nearly 20 states.

Almost a decade ago, Caring Senior Service created its own software that allowed the provider to curate more personalized service plans for its clients.

It was at that time when Salter believes he and his company made a considerable shift in philosophy.

“Around that time was when we decided to stop being what I consider order takers,” Salter said. “Instead of taking someone’s order like a server would at a restaurant, we started being actively involved in the planning for someone’s services.”

By leveraging its own technology and moving from analog assessments to a digital-first approach, Caring Senior Service and its caregivers were able to more deliberately assess.

And now, that swift progression in technology has only blossomed in recent years.

“When we launched it, we moved to a completely electronic format so that we’re sitting in front of the client with a tablet and were able to incorporate a smart algorithm in the assessment process,” Salter said. “Now we’re moving towards using AI to help us create the suggestions of what a service plan could look like for a client based upon what we’re discovering during those interviews.”

Home care providers are still tinkering with ways to incorporate AI into their operations. Providers have told HHCN they’re using AI for documentation, scheduling and marketing.

Caring Senior Service is also using it during the hiring process.

“We as an industry have created a bit of an arms race when it comes to acquiring caregivers,” Salter said. “Caring — and everyone else out there — is suddenly receiving a lot more applicants than they’re used to and it’s challenging filtering through those efficiently and effectively.”

Caring Senior Service is using AI in its chat bots to interact with applicants very early on in the hiring process as a way to better understand applicants in a speedier way.

“We’re investing in really smart chatbots that can interact with the applicants in a way that is very unique to the industry,” Salter said. “Using the AI technology, you can really have a regular, seemingly natural conversation to gain a lot more information about that applicant prior to them having to get engaged with in-depth questions.”

Salter clarified that it doesn’t use AI to filter out candidates. Instead, they are using it as a screening tool so that when real people in a human resources department take the lead, those employees are more informed on who they’re interviewing.

“That’s when we’re able to focus on those in-depth personality questions that give us a better idea if that person is a good fit for home care,” Salter said.

The post How Caring Senior Service Moved Away From Being An ‘Order Taker’ In Home Care appeared first on Home Health Care News.

At a macro level, home health organizations are struggling with Medicare Advantage (MA) for two main reasons: benefit design and reimbursement.

In order to build stronger relationships with MA plans, agencies are undergoing a strategic shift in their service offerings to meet the unique challenges posed by MA patients.

Those shifts include partnering with other stakeholders to have a clear understanding of what MA plans want.

“Right now, the benefit design of MA plans feels like it’s designed simply to minimize costs,” Michael Johnson, president of home health at BAYADA Home Health Care, told Home Health Care News. “How do we design a benefit that maximizes outcome but takes costs into effect? That’s where we’ve been at odds with each other. They’re trying to control their costs and their assumption is that we’re not interested in costs. The reality is we — home health agencies and MA plans — are interested in both.”

The differences in an MA patient

In 2021, 3 million traditional Medicare recipients received home health care at a cost of $17 billion. It’s unclear how much home health care costs for Medicare Advantage patients, although researchers with the University of Washington (UW) suggest the figure is likely less.

Medicare Advantage plans have claimed an increasing share of Medicare beneficiaries, surpassing the 50% threshold in 2023. This shift means a larger portion of beneficiaries now rely on MA plans rather than traditional Medicare.

While MA plans offer additional benefits, they frequently implement cost-cutting measures such as copays and prior authorization. Medicare pays MA plans a capitated rate per beneficiary to cover enrollee health needs, incentivizing them to coordinate care and minimize expenses, some experts believe.

Working through those cost-cutting tendencies is what Bayada and other home health agencies are grappling with.

At the same time, agencies are finding out that MA patients — generally speaking — are different from traditional Medicare patients in a lot of ways.

That recent study from UW found that home health patients under MA plans have worse functional outcomes compared to traditional Medicare patients, likely as a result of receiving fewer visits.

In the study, MA patients had shorter home health length of stay by 1.62 days and had 3% and 4% lower adjusted odds of improving in mobility and self-care, respectively.

The results of the study suggest that MA patients receive shorter and less intensive home health care versus traditional Medicare patients with similar needs.

