Home health agencies took hits to both their censuses and psyches when the public health emergency (PHE) was declared last March.
Since then, some industry insiders have argued that the space has gone through a five- to 10-year transformation. Subsequently, the second year of COVID-19 is set to look different than the first, for a variety of reasons.
For one thing, COVID-19 is far more prevalent than it was when agencies first began battling the virus. The seven-day daily average is now around 167,000 new cases per day. Earlier in January, 300,000 cases were reported in just one day, per New York Times data.
Up until November and December, the 100,000-cases mark had not been breached in a single day. In Q4 of 2020 it became commonplace — and those numbers have been reflected in home health admissions.
Plus, new strains of the virus have been found in the U.S., which could make the situation worse before it ultimately gets better.
In the summer, about 2% of patients admitted to home health care were COVID-19 positive. Now, that number is at about 10%, according to William A. Dombi, president of the National Association for Home Care & Hospice (NAHC).
“There has been a surge in patients admitted with a primary diagnosis of COVID,” Dombi told HHCN. “And the home health agencies haven’t missed a beat. They’re meeting the needs of [seniors].”
Lafayette, Louisiana-based LHC Group (Nasdaq: LHCG) is a prime example of the surge affecting the home health industry. The home health, hospice and personal care services provider saw sharp growth in its COVID-19-related admissions in Q4.
The company admitted 7,046 COVID-positive home health patients during the first three quarters of 2020. In Q4 alone, it admitted 7,544 COVID-positive patients.
“I think that really goes to drive home … the value proposition and what we’ve been able to prove throughout the [duration] of this pandemic of what the home health benefit can provide to the patients,” LHC Group President Joshua Proffitt said at the JP Morgan Healthcare Conference earlier this month. “I think it also points to the spike that we’ve all seen and all the national numbers throughout the fourth quarter, even here starting into the first quarter.”
Vaccines are bringing hope in the new year, but also present a challenge that didn’t exist early on in the pandemic.
Finding vaccines — and persuading workers to get inoculated when they do — is a chief concern for all home-based care providers.
“A new challenge for the year ahead will be navigating vaccine distribution and ensuring our caregivers and patients are protected,” Elara Caring CEO Scott Powers told HHCN in an email. “We are proud that a significant number of our caregivers have already received the vaccine, but the national rollout has been anything but smooth and we must still ensure that many more get protected in the months ahead.”
Addison, Texas-based Elara Caring is a provider of home-based care. The company currently has 225 offices across 16 states, and its more than 35,000 employees care for about 60,000 patients daily.
Legislation tailwinds
Legislation has been mostly favorable to home health providers during the public health emergency, which will likely last through the end of 2021, according to the U.S. Department of Health and Human Services (HHS).
That means that agencies will continue to benefit from more favorable reimbursement rates and the flexibilities that have been granted during the pandemic. The telehealth-related flexibilities, however, were already deemed permanent under the new spending bill passed in December.
“We believe telehealth will continue to play an important role in home care, and we are proud to be implementing telehealth services at Elara Caring that make us better, smarter and more agile caregivers,” Powers said. “But unlike other industries, we do not see telehealth replacing the role of caregivers in home care, … and we will work legislatively on issues that will help us better deliver quality health care in the home.”
Regulators have seemed to become more aware of the power of home-based care, in general. That is reflected in programs like the new Acute Hospital Care at Home initiative from the Centers for Medicare & Medicaid Services (CMS).
As of Jan. 13, the initiative had at least 80 participants, with many of the health systems involved enlisting home-based care agencies to help.
Although the hospital-at-home initiative is a temporary program, it already offers a slew of opportunities for home health providers. Its success opens the door for more opportunities down the line, too.
“During the 2020 pandemic period, [home health care] really gained awareness, respect and a recognition of how deep and wide it is, in terms of what it can provide,” Dombi said. “That led to things like CMS implementing the hospital-at-home program. All of that creates an environment for good opportunities.”
Dombi is bullish that continued investment in home-based options will yield favortable returns in the future.
“How big can it be?” Dombi said. “You know, I think we’ve seen the capabilities of home health to scale up to meet higher acute needs. So I’d say, we don’t see the ceiling on it yet.”
New administration
A new administration has taken hold of the White House in the second year of COVID-19, which could mean a lot of different things for the industry — both good and bad.
Home-based care has gained respect and recognition from both sides of the political aisle at this point, but the Biden administration’s concentration on the field is exciting for the sector.
“This is the first time somebody is taking it from a platform into something closer to reality,” Dombi said. “So that is a very positive opportunity and absolutely a tailwind. And without a doubt, even in the absence of details, that’s saying the culture for health care is going to be one of doing everything we can in the home.”
COVID-19 is still a top concern and staffing struggles are still omnipresent as demand rises.
Still, there is room for optimism. And even if it took reaching rock bottom to get there, home-based care has finally entered the mainstream.
“You have to sit back and say, ‘Well, it’s about time the rest of the world caught up with us,’” Dombi said.
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