Policymakers Can’t Afford to Neglect Home Care Providers During COVID-19 Pandemic

In the midst of the ongoing COVID-19 pandemic, non-medical home care providers — often called the “eyes and ears in the home” — are solidifying their position as a part of the larger health care continuum.

Over the past few decades, the health care sector has seen SARS, H1N1 and a number of other outbreaks take place. But the severity of the coronavirus and its overall danger to older adults makes it stand out, Jeff Huber, president and CEO of Home Instead Senior Care, told Home Health Care News.

“There is a more rapid spread with this [virus], and I don’t remember the others having such an impact on the senior population as COVID-19 has,” Huber said.

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Home Instead Senior Care is a provider of in-home care services with over 1,000 independently owned and operated offices worldwide.

Huber isn’t alone in his assertion. Last week, American Health Care Association (AHCA) President and CEO Mark Parkinson called coronavirus “an almost perfect killing machine” for the elderly.

“The death rate is not the 1% that we’ve heard about in Korea or the 3% that we’ve heard about in China,” Parkinson said during a CNN interview. “It’s not even the [higher percentage] that we’ve heard about for people who are over 80.”

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On a global level, the coronavirus has reportedly impacted more than 200,000 people. This number continues to rise daily.

As of Friday, the number of known cases of the coronavirus in the U.S. surpassed 15,000.

For Home Instead Senior Care, reinforcing the company’s already comprehensive safety protocols became especially important, according to Huber.

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“We’ve implemented a learning-management system so that we can deploy training in more real-time,” he said. “Caregivers can access training more virtually. We make sure that our caregivers understand good hygiene, hand washing precautions, covering their mouths when they cough or sneeze — all things that have been part of our mandatory training from day one.”

As the coronavirus continues to spread, keeping both clients and caregivers safe will be top of mind for many organizations.

However, due to the nature of the virus, there is the possibility that clients may turndown care services from providers.

In New York, for example, roughly half of surveyed in-home care providers have experienced patients or family members refusing entry of home care personnel, according to recent findings from the Home Care Association of New York State (HCA-NYS).

Nonetheless, the coronavirus pandemic may serve as a reminder of the critical role that the non-medical home care industry plays.

“What we’ve seen, now more than ever, is that home care is a critical component in the prevention and spread of this virus,” Emma Dickison, CEO and president of Home Helpers, told HHCN. “By being in the home, we are the first to notice any changes in the health of the clients that are the most vulnerable to this virus. As a result, we are able to help them seek care earlier.”

Home Helpers is a Cincinnati-based in-home care franchise company that has over 300 locations and operates across the U.S.

In addition to her role at Home Helpers, Dickison also serves as president of the Home Care Association of America’s (HCAOA) board of directors. HCAOA is a Washington, D.C.-based trade organization that represents nearly 3,000 companies.

Similarly, Huber said that the importance of home care is clearer than ever.

“I think this elevates the importance of home care as a critical part of the health care ecosystem,” he said. “We are, on average in North America, in the home somewhere between 20 and 25 hours per week. Part of what we do is notice changes in care needs and health conditions. This is a case study in that.”

Like Home Instead Senior Care, Home Helpers has focused on training its caregivers in response to the crisis.

“All of our caregivers have been trained on additional support for each client so that they can highlight these symptoms,” Dickison said.

In terms of a COVID-19 business impact, home care providers are reporting mixed observations.

Amid the coronavirus outbreak, for example, Home Helpers has taken on new clients that have been brought home from independent or assisted living facilities by family, the CEO noted. On the flip side, the company has had some clients reduce or suspend caregiver hours due to family being home and able to take care of them.

Apart from those changes, one of the biggest challenges for Home Helpers is making sure Congressional leaders are aware of the role that home care plays in health care.

“It’s about ongoing education with our leaders in Washington, D.C.,” Dickison said. “Helping them as they’re shaping these policies to help us navigate through COVID-19, that they understand the importance that home care plays in the continuum and in helping minimize hospital admissions.”

An understanding with lawmakers is especially important at a time when home care providers are trying to parse out how new relief policies apply to their businesses.

On Wednesday, for instance, President Donald Trump signed an emergency package providing paid sick leave and other benefits to Americans affected by COVID-19.

Broadly, the law applies to employees of companies with less than 500 workers and exempts those who are part of the health care sector. It’s still unclear if this includes non-medical home care providers.

“It’s a very, very significant issue in the industry right now, depending on how a health care provider is defined,” Angelo Spinola, an attorney, and shareholder at Littler Mendelson, previously told HHCN. “And if that is not inclusive of home care, then we have real problems because a lot of these companies need their workers to be out with the seniors and the patients. And a lot of these workers in this industry are single moms who have kids that are home from school.”

A similar issue is playing out at the state level, as New York, California, Illinois and other states enact shelter-in-place orders.

In New York, Gov. Andrew Cuomo recently announced a 100% workforce reduction for all non-essential businesses. Health care works are exempt, but it’s murky whether that includes non-medical home care staff — or home care administrative staff that help keep operations up and running.

On a federal level, there are at least signs to suggest that the nation’s personal care service workers should be considered essential health care workers.

In addition to “caregivers,” the following should be considered essential, according to the Cybersecurity and Infrastructure Security Agency: “Workers in other medical facilities (including Ambulatory Health and Surgical, Blood Banks, Clinics, Community Mental Health, Comprehensive Outpatient rehabilitation, End Stage Renal Disease, Health Departments, Home Health care, Hospices, Hospitals, Long Term Care, Organ Pharmacies, Procurement Organizations, Psychiatric Residential, Rural Health Clinics and Federally Qualified Health Centers).”

While a licensed, Medicaid-reimbursed personal care services provider isn’t the same as a non-medical, private-pay home care provider, the latter could still possibly fall under the “long-term care” bucket.

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