With the massive age wave set to hit the United States, in-home care receives a lot of attention as a way to meet seniors’ needs. However, there are many other populations being served by home health and private duty companies, and in some cases a significant portion of revenue for these enterprises comes from serving younger people.
Bayada Home Health Care and BrightSpring Health Services — formerly known as ResCare — are two examples. These companies are already serving patients of all ages, including children, and are dedicating resources toward expanding these care lines and showcasing their value.
“On some level there is more attention being drawn to [these services],” Rexanne Domico, president of the ResCare HomeCare and Neurosolutions division within BrightSpring, told Home Health Care News. “I think some of the payers have opened up, some of the state Medicaid programs have opened up. I think where funding is starting to become available, people are starting to realize the importance of these services and allowing us to make a difference for these children and also for these families.”
Pediatric home health care provides one example. Personal health care spending for those under 18 years of age in home health care was $7.6 million in 2012, according to the most recent publicly available health expenditures data from the Centers for Medicare and Medicaid Services (CMS). Nearly all of that home health care spending is from Medicaid for that age group.
The total spending for this group across services including hospital care, prescription drugs, nursing care facilities and dental services was about $267.8 million.
The market is far bigger than the health spending data suggests, though — families provide 1.5 billion hours of care to their young loved ones a year. If replaced with professional services ,that would total $35.7 billion in 2015 dollars, according to the University of Southern California, Boston Children’s Hospital and Rand Corp. These organizations examined 2009 and 2010 data from the National Survey of Children with Special Health Care Needs, which involved interviews with 40,242 parents and guardians.
“Honestly, our biggest problem is we need more nurses, there is plenty of business,” Melinda Phillips, pediatrics practice leader at Bayada, told HHCN. “There’s a huge opportunity, more and more opportunity every year.”
Pediatric care is only one facet of non-senior services. Other care areas include behavioral health, adult nursing and rehabilitation.
Growing up at Bayada
About one-third of Bayada’s business is made up of non-senior services that include behavioral health, pediatrics, habilitation and adult nursing. Moorestown, New Jersey-based Bayada employs 25,000 professionals across 22 states and in certain international locations, making it one of the largest home health companies in the United States.
“As technology improves, so does the ability for doctors to help children, [who] years ago would have never come out of the hospital,” Phillips said. “So, I think that as long as technology continues to improve, for adult nursing and pediatrics, you’re going to see more and more demand for the services.”
Bayada has seen double-digit growth in these areas of care year-over-year, according to Phillips.
Bayada has 13,000 non-senior clients and 15,189 field employees, currently, that serve those patients across its operations, according to the company. The year to date revenue of its non-senior services is $13.9 million, as of Aug. 19, which is 54.3% of its overall revenue.
Habilitation, for example, is a program that helps clients of all ages with intellectual and/or developmental disabilities to learn or maintain a new skill set, to allow the individual to live as independently as possible.
“We don’t specifically serve by age, as some of the other practices do at Bayada,” Donna Heatherly, practice president for Bayada’s Habilitation Specialty Practice, told HHCN. “It is more about the particular diagnosis that they are receiving.”
The skills these individuals learn can vary—it could be anything from learning how to use an ATM to simply how to pick up a toothbrush to brush their own teeth, Heatherly said.
The home health care trend is expanding and these non-senior services are a part of it.
“[In the past] it was institutions, smaller congregate settings or group homes — so from my standpoint the way I see the potential is that every person is going to be offered the ability to live with their family in that type of setting or on their own,” Heatherly said. “There is a clear, definite movement towards the most independence for that individual. There is [also] clear thinking that is being supported by the dollars from Medicaid that is saying, we want people to work and live in the community they choose.”
All of the habilitation services are funded through Medicaid.
“We have the ability to support all aspects of life, and thinking about home health care and where it is headed, we’re on that cutting edge of what that is going to look like,”Heatherly said.
Focusing on all ages at BrightSpring
BrightSpring has a similar outlook on expanding services to non-senior patients.
“I think [these services] will gain traction and continue to grow,” Domico said. “We see more of our state Medicaid plans starting to acknowledge the need for these services, as it is a lot less expensive than hospitalizations with this population.”
Louisville, Kentucky-based BrightSpring Health Services is the parent company of the ResCare family of brands that includes home care, Rehab Without Walls, community living and workforce services. BrightSpring serves 60,000 people daily in more than 40 states. The family of brands employs over 45,000 people.
Rehab Without Walls Neurosolutions is high-intensity neuro therapy services to children from infancy to young adulthood. The service is offered in an outpatient clinic and in-home.
“This is an area of growth,” Domico said. “What we see more and more as people are starting their families and more people in the home are working today, if there are children with special needs, then there is a greater need for these types of services. It is something we are focused on and keenly interested in as we see a real ability to make a difference in families lives that are dealing with some of these issues, as well.”
About 10% of BrightSpring’s revenue comes from their non-senior divisions and it makes up about 8% of the patient population, according to the company.
“People want their young adults and children to be treated like everybody else and the earlier we can intervene and provide these types of services, I think the better experience they have in the school setting, home setting, clinical setting,” Domico said. “It’s really becoming a part of that family. When we can be in the home it can allow a mom to work and a dad to work.”
Business mind
There are also staffing benefits that can be achieved by focusing on pediatric and other types of in-home care. For instance, it gives nurses more options for moving among divisions at Bayada as they gain new skills or desire new challenges. And offices within the Bayada system can call each other up to tap into their various areas of expertise, Heatherly said.
As families become more aware of the services and the Medicaid funding available to them, the need for professionals that can do this specific work will increase too.
“We are trying to do a better job of marketing the services and getting our name out there as a pediatric provider,” Phillips said. “So, we can educate everyone on the opportunities for not only the clients to receive the care with us but also the nurses to have a career with us.”
In the near future, high-tech nurses that are interested in this type of care will be in even higher demand, but experts report labor shortages are similar in these areas as they are in all parts of the home health industry.
“With the growing demand, we also [need] a pipeline of future leaders,” Phillips said. “I’m anxious to pick up our recruiting even more and meet this demand so we can also create a pipeline and be prepared for the future.”
While there is a lack of information about in-home care for non-senior patients, this is just part of a broader lack of knowledge of home care in general, Phillips said.
“I would like to see more home care rotations in nursing schools and even showing the different types of home care that you can work in,” Phillips said. “Very few offer private duty [or] pediatrics. We’ve been trying to get out to nursing schools and discuss this.”
Written by Kaitlyn Mattson
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