Home Health Referrals Skyrocketed, Patients Became More Complex During Pandemic

As predicted by many at the onset of the pandemic, home health providers gained a larger share of post-acute referrals in recent years than they did prior to COVID-19.

At the same time, data shows that patients coming to post-acute care are sicker and have more complicated care needs than before, all while staffing shortages continue to put a strain on home health agencies.

A new report from the post-acute technology company WellSky shows that by May 2022, home health referrals were at 123% of what they were in 2019.


The COVID-19 emergency added value to, and demand for, home-based care delivery. The industry should expect that demand to stick.

“As you start to bring to bear science on the discharge dynamic, you will continue to see a growing number of patients moving into home-based care settings,” Tim Ashe, chief clinical officer at WellSky, told Home Health Care News. “Complex care plans can be safely delivered effectively and efficiently at home.”

Referrals staying near 123% of 2019 might not be a realistic expectation, Ashe said. But now that the industry is removed from the worst of the pandemic, there is still plenty of room for growth.


“I don’t know what the growth rates are going to be, but I personally anticipate continued growth,” Ashe said. “That’s going to take some investments in the infrastructure across the home health industry. How do we make sure the tide is rising so that all providers can provide care at scale to complex patients?”

One of those solutions could be the Choose Home Care Act of 2021, a piece of legislation that — among other things — supports in-home care alternatives to skilled nursing facilities (SNFs).

The bipartisan bill is currently in limbo in Washington D.C., but would be a vehicle of relief for SNFs and a boon for home health agencies.

That’s particularly relevant given the WellSky report also found that during the first quarter of 2022, referral rate rejection among home health referrals climbed to 71% due to a lack of staff.

“That’s a direct result of staff capacity,” Ashe said. “Those rejection rates are concerning. It goes back to enabling the industry to scale and incent professional and paraprofessional care providers to come into the industry because it is a really attractive space. We just need to solve some of those economic and potential safety issues that I think were highlighted during the pandemic.”

Even if home-based care demand rises, without the corresponding staff capacity, that demand could be all for naught.

As it pertains to patients being sicker, obesity is up 11% in 2022 among SNF residents, according to the report, and complications of hypertension and diabetes amongst home health patients are up 25% and 34%, respectively.

As patients become more complex, more stress could be put on home health agencies as they adjust to the Home Health Value-Based Purchasing (HHVBP) Model, which will be implemented nationwide on Jan. 1.

“The Home Health Value-Based Purchasing pilot demonstrated very solid financial and quality returns,” Ashe said. “With that said, the payment methodology and the performance-based methodology around that has to overlay an infrastructure that is built to scale and provide the right level of care. [It has to exist] with the right investment in a growing set of professional and paraprofessional care providers.”

The goal for HHVBP is to provide better care, not more of it, Ashe said.

“But again, you can’t get there and make sure the industry is prepared for growth and performance without appropriate capital to make those investments,” Ashe said.

Given the needed investment in staff and innovation, the Centers for Medicare & Medicaid Services’ (CMS) proposed payment rule is arguably even more head scratching.

“The proposed rule is certainly not in line with [the fact that] these highly-acute patients can be cared for appropriately, with a high level of satisfaction, at home,” Ashe said. “The rate pressure has been real for these providers for some time.”

There’s a dichotomy between home health needs and the policies that affect the industry, Ashe said.

However, he’s optimistic about the push from advocacy groups on legislative and regulatory fronts.

“I do believe that the policy decisions and the policy direction will be aligned with providing the right incentives, the right payment methodologies and the right investment in care at home,” he said. “I think it’s going to take a bit of time – and certainly there might be some pain along the way – but I ultimately do believe all those things are going to be aligned in the right way.”

Companies featured in this article: