Nursing Home Executives Increasingly View Home Health Care as Strategic Complement for Lower-Acuity Patients

The largest nursing home advocacy organization in the nation cried foul following the July introduction of the Choose Home Care Act of 2021, a piece of legislation designed to shift more care into the home.

The group’s quick criticism of Choose Home only added to the “nursing homes versus home health” narrative that has repeatedly been brought up during the COVID-19 pandemic.

But while home health agencies are often depicted as enemies of skilled nursing facilities (SNFs) and other institutional settings, they’re really more like post-acute care allies, industry leaders say.

“It’s a complement,” Carespring CEO Chris Chirumbolo said last week during the Skilled Nursing News Rethink conference in Chicago. “I don’t see [home health care] as a huge threat.”

Carespring operates more than a dozen skilled nursing and rehab facilities across Ohio and Kentucky, with assisted living and independent living programs also included in that portfolio. In addition to its brick-and-mortar locations, the company is part of a home health joint venture in the Buckeye State.

Instead of viewing home-based care as something that siphons off volume from its facilities, Carespring sees it as the preferred option for lower-acuity patients, Chirumbolo explained.

“I wish every person, especially our long-term care residents, could be home,” he said. “But they can’t [be]. And if you walk down the hall and you look at the assessment of each person’s issues, from ADLs, to medication needs, to co-morbidity management, a lot of these patients, … I just don’t see that person being at home. But I’m a firm advocate for people going home.”

Chirumbolo isn’t the only SNF executive who thinks that way.

“I think [home health] is a complement. It’s not a competitor,” Ignite Medical Resorts CEO Tim Fields said at Rethink. “For the most part, home health is needing to step their game up just like we’ve had to do.”

Ignite Medical Resorts is an Illinois-based operator of post-acute care facilities. The company has tried to reimagine the traditional post-acute experience through its high-end “luxury resorts.”

Fields has seen SNF-at-home diversion play out over the past several years, with “easy-breezy” rehab cases and orthopedics patients more often being referred to home health agencies. But facility-based settings will always have a role for complex, higher-acute individuals, he said.

“Home care needs to step their game up,” Fields said. “We hand them a high-acuity patient and, you know, they come in once or twice. That patient goes back to the ER, starts the whole cycle all over again. And so I really see [home health] as a complement. I’ve joked with someone where I said, ‘Come in and find anybody you can take home right now. Go ahead and have them.’ I mean, most people we’re getting are pretty sick. And I think the hospitals are going to, of course, send the folks who can qualify for home care and can be successful at home.”

Mike Bailey, the CEO of American Health Partners, echoed those sentiments.

The Franklin, Tennessee-based American Health Partners operates a few dozen SNFs through its American Health Care arm, but it also provides a wide range of other services, from home health and hospice to psychiatric care to a nurse practitioner organization. The company serves 12,000 individuals annually across nine states, mostly in the South.

American Health Partners is also an example of a SNF operator with an in-house home health services line, which has been a big strategic advantage during the pandemic, Bailey said at Rethink.

“We were already on a path of diversification. We were also already on a path of trying to take a more complex or acute patient in a skilled facility,” he said. “COVID accelerated that for us. And we took the opportunity there just to kind of look at ourselves and say, ‘What can we do to be prepared to take the sicker patients in our facilities and let the less sick go to the home,’ which is the trend today. And so that played well, frankly, into our business plan.”