Fast-Growing Home Care Industry Still Dominated by Small Providers

Home care is one of the fastest-growing segments of the long-term care sector. Even so, the segment is still made up of mostly small businesses, a new report reveals.

Overall, about 78% of home care providers employ fewer than 50 workers, according to a Tuesday report from PHI, a New York-based direct-care workforce advocacy organization.

In the context of the coronavirus, the findings underscore the need for additional support for mom-and-pop home care providers, many of whom are currently struggling to source and pay for personal protective equipment (PPE) for their workers.


“Because we are dealing with many small businesses, they are having trouble getting the necessary masks, gloves, sanitizers, gowns, etc.,” Vicki Hoak, executive director of the Home Care Association of America (HCAOA), told Home Health Care News. [According to preliminary results from a recent HCAOA poll], 13% of our members said they have insufficient PPE.”

Washington, D.C.-based HCAOA represents nearly 3,000 companies that employ more than 500,000 caregivers.

Rapid growth and a highly fragmented home care landscape have made it difficult for states to identify and meet provider needs during the COVID-19 emergency, according to Stephen Campbell, data and policy analyst at PHI.


“The lack of coordination in the home care sector means that many providers have to navigate this crisis alone,” Campbell, the author of the report, told HHCN in an email. “They often compete against each other to get a hold of personal protective equipment, among other critical supplies. This is especially problematic for the many small businesses in the home care sector, which might have limited resources.”

Overall, the home care industry saw 22,200 new establishments from 2007 to 2017.

In part, the increase is due to a growing demand to age in place among older adults.

“For the last decade, we have seen the shift of people wanting to remain in their homes as they age,” Hoak said. “Many times, older adults have chronic conditions that require assistance. In order for them to stay at home, … they turn to an outside organization, like a home care agency.”

Despite the high demand for home care services, the financing structure of home care is inadequate, according to the report.

The majority of financing for home care and other long-term care services comes from Medicaid, which systematically underfunds long-term care, PHI argues.

“One of the main reasons is that, as a means-tested social assistance program, Medicaid is funded through general tax revenues rather than through universal payroll contributions,” PHI wrote in the report. “Therefore, Medicaid programs must always compete with other state budget items, like transportation and education.”

Looking ahead, policymakers have started to develop proposals focused on improving publicly financed long-term services and supports in the U.S., according to the report.

“As a leading example, Washington State has established a Long-Term Care Trust that,

beginning in 2025 will provide a daily benefit of $100, up to a lifetime benefit of $36,500, to people who require assistance with three or more activities of daily living,” PHI noted.

Other states, such as Maine and Michigan, have also begun considering long-term care social insurance programs.

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