A member of Catholic health system Trinity Health, Trinity Health At Home currently ranks as the eighth-largest home health provider in the country. It will gain even more market share next year, thanks to an ambitious plan to formally consolidate Trinity’s national network of home health agencies with regionally owned affiliates.
Despite the advantages of scale, Trinity Health At Home and its sister agencies continue to operate through various hardships caused by the COVID-19 virus, Mark McPherson, the organization’s interim president and CEO, told Home Health Care News in September.
Those challenges include a shortage of experienced nurses, restricted access to long-term care facilities and more.
“We want to be able to take on new business, but we’re limited by what we can produce, what we can accommodate within our nursing staff,” said McPherson, who also serves as interim CEO of Mercy Home Health and as CFO for the Trinity Health system. “Nursing, in particular, is the area where we are struggling the most to find adequate staff.”
The demand for nursing positions has grown across all health care subsectors, but there has long been an especially high demand in the home-based care arena. That demand has only accelerated due to the COVID-19 pandemic, with most hospitals and health systems looking to shift care into the home.
Overall, the U.S. Bureau of Labor Statistics projects a 14.8% growth in registered nurse (RN) positions through 2026.
While Trinity Health At Home is looking to hire more nurses broadly, the bulk of its focus is on finding and keeping veteran home health clinicians, McPherson said.
“In home health care, it’s difficult to take somebody who’s a new grad, right out of school, then put them in the field,” he said. “There’s just simply too much of a learning curve. There’s just not enough people to bounce issues off of when you’re out there working by yourself.”
Avoiding a ‘bidding war’
With a dearth of home health nurses nationally, McPherson has Trinity Health At Home and other Trinity home health agencies focused on retention. Part of that has meant supporting staff during the public health emergency and rewarding them with financial bonuses whenever possible.
“We’re going to have to be willing to invest in some additional bonuses or forms of compensation to capture those experienced nurses and make sure we keep them,” he said. “Unfortunately, it’s going to be a bit of a bidding war until there’s more of a supply of experienced home health nurses out there.”
In terms of other coronavirus-related challenges, Trinity Health At Home and its peers also faced decreases in patient volumes in spring.
Securing personal protective equipment (PPE) was likewise difficult in the early going, according to Ruth Martynowicz, who serves as interim COO of both Trinity Health At Home and Trinity Health Mid-Atlantic’s Mercy Home Health.
“The biggest problem back then, which I’m sure you’ve heard over and over again, was the lack of readily available PPE,” Martynowicz told HHCN. “With volume, there was a huge impact in March and April, in that patients did not really want to go into the hospitals or have people coming into their homes.”
For the most part, volumes have returned to “business as usual” for Trinity Health At Home and Mercy Home Health. In some regards, patient flow has actually improved compared to pre-pandemic levels, as some referral sources are turning to home health care more frequently.
But a persistent pain point from spring to fall has been access to patients in skilled nursing facilities (SNFs), continuing care retirement communities (CCRCs) and other congregate settings.
“The hospitals are bouncing back, and physician offices are actually thinking of us more frequently,” Martynowicz noted. “The biggest barrier — though this is getting better, too — is in the area of [facilities]. Skilled nursing facilities, CCRCS … have taken longer to come back. They want to make sure that anyone that goes into their building doesn’t have COVID, that they’re using the appropriate PPE.”
Aside from the COVID-19 virus, McPherson and Martynowicz are gearing up for the consolidation of all national and regional Trinity home health locations into one entity. In addition to Mercy Home Health, for example, those regionally owned home health organizations include Trinity Health Mid-Atlantic’s St. Francis At Home and St. Mary Home Care.
Overall, there are 15 different entities that will collectively be known as Trinity Health At Home when the consolidation takes place in July 2021.
“Right now, Trinity Health At Home, I think, is around the eighth-largest home care provider in the country,” McPherson said. “When we consolidate all those entities, we should move up to around No. 5, in terms of size.”
Once that consolidation is complete, Trinity Health At Home will have locations in 13 different states, stretching from California in the West, to Florida in South and New York in the Northeast.
Although next year will be the official “year of integration,” McPherson said all of Trinity’s nationally owned and regionally owned home health operations have started coming together to communicate and share best practices.
“There are some things that Mercy Home Health does better than Trinity Health At Home,” he added. “There are some things that Trinity Health At Home does better than Mercy Home Health. We’re taking the best practices of both putting them together.”
Based in Livonia, Michigan, the overarching Trinity Health includes 92 hospitals and 100 continuing care locations, including PACE programs and senior living facilities, plus home health and hospice services. In total, its continuing care programs provide nearly 2 million visits, annually.
Trinity Health has annual operating revenues of about $18.8 billion and assets of $30.5 billion, with the organization returning about $1.3 billion to its communities in the form of charity care and other benefit programs.
‘We’re doing our best to prepare’
During the spring surge, Trinity Health At Home and Mercy Home Health collectively recorded about 400 COVID-19 cases among patients. For context, the two organizations jointly have a combined census of about 7,000.
When HHCN connected with McPherson and Martynowicz in September, Trinity Health At Home and Mercy Home Health collectively had about 130 cases. Even with cases spiking across the country, that figure has held steady throughout October, the executives confirmed on Wednesday.
Over the last week, the U.S. has averaged about 59,000 new cases a day, with hospitals in some states once again approaching full capacity, reports The New York Times. The daily total could soon surpass 75,687.
“We’re doing our best to prepare for [a fall surge],” McPherson said. “We have an ample supply of PPE, and we’ve never really gotten away from conserving PPE, impressing upon everybody that we need to use the right mask for the right situation.”
To mitigate some of the pandemic’s challenges and the nursing shortage, McPherson said he hopes that lawmakers and the U.S. Centers for Medicare & Medicaid Services (CMS) will come together to create a pathway for telehealth reimbursement in home health care.
“Telehealth also allows us to use the same amount of nursing resources to treat more patients,” he said. “And that’s what we need to be able to do.”