The Big New Sheriffs in Town: 2019 in Home Care Leaders’ Own Words

While the home care industry wasn’t encumbered by a major regulatory overhaul, such as the Patient-Driven Groupings Model (PDGM), several themes and key topics emerged in a way that defined 2019.

Federal policymakers expanding home care coverage under Medicare Advantage (MA), for example, made waves throughout the year. Additionally, the ongoing caregiver shortage remained top of mind for most providers.

The biggest takeaway from 2019, though, was the recognition of home care throughout the broader health care continuum. Home care is no longer viewed as an afterthought — it’s a pivotal piece of the puzzle.

Before the year officially comes to a close, Home Health Care News wanted to take a look back at the most interesting, controversial and captivating quotes that were featured in the past 11 months.

These quotes from CEOs and industry experts shine a light on some of the biggest industry trends and challenges that shaped the year. You can look back on home health care in the industry’s own words here.

“We can all agree: Their work is of critical importance and that there isn’t anything ‘non-skilled’ about it.” — Mark Heaney, CEO of Magnet Health (Jan. 22, 2019)

If 2018 was a “coming of age” year for the home care industry — then 2019 was about further cementing the industry’s place within the continuum of care. It’s these efforts that made an industry veteran push back against “unskilled,” the common term used to describe non-medical personal care workers and the industry at large.

It all began when the Centers for Medicare & Medicaid Services (CMS) announced that it would allow MA plans to add “non-skilled” personal care services to their offerings in 2018.

In a guest column for HHCN, Heaney articulates the limits of the term “non-skilled” and argues that it is finally time to scrap it. Heaney isn’t alone in this general line of thought; throughout the year, HHCN talked to industry insiders who stressed the importance of professionalizing the caregiving job.

“I’d like to tell you we have a secret sauce, but we don’t. We have some really strong fundamentals that we just don’t get away from.” — BrightStar Care agency owner Gary Ratkiewicz (Feb. 18, 2019)

One of HHCN’s goals in 2019 was to get closer to home care agency owners and operators on a local level. Here, a Chicago-area BrightStar Care owner delved into his secrets to success, especially when it comes to recruitment and retention. How did owner Gary Ratkiewicz keep his talented team? The answer wasn’t technology or extravagant perks — it was mainly through respect and recognition. That takeaway will remain a poignant point for all home care owners in 2020.

“In terms of innovation in home care and aging in place, significant money and energy has flowed to technology startups. Traditional business models need to be changed to meet changing customer needs. For example, changing the pricing model to go from an hourly cost to a monthly subscription may not be as sexy as the newest gadget, but it could have more meaningful benefits for our industry and the clients we serve.” — Arosa+LivHome CEO Ari Medoff (March 12, 2019)

In March, HHCN took a deep dive inside CarePods, an innovative new model that sought to meld the best parts of home care and the Continuing Care Retirement Community (CCRC) concept. Moving forward, it will be this type of cost-lowering innovation that will distinguish successful home-based care operators.

“Health plans were asking CMS for clarification. Are we ok trying to do this? Can we do that?’ What CMS is basically saying now is, ‘We know you’re experimenting. We know you’re learning. We want you to invest here and see what happens.’” — Sherwin Sheik, CEO of CareLinx (April 7, 2019)

MA continued to be the talk of the home care industry in 2019. CMS originally announced that some non-medical home-based care services would be allowed as a supplemental benefit under the MA program in 2018. In April, CMS widened the scope to mean benefits that “have a reasonable expectation of improving or maintaining health or overall function.”

In the midst of this, health plans called for more clarity from CMS. This didn’t stop companies like CareLinx — a Burlingame, California-based nationwide network of more than 300,000 tech-enabled caregivers — from hopping on the MA-opportunities train.

“Home care agencies are going to be the big new sheriff in town. If you’ve got expertise in keeping people out of the hospital, you are going to find a very bright and rosy future ahead of you.” — Bill Thomas, senior care thought leader (May 19, 2019)

There’s a new sheriff in town — an old idiom that has come to mean the arrival of a new authority. The line perfectly captures the fact that home care climbed to new importance in 2019.

Senior care expert Bill Thomas — one of the masterminds behind the Green House model of smaller senior living properties and the founder of global nonprofit The Eden Alternative — described what he sees as a larger movement away from hospitals being the main source of care.

