NAHC’s Dombi: Home Care Opportunities Are on the Rise, Despite Ongoing Operational Challenges

Home care agencies have been through a turbulent year. But they’re coming out of it under a new light from the perspective of clients and potential partners.

That spotlight continues to grow brighter with each passing day, too, though COVID-19 cases within home care have fluctuated as of late. Far more agencies are dealing with COVID-19 patients now than early on, according to National Association for Home Care & Hospice (NAHC) data.

Overall, close to 10% of all home care admissions are currently tied to the virus, reportsNAHC, which shared those figures during a Tuesday virtual event.


Similar to cases, personal protective equipment (PPE) costs have also fluctuated as of late. Access continues to be a concern, but the days of scrambling desperately for any sort of equipment to keep workers and clients safe is likely in the rearview mirror.

Despite all of the hardships, home care agencies have absorbed the blows and survived, according to NAHC President William A. Dombi. This experience, he said at Tuesday’s event, is likely to pay off in the long run.

“We have seen — and this is coming by way of agencies’ good deeds — media attention as well as kind of a cultural change in health care,” Dombi said. “Public awareness and health care sector awareness of home care’s value has exponentially increased. [It’s seen] as a viable alternative to other care settings.”


Home care demand took a dip at the beginning of the public health emergency, but it has since stabilized and even increased in some areas. Likewise, the perceived worth of home care has skyrocketed — and that has presented new opportunities.

Payers had already begun recognizing the benefits of home care services, especially when it comes to managing social determinants of health.

But the value of home care — and its ability to provide both pre- and post-acute care — has really become evident during the COVID-19 crisis.

“We are also in the midst of an earlier integration of care at home,” Dombi said “If anybody ever talks to you about post-acute care as the way of defining home care services, they’re off base. Now, others are realizing that home care can be pre- and post-acute, and can also be a very successful way of dealing with individuals with chronic multiple comorbidities.”

Home-based care advocates have been touting the industry’s ability to take on greater challenges, reduce costs and improve care for a long time now.

It’s not a silver lining, per se, that this was recognized in the midst of a deadly pandemic. But it could mean more business for operators long after the public health emergency has subsided.

“Payers, like managed care organizations, are learning more and more about the value of home care services,” Dombi said. “For decades, we’ve had a real hard time convincing payers that the value of home care is something even better than other [means of care] and that it offers a dynamic value. But now that knowledge is starting to take hold, and other health care providers are also appreciating home care across the country.”

In the home care world, this type of realization is represented by the increased interest in palliative care. In some ways, palliative care is a parallel to traditional home care. It takes on patients’ basic needs outside of brick-and-mortar facilities.

“With private-duty home care services, agencies and the physicians make natural partners on this,” Dombi said. “So ultimately, we’re going to see policy building on the growing perception that home care is a total positive, which will translate to totally positive health care policy actions.”

PPE procurement

PPE procurement remains a struggle, according to Dombi. Home care agencies are not on PPE priority lists, nor have they been benefiting from direct government funding that helps pay for these increased costs.

“Back in March of 2020, I received numerous phone calls from the mass media,” Dombi said. “And they were all focused on how unsafe home care must be because there wasn’t PPE. And while it’s still difficult to acquire that, agencies have found ways to continue to keep your patients and staff safe. So that insecurity has somewhat faded away.”

The darker days of PPE may be gone, but the unit prices have also gone up as demand persists.

While private-duty agencies are finally eligible to receive governmental support from the Provider Relief Fund, it is a requirement that agencies also provide some sort of services under Medicare or Medicaid programs.

“We still have those PPE concerns that are persisting, but are we not at that stage where you’re cutting open empty soda bottles to make face masks or knocking on the doors of tattoo parlors to see if they have any spare gloves or masks,” Dombi said. “So I think the current environment overall has a real positive to it.”

Campaign promises

Politicians tend to make campaign promises, just as current President Joe Biden did when he announced a $775 billion plan to boost the caregiver economy in July.

The 10-year proposal would seek to dramatically change the way older adults are cared for in the United States. Specifically, it would expand home- and community-based services, for Medicaid providers and others, and also offer support for both agency caregivers and family caregivers.

Promises aren’t always kept, but Dombi said that NAHC and other industry advocates are determined to hold President Biden and his administration to this one.

“We do not expect this to surface in the near-term of 2021,” Dombi said. “But keep this one in mind, because we’re going to do everything we can to make the president honor that campaign promise to put this program out there. And I know you’re rolling your eyes, … but we believe that President Biden is at least somewhat serious about this.”

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