Should Nonclinical Home Care Be Serving a Bigger Role?

 In Expanding Services, Partnering for Growth, Podcasts, Preparing for the Future

For decades, people with a serious illness or rehab needs have preferred to stay at home if it’s medically possible. And when most people think of “home care” or “home health,” they think of clinical support in the home. 

Yet, as Baby Boomers age, a need for nonclinical services that can help seniors stay in their homes with greater independence continues to skyrocket.  

According to Jeff Salter, founder and CEO of Caring Senior Service, a lot of education is needed to help the general public know a different kind of support is available – and help the healthcare system advocate for nonclinical support. 

“Ever since I started our company in 1991, Ive been really challenged with defining what home care is and helping people understand that theres this whole different segment that is the non-skilled services or the custodial activities of daily living,” Jeff said. “Things we all take for granted that we just do day in and day out  simple meal preparation can become a challenge, keeping yourself clean, getting a shower, brushing your teeth even can become difficult as you age. And those are all home care things that a caregiver would help provide for an individual who requires that type of assistance.” 

In my conversation with Jeff, he also pointed out three areas where change is necessary to increase the role of nonclinical home care – and what this valuable service can offer in return. 


1. Providing nonclinical care that’s supported by insurance and/or tax breaks. 

Right now, CMS and private insurance payers offer little or no reimbursement for custodial care. It’s mostly covered by private pay, and many families may not be able (or feel they’re not able) to shoulder such an investment. Yet the relatively low rates of custodial care (compared to clinical care) can keep seniors out of the ER and hospital, saving the healthcare system and payers substantial dollars.  

“We need to all be advocating for anything that helps seniors,” Jeff said. “We’re seeing some changes happen with some of the managed care organizations looking at opportunities for payment, but those are still small drops in the bucket. Also, there currently doesnt exist any type of claim if, for example, if my mother is a dependent and Im paying for her care, I cant write that off as a tax deduction. Theres no benefit to me from a tax perspective, which I think is terrible. 

2. Partnering with clinical providers for more comprehensive home care. 

Providers of clinical care serve their roles well, but gaps exist in the cadence of care, as well as many families’ expectations. In working with dozens of hospice providers across the nation, I’ve learned that families can be disappointed when their loved one signs on for hospice care, then they discover those services don’t typically include a nurse or aide being at the loved one’s home around-the-clock. So, a big opportunity exists for providers of clinical care to partner with providers of nonclinical care to meet a wider range of patient needs and family desires. 

“It really starts with a good conversation, understanding what that other company, as in hospice’s case, what their mission is, what theyre trying to accomplish,” Jeff said. And while the concept of hospice is commonevery hospice has its own flavor, trying to accomplish different goals. When their clients have questions, we can help fill those gaps, helping them understand the hospice services stop at this point and the client would need to bring in additional assistance. And then having a ready answer for them, having someone they could refer to that they can trust. 

3. Creating a new opportunity for employment as other job sectors change. 

One of the greatest challenges for the entire healthcare system – especially for care provided in the home – is attracting and retaining a trained workforce. One study projected that by 2020 there would be a national shortage of 155,000 paid direct care workers. By 2040, that shortfall could swell to 355,000. However, the skill set for nonclinical care workers is less demanding than clinical care providers. At the same time, jobs in huge industries such as food service and retail are shrinking because of technology. Jeff feels this situation creates a dynamic for major career changes and opportunities – particularly if resources like the government will help. 

“Let’s actually fund the programs that help young individuals who are looking for a career path, maybe in senior care,” Jeff commented. “Someone can go to trade school to become a plumber, electrician or AC repair person, but theres no real good funding for trade schools for healthcare in general. And our type of service is a great career ladder move for someone. If we have the right positioning with the right training, that person can easily go from being a food service person, to learning some skills about caregiving, and then be able to help us with that massive worker shortage in the future. 

Jeff had much more to say about home care, including insights on how technology can support innovations in the near future. 

Has this topic caused you to think differently about nonclinical home care? Are you wondering how to partner with other providers in the healthcare continuum for better patient care and mutual business advancement? Want some help in thinking through these opportunities and how to pursue them? Email me at 


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