COVID-19 and Home Health Care
Nursing homes have received the bulk of attention in 2020, but not as much attention has been paid to Home Health Care. In the United States, approximately 12 million older adults receive health care at home. In 2016, the CDC estimated the number of home health care agencies in the country to be over 12,000.
COVID-19 has created new challenges for those older adults, their families, their home health care workers, and the agencies that provide their health care.
The concept of home health care was designed decades ago for the purposes of recovering from acute illness at home and assumed that the patient's medical issues would resolve without the added disruption and expense of hospitalization. It was not designed to enable strategies for wellness and ongoing care and its pay structure does not include comfort or palliative care upon the end of life, although those things have come under its umbrella.
Increase in-home care
Older adults who have survived COVID-19 are being discharged from the hospital and finding themselves reluctant to receive care at a nursing home. They view homecare as a safer choice. However, the increasing financial pressure on these home health care agencies restricts their ability to provide adequate care for older adults recovering from COVID-19 at home. In addition, home care for COVID-19 patients further stretches the resources for older adults already receiving care unrelated to the virus at home.
In addition to test kits and personal protective equipment (PPE) shortages, the number of staff is also running low. In fact, there were staff shortages before the pandemic and that problem is only going to grow as COVID-19 changes the landscape for patients and care providers. In several markets, hospitals where the pay is typically better are hiring away home care staff. Another contributing factor to the shortage is that many home health care agencies report increasing levels of absenteeism among their care providers. Some have contracted the virus, some are home caring for children, while others stay away for fear that they will contract the disease. Adding to the problem is the fact that home healthcare providers are at increased risk for contracting the virus since many also work in nursing home facilities.
The number of patients receiving home care continues to increase. Discharged patients contribute to the number of older adults requiring home care; older adults who had been considering a nursing home or an assisted living facility are also now thinking twice and choosing home health care as the safer option.
The Path Forward
Home Health care agencies are entitled to a portion of $30 billion in funding Medicare announced it would provide to healthcare providers. However, the agency must accept Medicare in order to qualify and the funding must be used for expenses related to COVID-19. At the same time, these agencies must also continue to provide older adults with transitions from hospital to home.
Home health care has been viewed as a relatively small player in the overall health care reform effort. Whether that will change as a result of COVID-19 remains to be seen.