The Patient-Driven Groupings Model (PDGM) was supposed to define home health care in 2020.
Instead, this year was almost entirely shaped by COVID-19, a point that’s reinforced by the most widely read stories on Home Health Care News. Of the top-10 stories on HHCN in 2020, eight were related to coronavirus coverage.
From the first outbreak in Kirkland, Washington, to the latest developments in government support for health care providers, HHCN was on top of it all. Reflect back on this unprecedented year in home health care by browsing through the content below.
There have been several different federal COVID-19 stimulus packages passed since spring, with the House and Senate often locked in tense political debates on the details. HHCN’s top story of 2020 was an inside look at a May House proposal — the Health and Economic Recovery Omnibus Emergency Solutions (HEROES) Act.
While nothing came of the Democrat-backed bill, it did highlight the growing recognition of front-line health care workers. Specifically, the proposed relief package included a $200 billion fund for essential-worker hazard pay.
As of Thursday, lawmakers were reportedly close to signing off on a roughly $900 billion relief deal that would include another round of stimulus checks and other much-needed financial benefits for Americans. Liability protections for businesses — something Republicans have pushed for — are likely not included in the deal.
Going into this year, one of the main storylines of PDGM was the reimbursement overhaul’s impact on in-home therapy services.
After the Patient-Driven Payment Model (PDPM) was implemented in the skilled nursing facility (SNF) space in October 2019, many operators opted to cut or furlough therapy staff. Some industry experts expected home health agencies to do the same.
Certainly, some providers did shift their therapy strategies. But it’s almost impossible to identify whether home health therapy cuts were tied to PDGM or the ongoing public health emergency.
Early on, home health providers had to adapt to care for a surge of COVID-19-positive patients. Quickly, though, it became clear they would have to respond to other challenges as well.
Among those challenges: the influx of non-COVID patients that were getting discharged from hospitals faster to maintain acute care capacity. By not recovering in the hospital for longer, patients discharged to home health care in 2020 have been weaker and more deconditioned than in the past.
A similar trend has emerged — higher patient acuity levels — as referral sources looked to avoid congregate care settings like SNFs.
On one hand, labor experts predicted that a depressed economy and the closure of certain businesses would lead to a larger worker pool for in-home care agencies. On the other, initially robust unemployment benefits meant some caregivers could get paid more by opting out of work.
In conversations with HHCN, most home health and home care executives have said the recruitment and retention of workers remains extremely difficult.
Although COVID-19 outbreaks started to surface in mid-March, home-based care agencies didn’t start feeling pandemic pressures until mid- to late-April. Leading up to that time, operators scrambled to secure enough personal protective equipment (PPE) and educate their patients on the safety of their services.
In April, CMS announced that it was sending a first tranche of $30 billion to all Medicare-reimbursed health care organizations, with funding coming from the Public Health and Social Services Emergency Fund under the CARES Act. More tranches followed, with HHS releasing another $1.1 billion in direct aid to nursing homes on Wednesday.
In September, CMS announced the availability of up to $165 million in supplemental funding to states operating Money Follows the Person (MFP) demonstration programs. While that news was exciting, it was related comments from Administrator Seema Verma that really piqued home-based care agencies’ interest.
The tragic devastation wrought by the coronavirus on nursing home residents exposes America’s over-reliance on institutional long-term care facilities,” Verma said at the time. “Residential care will always be an essential part of the care continuum, but our goal must always be to give residents options that help keep our loved ones in their own homes and communities for as long as possible.”
Staffing continues to be a challenge for home-based care providers. Even as unemployment rose to record-highs during the COVID-19 crisis and demand for home-based care skyrocketed, providers found it hard to find qualified workers.
But one undeniable tailwind was how spotlighted home care careers became during the public health emergency. President-elect Joe Biden outlined a plan to boost the caregiver workforce, politicians vied for home-based care on both sides of the aisle, and everyday Americans become more aware of what home-based care workers did on a daily basis.
“One positive thing that I think came out of COVID — and I think this is just a real positive thing for the whole industry — is home care careers are suddenly on the map,” Brandi Kurtyka, the CEO of myCNAjobs told HHCN. “Senior care just got the biggest ‘Got Milk’ campaign that we’ve ever seen.”
Efforts have certainly stalled since, but when the initial relief packages came out in March, home-based care providers could not get enough of the details — of which there were many.
When the record-breaking $2 trillion stimulus package known as the CARES Act passed, providers were granted monetary and regulatory relief. It was the first shoe to drop in a litany of changes ultimately made to the home-based care space.
It created the Provider Relief Fund and made temporary, beneficial changes to reimbursement. But it also created a more virtual industry, rendering face-to-face requirements and other traditionally in-person practices as relics of the past.
This is the story that kicked everything off — the first time that HHCN reported on the coronavirus in 2020. “People have been asking me, ‘Where are we with the coronavirus?’” National Association for Home Care & Hospice (NAHC) President William A. Dombi was quoted saying. “It’s scary.” Those fears would soon turn out to be well founded.