“Similar to previous research, we found that Medicare Advantage patients receiving home health were younger and more racially and ethnically diverse than traditional Medicare patients,” Rachel Prusynski, a professor at the University of Washington School of Medicine, told HHCN. “But while they were less medically and clinically complicated, they also had fewer social resources.”

Compared to traditional Medicare patients, patients under MA plans were more likely to live alone and live in areas with more poverty, unemployment and less access to transportation, Prusynski added.

Not only were MA patients healthier across the board, the study found that MA patients were less likely to have cognitive impairment, had fewer recent falls, fewer pressure sores, less pain and were taking fewer medications.

With that in mind, it’s up to home health agencies to adapt.

“Broadly speaking, Medicare Advantage patients don’t have as much medical need as the population we typically see,” Johnson said. “The fact that there are fewer visits delivered is not a surprise. Now, we’re forced to think about how those visits are delivered.”

How to adapt

In order to address some of these differences, home health agencies need to form the right relationships.

“The first thing we’re thinking about is, how do we partner with managed care organizations to tap into the extra services they provide around care management?” Johnson said. “If they’re doing some of that work, home health providers shouldn’t feel obligated to do that same work. We could share the load, in theory. It’s easier said than done, but it’s certainly a reasonable goal.”

Using the study’s findings as a research tool, Bayada has started to consider tinkering with its clinical mix based on a patient’s specific needs.

“If you’ve got a limited number of visits, which is generally the case, and there is less clinical need, should we be using more therapy and less nursing?” Johnson said. “We’re digging into that and being more thoughtful about our care plans. We’ve got plenty of clinically complex patients in both MA and traditional Medicare to keep our nurses busy. It’s this other population that we’re trying to tap into.”

The other component is pace.

In other words, if home health agencies have a fixed number of visits set by an MA plan, how are those visits paced in a way where they’re most beneficial for the patient, while also improving outcomes and keeping costs down.

“There’s a difference between delivering eight visits in 30 days and delivering eight visits in 60 days,” Johnson said. “Time does several things. It gives the patient the opportunity to learn and really understand their care plan. I don’t care how good your wound care is, Mother Nature is only going to heal the wound so fast.”

Instead of going to a patient’s home once per week for two months, Bayada may spread those visits out to allow a more measured coaching environment between a nurse or therapist and their patient.

Taking risk

Medicare Advantage plans have historically used a lot of strategies to reduce costs of home health care, Prusynski said.

Things like prior authorization requirements, visit limits and network restrictions are a few examples. One way to avoid some of those cost-cutting strategies for home health agencies is to take on risk of their own.

“If the payer is the only one that has any risk, of course they’re going to manage the costs,” Johnson said. “Things like case rates, which we and a lot of organizations are doing, is one way to take on risk. So rather than paying me for eight individual visits, an MA plan pays me a lump sum and then basically steps away and says, ‘OK, deliver it how you would.’ This gives us the opportunity for more time with an expectation that we’re hitting specific metrics.”

At the end of the day, everyone wins if a patient is able to get better at home on a reasonable amount of visits.

“Much of our outcomes are related to the benefit design that everybody’s dealing with,” Johnson said. “My message to other home health providers, particularly larger ones, is let’s start thinking about who we can partner with to understand our data better and change our behaviors. Then we can go to MA payers and have more meaningful conversations about benefit design.”

The post Why Bayada Is Reconsidering How It Deals With Home Health Patients Under MA Plans appeared first on Home Health Care News.

“The boomers are going to evolve and dictate how we live in later years,” Jisella Dolan, an advisor and consultant with Reverence Care, said during a webinar Thursday. “Retirement is going to be different. We all remember the show ‘Golden Girls.’ That’s going to become more of the norm. Communal living is going to come back in vogue and that’s what we’re seeing.”

Reverence is a New York-based digital home-based care coordination platform. The company’s core technology does what a scheduler would do and automates that work with a particular lens on filling difficult-to-cover shifts.

The company works with a number of different types of providers, including home health agencies, post-acute facilities and health systems.

When trying to predict future opportunities for home care providers, Dolan suggested paying attention to certain trends and looking outside of the box for potential partnerships. She herself is a veteran of Home Instead.