“We’re starting to get recognition. The health care system is saying, ‘As home care, you’re really a part of us. You’re the tip of the spear. You’re in the home.’” — Peter Ross, co-founder and CEO of Senior Helpers (June 19, 2019)

Bill Thomas isn’t alone in his thinking. The idea that home care is finally gaining more recognition within the larger health care continuum for its ability to improve outcomes was one HHCN saw echoed throughout the year.

Ross, co-founder and CEO of Baltimore-based home care franchiser Senior Helpers, sums it up colorfully when he compares the industry to a sharp tool that has the ability to enact change when wielded correctly.

“We would like to expand our business. At the same time, what can you do to build effective partnerships? You contract and you build them as part of a network and drive mutually beneficial business through the network. That’s what we are doing here.” — Paul Kusserow, president and CEO of Amedisys Inc. (July 25, 2019)

One of the major deals to come out of 2019 was the Amedisys Inc. (Nasdaq: AMED) and ClearCare Inc. partnership. The home health, hospice and personal care giant entered an agreement to establish partnerships between its home health centers and non-Amedisys personal care agencies, using ClearCare to coordinate the care of patients. The deal positioned Amedisys for possible MA opportunities.

It’s very likely that innovative partnerships such as this one will become more common as we enter 2020.

“Frankly, I would argue that the worker shortage is a myth and an excuse. Are there pockets where there is a shortage of specialties? Of course. But overall, there are enough persons to cover the need. What we do have is an environment of providing too much care and of protecting our silos.” — Anonymous home care veteran (Aug. 19, 2019)

It wouldn’t be an understatement to say that the caregiver workforce shortage dominated the larger conversation among home care providers.

An ongoing challenge was elevated to crisis level when Home Care Pulse, an industry market research and education firm, reported that the issue had reached an all-time high. In 2018, the median caregiver turnover rate jumped to 82%.

That said, one home care veteran was quick to question the pervasive narrative surrounding the industry-wide problem during HHCN’s “confessions” interview series. Our interview subject believes the workforce shortage is largely self-inflicted. In terms of solutions, the industry vet thinks that providers need to embrace technology and make the job more appealing to caregivers.

“I’m a big believer in iterative innovation versus disruptive innovation, especially in this space. I think there are ways we can provide small iterations to how the industry operates. Right now, we’re not saying, ‘Let’s throw the baby out with the bathwater and start over from scratch.’ I think that was the biggest issue with the technology entrants we were seeing five years ago.” — Kiel Dowlin, president of Family Directed (Sept. 16, 2019)

For several years, successful and unsuccessful in-home care startup companies alike have promised to completely change the world of caregiving. But many of those companies are no longer around. As new venture capital-backed players continue to enter the in-home care space, it’ll be important to remember not to throw a proven formula into the garbage entirely, according to Family Directed President Kiel Dowlin.

“Go into it with realistic expectations. It’s going to take quite a while to educate the plans themselves about the value of home care overall. It’s not going to be an instant home run.” — Jeff Bevis, CEO of FirstLight HomeCare (Oct. 14, 2019)

Many industry experts took CMS expanding home care under MA as a major acknowledgment of the value of these services. Still, industry heavy-hitters like Bevis warned that MA opportunities could take some time to materialize.

In 2019, about 11% of MA plans offered some sort of a supplemental benefit. For some, this meant in-home support services. For 2020, 377 MA plans will offer at least one supplemental benefit — or just 7% of all plans out there, according to Duke University’s Margolis Center for Policy Health.

“Without knowing a lot about it yet, I think it’s a wonderful idea to create a dedicated care corp. I’m very supportive, in general, to the idea of dedicated service, particularly in the area of aging. There is a vast need to support our aging population, and young people can learn so much from a service opportunity [and] from our seniors.” — Jeff Huber, president and CEO of Home Instead Senior Care (Nov. 11, 2019)

The idea that the Peace Corps, a U.S. government-run volunteer program, could be replicated to mobilize caregivers to serve the country’s aging population created a buzz throughout the industry.

Instead of seeing the new program from the U.S. Department of Health and Human Services’ Administration for Community Living (ACL) as potential competition, many industry insiders embraced the upcoming program as a potential ally. The move to establish the program comes at a time when the industry is facing recruitment and retention challenges, and a National Volunteer Care Corps could increase the pool of viable caregivers.

Additional reporting by Robert Holly