Staffing Reclaims Title of Home-Based Care Industry’s Biggest Challenge

Apart from the COVID-19 virus, staffing is the single-most challenging aspect of delivering care inside the home, with the national supply of clinicians and caregivers drastically overwhelmed by service demand.

That’s according to the 2021 Home Health Care News Outlook Survey and Report, produced in partnership with home-based care software company Homecare Homebase.

More than 350 individuals working in the home-based care industry participated in the survey, conducted online from Nov. 9 through Dec. 7, 2020. In addition to top operational challenges facing home-based care operators, the annual report also digs into the biggest areas for growth, technology trends and more.


While staffing was ranked as a major challenge in last year’s outlook report, it was somewhat overshadowed by the Patient-Driven Groupings Model (PDGM) and other changing payment models.

But that’s no longer the case.

“Home health care is an industry that changes every year,” Scott Decker, CEO of Homecare Homebase, said in the report. “In 2020, we witnessed rapid transformation and new standards adopted to take both PDGM and the unprecedented COVID-19 pandemic into account. Now is the time to reflect on the lessons we have learned as an industry over the past year — and look forward to new challenges and opportunities in 2021.”


Overall, 59% of the individuals who participated in this year’s survey cited staffing as the greatest non-COVID-related challenge in the home-based care field in 2021. Less than 19% of respondents identified changing payment models as the greatest challenge, which largely reflects the home health industry’s success in transitioning to PDGM.

Other challenges ranked behind staffing and changing payment models include regulatory changes and market consolidation.

Staffing troubles aren’t directly related to the ongoing public health emergency, but the two topics are closely related.

Since last spring, home health providers and home care agencies alike have struggled with front-line workers retiring early, taking time off to care for family and leaving the workforce due to health concerns.

Some operators have even reportedly lost workers due to pandemic-related unemployment benefits that are stronger than employees’ regular pay.

Family & Nursing Care — a Silver Spring, Maryland-based private-pay home care provider — saw its total caregiver count drop by nearly 20% from February to April of last year, for example. The company has built that employee base back up, but retention remains a daily grind.

“We’ve been trying to rebound ever since May,” Mitch Markowitz, Family & Nursing Care’s vice president of business development, told HHCN in January. “And it’s been very, very slow incremental growth. That’s mostly because those caregivers, once they’re gone, they’re gone.”

A higher-than-normal number of early retirements is something that EvergreenHealth Home Care experienced firsthand.

Affiliated with a local hospital based just outside of Seattle, EvergreenHealth Home Care is one of the largest home health and hospice providers in the Pacific Northwestbegan. It’s also widely viewed as the first home health provider to care for COVID-19 patients.

“That’s diminishing our staff at our highest census,” Chief Home Care Officer Brent Korte previously told HHCN, noting how the organization’s patient volumes have skyrocketed due to increased demand for home-based care. “Then the rest of our remaining clinicians certainly end up more busy, which means we have to be concerned about burnout.”

Staffing is a serious concern, but that doesn’t meant home-based care operators aren’t hopeful about 2021.

Of the 350 individuals who took part in the 2021 outlook survey, 63% said they expect their organization’s revenue to increase in the year ahead compared to 2020. Another 20% said they expect their organization’s revenue to stay the same.

When it comes to new opportunities, 34% of survey participants identified “skilled home health care” as the greatest growth area for 2021. Another 21% of participants picked “non-skilled home care services” as the greatest growth area, with 19% selecting “SNF-at-home.”

Home-based care advocates have been trying to help advance the latter by lobbying for an official SNF-at-home payment mechanism.

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