Mark Heaney: Why Home Care Providers Need to Shake ‘Non-Skilled’ Label 

By Mark Heaney for Home Health Care News

Names are important. That’s why it’s time to scrap the “non-skilled” label in home care.

With very good reason, the industry has reacted with great excitement to the early 2018 news that the Centers for Medicare & Medicaid Services (CMS) is permitting Medicare Advantage (MA) plans to add home and community services to their offerings. This step is one more that further confirms the tremendous value consumers, families, payers and citizens realize when those at risk receive care attending to their activities of daily living (ADLs).


Unfortunately, in making this important announcement — and most certainly without any pejorative intent — CMS referred to the newly permitted level of care as “non-skilled.” Their Feb. 2, 2018 press release reads: “CMS is redefining health-related supplemental benefits to include services that increase health and improve quality of life, including coverage of non-skilled in-home supports … ”


I know that CMS used the term without any thinking that this work is actually “non-skilled.” In fact, I had reason to speak with senior CMS staff involved in this key decision just after the announcement. They regretted using the term and promised to try to unring the bell in future announcements. In working on this piece for Home Health Care News, I did a little research and, indeed, found examples indicating that CMS has curtailed its use of this term. That is appreciated.


But the bell had been rung.

Since the CMS announcement, numerous (but not all) publications, associations and companies have repeated the “non-skilled” term in their reporting, statements or advertising. Their intentions, of course, were innocent and not to demean or insult the industry. Worse, in some cases, the term “unskilled” is used.

Double ouch!

Names, labels and titles are important. In our own work, we are careful when selecting job titles for all positions in our organizations. We care about our own job title. We are thoughtful in how we describe the work we and others do in furtherance of our organization’s goals. Beyond just the label, everyone I know in home care recognizes the significant contribution personal care staff have made in making it possible for those at-risk to now reasonably expect to live at home as long as they want to.

Need proof? Here is the most beautiful graph in all of home care.

I have been fortunate and blessed to have spent my entire career involved in the delivery of home- and community-based care — especially Medicaid personal care services. From this vantage point, I have seen first hand what a home care aide does and has to do to make it possible for the infirm to live safely and healthfully at home. So have almost all of those reading this article.

We can all agree: Their work is of critical importance and that there isn’t anything “non-skilled” about it.

What are “skills” anyway? Am I “skilled” because I can read and send email? Go to meetings? Talk on the phone? Oversee others doing skilled work? Have accumulated home care knowledge? Contribute to strategy? Actually, I think I am. Likewise then, don’t we agree that qualities like reliability, compassion, patience, fortitude, applied common sense, attentiveness and trustworthiness are skills?

Don’t we all agree that significant skill is needed to work effectively without regular supervision, consistently observe and report, create and sustain a safe and healthful living environment, coordinate and take direction, provide intimate personal services with dignity and respect, safely ambulate frail persons, and to do this and more, consistently and dependably in frequently difficult and dynamic work environments?

No one I know in the industry thinks those that can do that — and much more — are “non-skilled.” As an industry, let us continue to celebrate that the work of these team members is increasingly being acknowledged at the policy and payer level.

In so doing, let us settle on and reinforce a uniform title for this critical role that is both descriptive of the work they do and honoring of their contribution. If not for that good reason alone, at a pure policy level, I think it’s much more to our advantage as an industry to advocate for expanding the personal care benefit than for asking legislatures and payers to fund “non-skilled” care … whatever that means.

Following the CMS announcement, I spoke with leadership at the National Association for Home Care & Hospice, the Council for State Home Care Associations, the Home Care Association of America and the Partnership for Medicaid Home-Based Care. While each use slightly different names for the service and titles for the care providers, all agree that the use of the term “non-skilled” should never be used.

So many more appropriate titles can be adopted to identify the service type (e.g. personal care, home and community services, continuous care and others) and as a title for the care team member (e.g. home care aide, personal care assistant, personal care aide).

For so many obvious reasons, the time has come. Let us continue this celebration with our industry leadership coming together to advocate — and insist — that henceforth, we will not use the term “non-skilled” or “unskilled” to describe this important mode of care, nor its care providers.

Not only does it not serve our ends … it isn’t accurate.

Names are important.

About the author

Mark Heaney has been involved in the delivery of home care for more than 35 years. Mark was with Addus HomeCare Corporation (Nasdaq: ADUS) for 31 years serving as its CEO until 2016. Throughout his career, Mark has been very active in state and federal Medicaid policy, especially as related to home- and community-based care. Mark has served on numerous industry association boards including NAHC, the Home Care Aide Association of America and as a founding member of the precursor to the Partnership for Medicaid Home-Based Care. Mark has recently joined Post Capital Partners as an executive partner to pursue investments in home care and adult day care.

Companies featured in this article:

, , ,