HCAOA Director Sets Sights on Caregiver Crisis, Medicare Advantage

With the caregiver shortage at an all-time high and Medicare Advantage (MA) opportunities expanding like never before, the Home Care Association of America (HCAOA) has been busy.

Currently, the trade association — which represents the home care industry in state and federal advocacy efforts — is busy with policy initiatives to bring more workers to the sector and further legitimize home care’s place as a vital asset in health care.

Executive Director Phil Bongiorno is heavily involved in that. Bongiorno is tasked with helping almost 3,000 home care providers across the U.S. advocate for their interests and navigate regulatory hurdles.


Home Health Care News recently caught up with Bongiorno, who says Medicare Advantage’s expanded supplemental in-home benefits are just the first win of many to come for providers in the space.

Below are highlights from that conversation, edited for length and clarity.

HHCN: Let’s start with something big picture: What is HCAOA currently doing to support home care providers as they navigate top industry challenges? And there are a lot. For example, I know you’re backing the Credit for Caring Act, which would create a federal, nonrefundable tax credit of up to $3,000 for family caregivers.

Bongiorno: We just completed a strategic planning process, and we’re working on implementing that to reinforce both our advocacy and leadership for the industry.


We’ve established a chapter network where we have supported our members at the state level on certain policy issues. You mentioned — at the federal level — the Credit for Caring bill, something we are supporting to help families take advantage of a tax credit in order to pay for home care services.

In addition, there’s also a bill that would expand the scope of the health savings accounts. It would allow for home care services to be covered under health care savings.

The health care savings account allows for a rollover every year, as opposed to the flex spending program. We see this as an opportunity to help families afford and pay for home care services.

The other area we’re following, of course, is the Medicare Advantage opportunity.

We are educating our members about that opportunity. We are also working with the Medicare Advantage industry trade group to educate them about the types of home care services we provide and the benefit they can bring to their beneficiaries that are covered under their plans.

In 2018, caregiver turnover hit 82%, up from about 67% in 2017. Does that figure surprise you?

That trend has been there.

It’s something that not only impacts our particular industry but service industries in general. We now have full employment to a greater degree because the economy, and I think we’re trying to be attractive to workers as best we can.

One of the things we focus on is the fact that we do employ our caregivers. Our members are distinguished in that way as opposed to [placing caregivers] as independent contractors.

Our members are looking at different ways that they can attract and retain caregivers, so our efforts as an association have been to provide those resources to our members to help them address this.

It’s obvious we want to continue to keep care cost-effective for families [and] at the same time be able to attract caregivers to our industry.

That’s been an ongoing challenge, but I think there are opportunities we’re looking at to expand the number of caregivers.

With this current administration, we may not have a great opportunity to look at immigration reform, but there have been some discussions at the federal level to look at … how [immigration reform] could address some of our workforce shortage needs.

Your organization is working with Congress to support meaningful employment-based visa reform, which could help add more caregivers to the workforce. I think that’s a topic we don’t often cover, though a large portion of home care workers are, of course, foreign-born. Why is visa reform important?

We are looking at expanding the pipeline for our industry. It’s like other service industry where these opportunities can be opened to individuals that are seeking legalized citizenship.

We were supporting something a few years ago when there was a legitimate immigration reform package being considered on Capitol Hill.

Let’s talk about industry trends that don’t necessarily include challenges. What opportunities or just shifts in home care business operations are you noticing? For instance, we’ve covered Medicare Advantage frequently, as well as how home care agencies are starting to become more specialized in focus.

The opportunity to utilize technology in the home and to really look at ways that we can better utilize technology to help augment the services that our members provide — that’s one area that we’ll be looking at in particular.

Another one is educating the public on the differences in the models.

We have a safe home care initiative to really emphasize the need for W-2 employment, that’s one of our standards. Oftentimes companies are independently contracting caregivers in order to work around the existing Federal Labor Standards Act requirements.

That’s a problem, and quite frankly we see oversight, employment and supervision as a standard in home care. You really can’t have your cake and eat it too. You are either an employer and you’re supervising and overseeing care or you’re not.

Oftentimes placement agencies do not want to have the label of employer [because] they would be required to follow those employment requirements and be subject to the same requirements as other W-2 employers.

You mentioned technology as an opportunity. What types of technology, specifically?

Anything that is being developed for the home in a universal way. Companies that are looking at monitoring devices –wearables where you can monitor a loved one or that would allow professional caregivers to monitor their clients.

For example, if someone is experiencing dementia –and they tend to wander and not realize where they are — there is technology that can identify their location. It would give alerts if they go beyond a certain point that’s designated within the home.

That’s the kind of technology we’re talking about: monitoring devices, fall detection, remote patient monitoring.

There is some great technology being developed by different companies that we are looking at to see how we can harness them best to support delivering home care services.

This year we didn’t see a ton of Medicare Advantage action when it comes to taking advantage of in-home services and supports. What do you think 2020 is going to bring on that front?

We will likely see a larger amount of plans taking advantage of this coverage policy, from what we understand.

We are among a number of different health-related, non-health services covered under Medicare Advantage.

We see that some of the MA plans may be taking advantage of that to really utilize that policy development within CMS, along with home care services. There are meals delivery and home modification opportunities.

All of this potentially could be covered by this new policy change within CMS for the MA plans.

What other future plans do you have for HCAOA?

Our primary role is to show home care provides value to seniors, their families and employers.

In order to continue to be competitive, corporations really need to look at how they’re supporting their employees when it comes to home care services.

Showing value to the health care system is the other thing I wanted to emphasize.

Just as the health care system is looking at value-based care, we at HCAOA are looking at ways that we can show our value and how we contribute to better health outcomes.

The policies that the Medicare Advantage program is moving forward on are leading to that effort.

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