YOUNGSTOWN, Ohio – Home health care services have skyrocketed in popularity in recent years. Revenues hit $102.7 billion in 2020, according to the U.S. Census Bureau, up 50.5% from $68.3 billion in 2013.
With increasing numbers of patients from different backgrounds come multiple types of care and new issues. Worker shortages, changing medical coverage and rising demand all have changed the home health care industry.
Not all home care is directly health related. In the geriatric segment, long-term companion-based home care is an option for which demand is rising.
Ryan Gillis, client manager for Visiting Angels in Salem, handles home care for a region that includes Columbiana, Mahoning and the eastern part of Stark counties.
In 2013, Gillis took a part-time caregiver job at Visiting Angels to augment his full-time job. When availability opened up in 2018, Gillis took a full-time job in the office.
“One client that I know has been with us for almost 10 years,” says Gillis. “He is someone that I started with when he started with us. That was soon after I started working here.”
The patients Gillis sees are mostly older adults, many dealing with physical problems such as Parkinson’s disease or severe arthritis; others deal with memory issues, dementia or Alzheimer’s.
In his time at Visiting Angels, Gillis estimates he has served about 20 patients, ranging from a couple of visits when he was filling in for someone, to 300 or 400 visits per patient.
“Many times, we’re contacted by the person that receives care. But more often we are contacted by family members who are looking for care for their family member just because they can’t be there with them or they need a little bit of help to supplement what they’re already doing,” says Gillis.
Gillis says oftentimes a husband or wife is the primary caregiver for their spouse and the service is used to give them a hand when they cannot be
“[Clients] would prefer to stay in their home,” says Gillis. “Some of them insist that they are going to stay in their home. They really appreciate that we are there to help them do that.”
According to the U.S. Census Bureau, the population has been growing continuously older for the past two decades.
In 2017, the bureau projected – for the first time in U.S. history – that older adults would outnumber children by 2023.
“You have the baby boomer generation that is growing older and younger generations who are not having as many children,” says Gillis. “The number of adults 65 and older is going to be higher than the number of children 18 and younger.”
Gillis says as people grow older, they have more limitations and a greater need for help. That’s why the biggest issue in the home care industry is staffing, he says.
“That was actually predicted to be a challenge in 2018-2019,” says Gillis. “They were talking about how there was going to be more of a demand for people who provide the kind of care that we provide. As far as the people we hire – STNAs, home help aides – there was going to be more of a demand for that. But then the pandemic hit and you have people dropping out of the workforce for a variety of different reasons.”
While different agencies accept reimbursement in various ways, Visiting Angels is primarily private pay. Some long-term care insurance policies cover the cost of the service. But other than that, it’s out of pocket.
Jaime Gillen, corporate director of marketing, sales and communication at Shepherd of the Valley, says there are many factors that may lead a person to choose home health care.
“It could be an individual who is doing pretty well at home. But maybe a loved one is noticing their mom or dad is in need of a little bit of assistance taking their medication or they need help going to a doctor’s appointment and their family [members] have a work schedule where they are unable to do so,” she says. “That’s where home health care comes in.”
Shepherd of the Valley serves patients and clients in Mahoning, Trumbull and southern Columbiana counties. Patients often need nursing
services or a variety of therapy services, such as physical therapy, occupational therapy or speech therapy.
Gillen says a lot of times home health care is also used for more short-term situations, such as being discharged from the hospital too early while the patient still needs extra care.
“I think for the families, too, it brings a peace of mind,” she says. “A lot of times family members become the caregivers for their elderly loved ones and sometimes that’s not always possible.”
Home health care services may be covered by insurance for a certain period of time. When that time frame ends, private pay kicks in.
“There’s a silent generation where our current population aligns in Shepherd of the Valley,” says Gillen. “They are more inclined to live in a retirement care, where as the boomer population, which is now in that age-70 ballpark, they are more apt to use home health than they are to use skilled nursing no matter what their surgery is.”
Home health care “is the future,” says Liz Jornigan, director of home health care at Shepherd of the Valley. “Insurance companies dictate so much. Patients want to go home, and I think insurance companies are pushing patients to go home. I really feel that home health is the future.
“A lot of patients do so much better being in their own home,” she says.
Shepherd of the Valley employs home health aides, state tested nurse aides and medical social workers. Patient referrals may come from facilities, hospitals or physicians
“When those patients are coming home from facilities, they may have quite a bit of comorbidity,” says Jornigan. “Nursing is out to provide skilled services, medication compliance, cardiopulmonary assessments, wound care, catheter care – those types of services.”
The typical age range of patients seen is between 50 and 100 years old, says Jornigan, and care periods are generally four to six weeks.
“They want to be home,” she says. “They want to be independent. So we work hard to get them to be as independent as they can.”
Jornigan says the biggest challenge she has noticed resulted from the COVID-19 pandemic.
“It’s still there,” she says. “COVID is not going away by any means. [Adequate supplies of ]the appropriate protective equipment has eased that concern somewhat.”
Additionally, Jornigan says there is a continuing need for nurses, as staffing shortages are affecting almost every home health care provider.
Amy Stockton, administrator for Windsor Home Health, says more challenges will emerge as the number of home health care patients continues to rise.
“With baby boomers getting up in age, as well as a lot of people who don’t want care to be in a skilled nursing home or an assisted living environment,” the need for home care will grow, she says. “They want to stay at home as long as possible. So when you bring home health into that situation, our goal is to get them safely into that home so that they can stay there longer.”
Patients receive differing lengths of care depending on their situation, ranging from a few weeks to longer periods of time if additional wounds should appear. This prevents the patient from having to return to the hospital.
“I think the biggest issue with home health care is the guidelines are always changing, with Medicare and those Advantage plans. So it is making it harder to get home care,” says Stockton. “We’re trying to service them the best we can and give them the most efficient home health care that we can. Some of those guidelines tie it tight and make it a little more difficult.”
As far as the patient population, Stockton says she really hasn’t seen any other issues.
“Everyone is dealing with staffing, unfortunately, because of COVID. But we are blessed to have an awesome team here,” she says. “We have therapists that have been with us for quite some time. We have quite a few nurses, as well.”
Since such a variety of patients are now receiving home health care, Stockton says there is staff from all different backgrounds including, registered nurses, licensed practical nurses who start as aides, therapists, physical therapists, certified occupational therapists, speech therapists, and social workers.
“We have it all,” says Stockton. “It’s not just therapy – it is so much more than just that.”
“When you are in the hospital as a nurse, you specialize in one unit and all you see is the same thing everyday,” she continues.
“In home health when you’re a nurse, you are seeing diabetics, you got wounds, you’ve got ostomies, you got tube feedings – you’re getting every unit of a hospital when you are doing home health. It is such a broad array. You are keeping all of those skills you learned in nursing school with home health.”
While many challenges continue to face the home health care industry, and new ones lie ahead, Stockton says it still provides a very rewarding career.
“I just love the geriatric population in general,” Stockton says.
“They are history books that have never been written and a lot of people kind of ignore them – especially our younger generations. They just don’t appreciate what their older generations have gone through. So when I do have the availability to go to their homes and talk to them,” she says, “I put myself in their shoes. In, say, 40 years from now, I would want some one treating me like I am treating them currently.”