As Demand Rises For Home-Based Care, Patients Becoming More Complex

Since the onset of COVID-19, the demand for home-based care has gone up. At the same time, patients are becoming more complex.

Those were the main takeaways from a recent study done by USAging, an advocacy group that represents and supports the national network of Area Agencies on Aging (AAA).

“Even clients that area agencies had before COVID hit, the complexity had really increased dramatically,” Sandy Markwood, CEO of USAging, told Home Health Care News. “We circled back in the spring, recognizing that a lot of the COVID relief funding was starting to be exhausted, and found that 94% of the area agencies were still seeing an increase in the number of older adults requesting service.”


AAA organizations offer local services that allow seniors to age in place. Those services include at-home care, as well as other ancillary services. Some AAAs are affiliated with local government entities, while others function independently. They have been proven to reduce Medicare spending.

Over 95% of the nearly 200 agencies reported an increase in complexities in the USAging report.

“They just didn’t need a meal, they needed a meal and they needed a ride to the doctor while also needing in-home support,” Markwood said. “It’s really a full range of supportive services that were necessary to keep them living while at home.”


It’s no secret the demand for home-based services continues to be on the rise. What did surprise Markwood, however, is the older adults not being able to receive one or more services due to a gap in workforce availability.

According to the results, 94% of agencies said their workforce challenges resulted in older adults not receiving the frequency of care they need.

“That is beyond startling,” Markwood said. “Meanwhile, 92% said that some older adults are not able to receive one or more needed services. These are critical services that people are going without because there’s not the investment in the workforce and the services to be able to provide to them. It is so concerning.”

Not only are AAAs facing employment shortages, but 62% of respondents said they have seen a significant drop in volunteer help since the pandemic.

Markwood understands that solving this issue comes with complex solutions. If wages are increased for Medicaid, for example, and not for other programs like the Older Americans Act, then workers will move from one program to another and the issue will persist.

Experts with USAging believe that viewing care services with a holistic approach is the first step in beginning to make changes.

“One thing that Area Agencies on Aging do is they look comprehensively at the whole person through case management,” Markwood said. “It may be that a person needs in-home supportive services but they also need a meal, medical transportation and a ramp put in their house. We need to continue to look holistically and from a person-centered perspective. Then we need to have a workforce that can address it.”

The workforce shortage becoming a national conversation is one hope Markwood has for the near future.

“My hope is that we will look across the board at raising wages, providing benefits, but also in developing a workforce as looking at it as a career opportunity, rather than something that people that people fall into,” Markwood said.

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