“Independent living and assisted living, as we’ve thought about it, is changing,” Dolan said. “Communal living where people are coming together to support each other creates an amazing opportunity for us in home care to work with those organizations and to ask ourselves, ‘How can we build this community together and how can home care support that?’”

Facility-based home care may not seem like a golden opportunity for home care providers, but as Dolan laid out, it’s expected to look a lot different in the future.

“There’s a great opportunity for us to do things like have one caregiver in a community where they are supporting 30 to 50 adults in one place,” Dolan said. “All of a sudden, you’ve unlocked capacity, your caregiver gets unique, interesting work. They’re busy, they’re getting hours and you are getting that revenue and the client base. You’ve also got [built-in] scale.”

To take advantage of any sweeping changes that may come to the long-term care continuum, home care providers also need to keep technology and staffing at top of mind, Dolan said.

One way home care leaders can ensure that certain technologies pair well with their service offerings is to be involved in the tech implementation process.

“It’s amazing to me when tech is developed without home care stakeholders in the room,” Dolan said. “There are so many examples of certain tools that were meant to support home care that failed because they were not integrated in a personal way that we’re used to. The cool thing is that we’re now seeing more and more of that happening, where technology companies and venture capital are moving into the space and are saying, ‘We need to listen to home care.’”

Home care leaders have a bigger seat at the table than they might think, Dolan said. Influential changes are coming to the space and in order for those changes to be successful, home care leaders should have a say in that.

On the staffing front, the key to success today — and in the future — is making caregivers feel respected and treated like a professional.

“What it really comes down to is agency choice,” Dolan said. “Caregivers want the freedom and the ability to say, ‘These are the hours I need to work,’ and then they get those hours. Raising wages is important, and so are benefits, but what caregivers really want is income security.”

Whether it’s scheduling caregivers with AI assistance or developing a career opportunity ladder, home care leaders should be thinking about the present and the future at the same time.

Or as Dolan put it: “having one eye on the microscope and one eye on the telescope.”

The post Communal Living, Tech And Staffing: Addressing Baby Boomer Demands In Home Care appeared first on Home Health Care News.

There are benefits of a patient staying in the hospital. Chief among them is the ability to have regular attention being paid to the patient.

Home-based care enablers are targeting that precious transition period to ensure that patients don’t feel the loss of the hospital post discharge.

“Patients who are in the hospital are seen multiple times a day by a nurse, a physical therapist, a doctor,” myLaurel President and Chief Medical Officer Dr. Marcy Carty told Home Health Care News. “Then they’re discharged, get in a car and don’t see another health care provider for two weeks. That slow ramp to home has really been an effective way for us to have an impact on patients.”

The New York-based myLaurel provides acute care in the home for people who are frail, elderly or complex. To do that, it partners with payers, health systems and home health providers through value-based payment arrangements.

Its offerings include Rapid Advanced Care and Recovery at Home, two intervention programs for patients pre-hospital and post-discharge that aim to lower hospitalization visits and readmission rates for health systems and its home health provider partners.

This year, myLaurel launched Acute Care at Home, a second post-discharge initiative that aims to facilitate the transition of care from the hospital to the home.

“We partner with hospitals to either take someone who wouldn’t be otherwise admitted, take them directly home out of the emergency room and continue that acute care in the home,” Carty said. “Or we can take someone home who has stabilized so that we can transition them home and allow them to both continue what they were getting in the hospital while also making sure their services are coordinated and that their caregivers feel empowered to continue that care.”

The need for this kind of service really started to emerge post-pandemic. Overcrowding in hospitals and emergency rooms have forced companies like myLaurel to innovate and to fill a need in the marketplace.

The second component of this, Carty explained, is how the industry has shifted to value.

“A lot of hospitals are also now part of a system that takes risk for patients,” Carty said. “They’re taking value-based contracts from payers and they want to do what they can to avoid admissions and so that’s like a perfect target for us. Both use cases allow us to leverage our team in ways that we want to.”

Before her time at myLaurel, Carty worked for Blue Cross Blue Shield where she said a third of patients saw a primary care doctor within two weeks post-discharge.

That quick turnaround meant that the ramp from hospital to home included significant barriers for patients adapting to their new situation.

