Home Health Agencies Grapple With ‘Acuity Creep’ As Patient Needs Become More Complex

In recent years, due to factors like the pandemic and the reinvention of hospitals, home health agencies are having to take care of much more complicated patients.

As the demand for home-based care continues to rise, so does the need for more intensive care plans as patients continue to be sicker and more complex.

Home health agencies are feeling this “acuity creep,” and they’re adjusting. But at times, it’s hard to keep up.


“When I’m talking about acuity creep, I’m thinking about how much need do the patients in our care models require?” Michael Johnson, president of home health and hospice at Bayada Home Health Care, said. “It’s not just medical needs, either — there’s a social need as well. We’ve seen a definite increase in the needs of our patients.”

The Moorestown, New Jersey-based Bayada is one of the largest home health providers in the country. It has over 360 locations across 23 states and six other countries.

In order to find out if the acuity creep had affected Bayada, Johnson recently dug through the last four years of PDGM data for patient diagnoses and found a noticeable decrease in categories like musculoskeletal rehab and an increase of patients who needed neuro rehab, cardiac and complex behavioral health.

Michael Johnson, president of home health and hospice at Bayada Home Health Care, speaks at Aging Media Network’s Continuum.

The last three categories can be filed under “more need,” Johnson said. With the need for intense care comes the need for more nurses, home health aides and other caregivers.

“When they’re sicker — as we’ve seen it — we need nursing care for the same person,” Johnson said. “In the case where there’s a nursing shortage, that becomes a bit of a crunch, so from a staffing perspective, that’s been a challenge. When I think about need, I think about workforce.”

Eric Gommel — chief strategy officer at Virginia Health Services — is also focused on workforce development due to this acuity creep.

Virginia Health Services is a provider of home health, palliative and hospice care, and also offers senior housing and other nursing services.

The company has invested heavily in apprentice programs and career ladder initiatives as a way to combat the acuity creep.

“They’re the primary people taking care of our seniors,” Gommel said. “It’s the sad reality of our society that we expect the most out of our children and these caregivers – and we pay them the least.”

Many of the issues that arise when trying to take care of more complex patients, Gommel has found, are in the preparation and education of staff members.

“On the acuity side, when I think of [Institutional Special Needs Plans] or value-based plans, the physician is very skilled and is on top of it; the insurance company is on top of it; the training and ability to handle those higher acuity patients is where the problem lies,” Gommel said. “You have to invest in your team, and that means making sure they’re not turning over and you’re spending time preparing them for these changes.”

The other concern for home health agencies is that now that star ratings have dollars attached to them — through the Home Health Value-Based Purchasing (HHVBP) Model — agencies might take fewer complex patients for reimbursement reasons.

“Hopefully that doesn’t happen, but we can’t keep up with demand,” Johnson said.

Regardless of how quickly higher acuity patients are getting care into the home, both Johnson and Gommel believe investments made in home-based care are good ones.

“I do wholeheartedly believe that the home is going to be the growing center for where people are going to receive their care,” Gommel said. “I have that unpopular stance where I’m still trying to figure out what the role of a SNF is, and how many beds we actually need. I’m betting on home.”

Then again, home health agencies need qualified and prepared nurses in order to make those investments worthwhile.

“A really good home health aide is worth his or her weight in gold,” Johnson said.

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