‘Perfect Storm’ of Staffing Challenges Continues to Batter Home-Based Care Operators

Staffing remains far and away the most pressing challenge for home-based care providers, a recently released report from Homecare Homebase and Home Health Care News found. But changing payment models and regulatory policies are still proving difficult as well.

The findings are sure to be familiar to those in the home-based care industry, but they’re yet another reminder of what providers are up against in 2022 and beyond.

Luke Rutledge is the senior vice president of operations for Homecare Homebase. Rutledge told Home Health Care News on Wednesday that he’s never seen staffing shortages this intense ever before.


“We always knew that there was a silver lining out there as baby boomers were getting to the age where they needed home care services, but we have not ever seen it this pronounced,” Rutledge said. “With COVID, it’s been a little bit of a perfect storm [with trying] to retain some of the nurses in this industry and then also the heightened awareness of what home care can provide.”

The report, based on a survey conducted by HHCN in partnership with Homecare Homebase, received over 380 responses from home health and home care professionals. In addition to staffing, they were asked about their thoughts on the home-based care industry in 2022, on navigating the evolution of the business, on investing in technology to improve efficiency and care delivery, and more.

Home-based care providers of all shapes and sizes have struggled with staffing shortages since the start of the COVID-19 pandemic — and even before that for many. These shortages have caused providers to turn away an increasing number of patient and client referrals, despite skyrocketing demand for services.


In January, for example, the home health industry’s referral rejection rate was 58%, according to a data analysis from CarePort, a WellSky company.

Staffing was the greatest non-COVID-related challenge for 2022 for 80% of the survey’s respondents. In relation to staffing, 57% of respondents said recruiting was their main concern for the foreseeable future, with 32% saying the same about retention.

About 15% of respondents said that the combination of changes in payment models and regulations were the greatest non-COVID-related challenge.

In home health care, an example of the former is the nationwide expansion of the Home Health Value-Based Purchasing (HHVBP) Model. Meanwhile, in home care, an example of the latter is changes in state licensure requirements.

Source: 2022 Home Health Care News Outlook Survey and Report

The tricky thing for providers is figuring out how to take advantage of the great market opportunity while also retaining staff and making the job appealing for clinicians, Rutledge said.

The pandemic, he added, made nurses and clinicians retire earlier than usual, and made those new in the field question and rethink their career decisions. For providers now, Rutledge said the focus should be on retaining clients, making the workplace a more welcoming environment and having the technology in place to make clinicians’ lives easier.

Generally, when companies pursue recruitment to try to get the right people for the right jobs, retention comes easier, Rutledge noted, citing Homecare Homebase metrics.

“A lot of the bigger [providers] have some really good retention rates, and it just speaks to their culture and recruitment,” Rutledge said. “Some of the bigger clients have great retention rates. It doesn’t mean that [smaller operators] are focusing on that any less. But I think they’re probably trying to solve more of the problem by working with universities and some of the nursing institutions out there to recruit new talent.”

An example: LHC Group Inc. (Nasdaq: LHCG) invested $20 million in the University of Louisiana at Lafayette’s College of Nursing and Allied Health Professions last March.

Recruiting has been found to be the most difficult part of the staffing battle, and providers are having to widen their net for talent to fill positions. Some have started to search for potential caregivers within other service-oriented labor pools, including the retail, hospitality and restaurant sectors.

To overcome these difficulties, home-based care providers are investing in a range of technologies. The most common are those related to staff management, telemedicine, telehealth, predictive analytics and patient engagement.

Source: 2022 Home Health Care News Outlook Survey and Report

Rutledge said a lot of the momentum was heading in this direction, but the COVID-19 pandemic simply sped it up.

“From the Homecare Homebase perspective, last year and into this year, we’ve been doing more with interoperability. Not just point to point, but really around the API’s to make it easier and faster for partners and vendors and organizations to connect easily into the EHR, grab the data or provide a service,” Rutledge said. “I think you’ll see those continued trends. When I look at the survey, 27% want interoperability with EHR. That’s where most of the data is kept with the patient, and so we definitely are trying to get customers there.”

Companies featured in this article: