Who Will Lead Change in Home-Based Care?

Dorothy Gale in The Wizard of Oz said it repeatedly: “There’s no place like home.”

When most Americans are sick, they feel that sentiment more deeply. They want to be in their own bed, in familiar surroundings, and in the company of those they love. Surveys show that 70 percent say they would even prefer to die at home.

Yet the realities of serious illness often have required patients to be in a facility. Many have felt more secure about their condition in a professional environment. Then COVID-19 struck.

The pandemic magnified people’s desire to stay at home despite a serious illness and to keep seriously ill loved ones at their homes. A national survey by Transcend Strategy Group revealed that 60 percent of family healthcare decision makers are now more confident that quality care can be provided at home versus 33 percent feeling more confident in the quality of care at a facility.

This shift is shining a bright spotlight on home-based care. The preference for care at home combined with the ever-growing volume of medical needs as Baby Boomers age is forcing a reevaluation of home-based care – and amplifying the need for significant change.

Bill Dombi – Doctor of Law and President of the National Association for Home Care & Hospice (NAHC) – has said that providers of home-based care must demonstrate “a willingness to not only embrace change, but to lead it.”

A recent conversation I had with Bill explored three key areas where change is essential, sounding a cry for providers and payers to lead that change. You can hear the full discussion in our most recent podcast. Here are some highlights:

1. Change the perception and acceptance of what home-based care can do.

Bill Dombi feels that healthcare professionals and patients alike have had “blinders” on regarding home-based care. “So many looked at home healthcare as a short-term, rehabilitation-oriented, post-acute service, otherwise a custodial care service providing personal care supports,” he said. “Those of us in the field have long seen that it’s acute, post-acute, pre-acute, end-of-life, beginning of life (and more).” Indeed, home-based care has continually expanded to provide a greater range of services addressing a greater range of needs – including more complex ones. Once upon a time, infusions happened only at hospitals or clinics. Now, home infusion is a valued service. New models are being explored by CMS, including SNF-at-home and hospital-at-home. As Homer Simpson might say, “Is there anything home-based care can’t do?” Providers need to lead the charge in demonstrating the full capabilities of home healthcare at all levels and help their communities see the value.

2. Continually integrate technology for better care and greater efficiencies.

The distancing demands of COVID-19 catapulted the use and acceptance of telehealth. CMS relaxed some of its restrictions on reimbursement for remote care. And we’re only at the beginning of a new and necessary frontier. “Look at telehealth and its range of what it can do in the hands of the right professional,” Bill said. “Everything from monitoring a patient 24/7, to being there with 20/20 vision monitoring the condition of a wound, to helping someone regain their ambulation capabilities through therapy services. At the same time, the most negative part of care in the home is getting from point A to B, that transportation time when it’s not particularly productive. Telehealth helps make the time of that professional more productive.” Home healthcare providers should continually consider existing and emerging technologies that will help them care for patients more thoroughly and efficiently, supplementing their high touch skills with high tech.

3. Groom a workforce for home-based care that finds fulfillment in the challenge.

Healthcare in general, and home-based care in particular, continually faces shortages in staffing. Certain positions such as RNs and CNAs often have the most vacancies. The gap will continue to grow as the patient volume of Baby Boomers swells. To make matters worse, experts project that for at least the next 20 years, fewer people will choose healthcare as a career, multiplying the shortage. Something has to change. Bill commented, “There really needs to be a wide and coordinated effort around getting people who are growing up, high school age, to understand how valuable and how interesting and how challenging and how exciting a career in healthcare can be. One of the key factors is the misunderstanding of where healthcare in the home fits in terms of level of respect and achievement. Most people do not understand that sending a nurse into a home is one of the most professionally challenging things that a nurse can go through because she (or he) is there on their own.” Bill also made it clear that more educators, mentors and internships are needed to train the home care workforce. And better compensation is crucial to attracting more recruits to the field. Admittedly, these factors may be beyond the control of providers. But you can join Bill and NAHC in advocating for policy changes at the state and federal levels to fund initiatives like healthcare worker education, training and wages.

Change is seldom easy. Passion and persistence are required to lead change. So, we can take one more lesson from The Wizard of Oz. “Courage!” (Please read that with the voice of the Cowardly Lion in your head.) Providers, we encourage you to be bold. Lead the change. Be the change.

Want expert help in educating your community on the full value of home-based healthcare? Drop me a line at stan@transcend-strategy.com.