In-Home Care Providers Look to Avoid New Minefields as States Reopen

All 50 states have started to — at least partially — reopen after shelter-in-place orders swept the nation starting in March to curb the spread of the coronavirus. As states forge ahead on their reopening plans, in-home care providers are also looking to the future.

As of Thursday, 47 states have begun large-scale efforts to reopen, ending mandated shelter-in-place orders and kickstarting at least one major economic sector. The three states that haven’t fully opened up — Oregon, Tennessee and California, the first state to order residents to stay home — have opted for regional reopenings.

Across the country, many businesses are now resuming their services. In-home care providers, however, have been operating throughout the duration of the COVID-19 public health emergency.


“We’ve been pretty much business as usual as an organization from the start of the pandemic,” Peter Ross, CEO of Maryland-based Senior Helpers, told Home Health Care News. “We were given ‘essential personnel status’ as home care workers by pretty much every governor in the country.”

In addition to its caregivers, Senior Helpers is also now slowly starting to resume operations among its “non-essential” staff, according to Ross. That includes sales and marketing positions, plus billing and schedules roles.

“Our staff in the offices around the country are going back to a more regular routine,” he said. “This includes our corporate franchise support center, which has been pretty much shut down by the governor of Maryland, preventing non-essential personnel from going into the office.”


Senior Helpers and most other in-home care providers have continued to recruit caregivers over the past few months, often turning to tools that allow them to conduct virtual interviews and onboarding.

Senior Helpers plans to begin slowly shifting back to in-person interviews, though still utilizing personal protective equipment (PPE) and practicing social distancing as part of the process, Ross said.

The franchise company, which also launched an adult day center franchise brand last year, has more than 320 locations across the U.S., Canada and Australia.

Pros and cons

As the United States inches closer to pre-coronavirus normalcy, one major opportunity in-home care providers are looking forward to is the return of elective procedures.

In March, the Centers for Medicare & Medicaid Services (CMS) recommended limiting “non-essential” medical and surgical procedures in an effort to preserve PPE, ventilators and hospital beds. CMS also wanted to ensure the availability of a health care workforce for those most in need during the public health emergency.

Caring for patients returning home after elective procedures, including hip and knee replacements, has historically been a consistent source of revenue for in-home care providers. That’s particularly true for rehab-focused Medicare-certified home health providers, but also non-medical home care providers.

On the home health care side, some providers have reported reductions in revenue exceeding 25%.

Pennsylvania-based Seniors Helping Seniors is among the providers that welcomes the return of elective procedures, Howard Algeo, the home care franchise company’s director of business development and training, told HHCN. Seniors Helping Seniors has 200 locations in 36 states.

“It will have a positive impact,” he said. “A lot of the people we take care of are post-surgical or post-rehab patients. It’s a big part of our referral base. The return of these procedures may cause a spike in demand [for home care].”

Illinois-based Phoenix Home Care has already begun seeing these patients return to its business, Peter Miska, the company’s president, told HHCN. Phoenix Home Care — a Medicare-certified home health care provider — serves eight counties in Illinois.

“We are starting to see the surgical patients come through the agency again, where before we didn’t see any unless it was an emergency,” Miska said.

As a smaller provider in terms of Medicare volume, the suspension of elective procedures hit Phoenix Home Care even harder, he noted.

“When you have all of these different blips happening at the same time — and then, all of a sudden, elective surgeries stop — it was a double whammy,” he said. “Because it’s not like the Patient-Driven Groupings Model (PDGM) stopped as this was all happening.”

In-home care providers are generally happy that states are reopening, but they may also be heading toward another minefield. Some states that were largely spared during the early days of the coronavirus are now seeing record hospitalizations and spikes in new cases.

In Arizona, for example, the state’s health department recently cautioned that intensive-care units were approaching 80% capacity, the Wall Street Journal reported. Meanwhile, Texas just set three straight days of hospitalization records this week, surpassing 2,000 a day for the first time.

Nationwide, cases are currently on the rise in at least 21 states.

As business begins to ramp up forthe in-home care space, providers will need to navigate these rising numbers and ensure their caregivers remain protected on the job. After the initial shock, a second wave of business disruption would likely be devastating to many.

“We want to make sure that we have enough caregivers to help as things reopen,” Algeo said.

Business as usual

In addition to the return of elective procedures, heightened anxieties around nursing homes may also lead to an increase in business for in-home care providers as states reopen.

“[At nursing homes], there’s still the problem of loved ones not being able to come and see their family,” Miska said. “Now, you have a situation where they opened up and elective surgeries are being performed, but that doesn’t mean they don’t need an in-patient stay somewhere and families are apprehensive to do that.”

Home health care providers are also in a good position to help lower hospital readmission rates as the public health emergency continues.

“As Americans, at this point what we are looking at is trying to minimize the death toll,” Miska said. “Where we fit into it … is making sure those readmission rates don’t go up, so they aren’t using scarce resources that could be used in other places.”

As of Friday, the virus has resulted in 107,803 deaths in the U.S.

On its end, CMS has implemented a number of flexibilities in order to address the public health emergency and assist providers. Some of those actions have been permanent — and others merely temporary.

Even as states reopen, home health providers should expect most changes to remain in place, William A. Dombi, president of the National Association for Home Care & Hospice (NAHC), told HHCN in an email.

“CMS has indicated that it does not intend to abruptly end them, so we can expect to see a gradual phase-out over time,” Dombi said. “At this point, there is no official word on extensions. Most likely, such action will be tied to the level of infections, hospitalizations and other indications of COVID-19 impact.”

On the home care side, Seniors Helping Seniors expects to see an uptick in admissions in the coming weeks.

“We’ve seen a 14% increase in visits to our website,” Algeo said. “I think that some people are concerned about having their loved ones in assisted living facilities. I believe there will be an increase in inquiry and demand for our services. Through the pandemic, we really showed people the value of the work that we do.”

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