“What we found is being able to take someone out a couple of days early, continue that care in the home and then continue to offer touch points for two weeks is a much better patient experience,” Carty said. “It also decreases your risk of hospital acquired infections, decreases your debility and a bunch of other things that lead people onto SNF.”

It also allows the caregiver at home to learn more slowly, Carty said.

For home health providers taking on risk, myLaurel can also act as a complementary piece in the mission to drive down readmission rates.

“Many home health companies are also starting to take risk for readmissions,” Carty said. “Readmission reduction is not only about taking care of the physical ailments, right? Sometimes those symptoms worsen. Our services really are complementary. Instead of calling 9-1-1, we can be called to keep that patient at home. Home health providers, as they take risk for readmissions, we’re an incredibly important tool to keep people out of the emergency room.”

Carty also pointed to her clinical staff’s experience with chronic conditions and complex patients as an added benefit to home health agencies needing another card to play.

“Your 83-year-old with six chronic conditions comes into the ED,” Carty explained. “It’s not the ED visit that all of us are worried about from an MA plan and total cost of care perspective — it’s the admission and then the subsequent SNF costs. We’re a really good tool in the tool belt to work with home health just because of the acuity we work with and what we can bring into the home.”

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Part of that conversation with hospital and health system partners includes convincing case managers that patients will be better suited at home.

“The longer a patient lays in a hospital bed, I’m convinced that it catches on fire,” Choice Health at Home CEO David Jackson said at the Hospice News/Palliative Care News Palliative Care Conference in Tampa, Florida. “Our mission is the pursuit of excellent health care in the home. Our value prop to hospitals when promoting palliative care is, ‘We want to continue these difficult conversations in a less stressful environment.’”

The Tyler, Texas-based Choice Health at Home is a home health, hospice, rehabilitation and home care services provider that operates mainly in Texas, as well as Louisiana and Oklahoma.

Showing value to health systems and hospital partners at the top of the health care ecosystem has been a main focus for Jackson and his staff as they continue to build out the fill care-at-home continuum.

Choice Health at Home is in a position to have those conversations with referral partners and has the bandwidth to make the transition to the home more manageable.

“If you discharge out into our organization, these are the things that will happen,” Jackson explained. “We will strive to integrate a nurse practitioner group that can actually go out and have a controlled conversation for four or five hours with the family. An MSW is going to engage and continue to continue to try to provide additional resources for this complex patient. We want to be an extender and that’s a value prop that we can provide because the systems — in most cases — don’t have the resources to do that part of discharge.”

Once referral partners understand what at-home palliative care can bring to the table and what the comprehensive care plan looks like, doors open, Jackson said.

Another key value prop that palliative care offers is as a bridge in the continuum of care. It’s always patient-specific and when done correctly, meets patients where they are.

“Palliative care is not a one-size-fits-all type of service,” Kaiser Permanente Senior Director of Hospice and Palliative Care Gina Andres said. “But it does meet the needs of patients wherever they’re at in that continuum. We really focus on giving the right care at the right time in the right place.”

Kaiser is one of the largest health systems and medical groups in the country. Its health plans cover over 13 million people across eight states.

Its home-based care network is made up of about 26 agencies, including companies like LHC Group, Bayada Home Health Care and Pavilion Medical Home Care & Staffing.

Some patients will need palliative care services in a traditional setting. Others will use it strictly as a bridge to hospice, Andres said.

However, it can also be used with a more innovative approach in addressing the gaps that exist in the care continuum.

“I think there’ll always be a need for inpatient palliative care,” Andres said. “But if we touch the patient in outpatient palliative care and we’re giving them education and information and support, it prepares them as they go down the line in their serious illness and need care at home.”

It can also be a lifeline for both patients and caregivers who are going through a new and oftentimes confusing process.

“For the caregiver and the patient, palliative care is such a gift,” Andres said. “There are so many patients that are not ready for hospice, either physically or emotionally or for whatever reason. The number one thing we see with patients and families is a lack of caregiver support and a lack of knowledge. There’s nothing like palliative care for these patients because if they don’t have palliative care, they fall through the cracks. And then what happens? They wind up with unnecessary hospital stays.”

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