Calm Before the Storm: In-Home Care Providers Brace for COVID-19 Surge

As the coronavirus continues to spread across the U.S., one might assume the home-based care industry is booming, due to providers’ special ability to keep vulnerable senior populations safely at home.

However, it seems the opposite is true: Many home health and home care providers have reported that business is down, due to factors like the elimination of elective surgeries, family members being home more often to care for loved ones and seniors turning caregivers away over coronavirus fears. 

In fact, one home health agency in San Diego told Home Health Care News it anticipates April revenue to be down about 33% — a huge hit when you consider the agency’s typical profit margin is just about 5%.


Even industry powerhouses like Baton Rouge, Louisiana-based Amedisys Inc. (Nasdaq: AMED) have seen volumes decline.

While medical and non-medical agencies continue to struggle in the short term, many predict business will pick back up at a fast-and-furious pace in the weeks to come. Industry stakeholders have coined the current reality as “the calm before the storm,” as they expect home-based care providers to soon be tasked with taking on large numbers of COVID-19 patients to help overburdened hospitals. 

“We were texting that out literally [in early April], that this was the calm before the storm,” Kevin Colman, president of Home Healthcare Solutions, recently told HHCN.


Home Healthcare Solutions is a Medicare-certified home health agency based in the Chicago area. About 60% of its clients reside in senior living communities, while the rest live at home.

Last year, it did about $5.3 million in revenue, according to Colman, who started the company back in 2006.

Since then, business has been somewhat steady. For the past several years, the agency has received an average of about four to seven new referrals per day. That’s until late March of this year, when the agency went days at a time without a single new patient.

“I hadn’t had that in seven years,” Colman — who also has a minority stake in a non-medical home care company called Concierge Home Integrative Care — said. “I was like, ‘What the heck is going on here? How are we not getting any business? This is crazy.’”

But as more people come down with and begin to recover from the COVID-19 virus, business has slowly started to pick back up, Colman told HHCN on April 6.

“I’m preparing for each day to probably get busier,” he said, predicting home-based care providers to see business peak in the next few weeks. “We are anticipating … patients being discharged [from hospitals quicker] and coming back to their homes or their communities, which [means] a whole separate set of risks.”

In New York — the current epicenter of the coronavirus outbreak in the U.S. — home-based care providers like the Visiting Nurse Service of New York (VNSNY) have already started taking coronavirus patients out of hospitals’ beds to free up space.

The not-for-profit home health, home care and hospice provider is taking COVID-19 referrals and treating patients who are stable enough in their homes. The referral boom has come with other positives, too, namely in the form of personal protective equipment (PPE).

“Hospitals need beds for sick patients, and home health agencies are the off ramps,” Dan Lowenstein, vice president of government affairs at VNSNY, said on a recent HHCN webinar. “If we have problems, they have problems.”

As such, VNSNY has been able to secure more PPE for its workforce, as hospitals realized the agency wouldn’t be able to offload COVID-19 patients without it.

“That set off alarm bells,” Lowenstein said. “That set off the hospitals and the hospital associations putting us in the mix to get what we needed, and we’re seeing the same thing on the policy side.”

In order for home-based care providers to weather the imminent storm of COVID-19 patients, such teamwork and assistance is vital. Just like agencies can’t provide care without PPE, they’re struggling to operate without certain financial support.

On the home health side, that means agencies need reimbursement from CMS for telehealth visits; meanwhile, non-medical home care agencies are hoping for federal hazard pay for their caregivers.

But if there’s anything the past few weeks have taught the industry — and the country as a whole — it’s that the COVID-19 emergency is unpredictable and agencies have to be ready for anything, according to Sean Kajcienski, chief operating officer (COO) and chief revenue officer (CRO) of Best Life Brands, the parent company of ComForCare and At Your Side, which are franchised non-medical home care brands.

Despite the fact that Kajcienski told HHCN business appeared to be down slightly back in late March, he’s confident that home-based care providers will be an essential part of navigating the nation back to normalcy.

“We’ve got to be a little bit more flexible, adaptable and responsive to business demands,” he said. “We’re all just adjusting, but the need is there. It’s such a great need in this country, and I see it continuing to grow.”

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