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Home health providers are transforming patient care by incorporating specialized home health care initiatives, from pediatric support to dermatology and dental services.
These innovative approaches aim to enhance safety, expand access and address workforce shortages, underscoring the evolving landscape of health care delivery in the home. Despite manifold benefits for patients and bottom-line benefits, regulatory and reimbursement challenges are likely to hinder the adoption of specialty in-home care offerings, experts told Home Health Care News.
“I certainly believe that financial incentives combined with opportunities to provide care to the underserved, homebound population will drive further home-based care,” Dr. Hao Feng, an associate professor of dermatology and director of laser surgery and cosmetic dermatology at UConn Health Department of Dermatology, told HHCN. “Certainly, some services can be furnished appropriately, but I expect regulatory hurdles will prevent the delivery of more complex procedures in the home setting.”
Pediatric intensive care at home
Each year, over 300,000 infants are admitted to neonatal intensive care units (NICUs) in the U.S., with the Centers for Disease Control and Prevention (CDC) reporting a 13% increase in NICU admission rates between 2016 and 2023. Research shows that many of these patients remain in the hospital after they are ready for uncomplicated discharge – opening the door for increased in-home pediatric services.
To help move these children home, Bayada provides in-home pediatric care to over 4,000 clients each week, with 10% of these clients discharging from NICU under 18 months old. Pediatric care accounts for approximately one-third of the organization’s total business, according to Cris Toscano, skilled nursing practice president.
Skilled nurses manage complex cases, including those involving technology-dependent children, with the goal of achieving eventual independence.
“We bring children home from the NICU, and they may be technology-dependent or ventilator-dependent,” Toscano told HHCN. “As they age and grow, sometimes we can wean them off the ventilator; sometimes we see them ‘graduate’ from our services. Those are our best days – when they no longer need us.”
Moorestown, New Jersey-based Bayada provides home health, home care, hospice and behavioral health care services in six countries. Bayada has about 32,000 employees in the U.S.
Toscano said that some patients stay with Bayada’s services for years, allowing them continuity of care and the ability to build a relationship with the agency, helping them thrive and grow.
However, obstacles such as insufficient reimbursement and nursing shortages make providing this type of care challenging.
According to Toscano, across the country, NICUs are either at or above capacity. Generally, these children are ready for discharge, but there are too few nurses to take them home, she explained. That, in turn, limits the availability of NICU beds for other children.
Some children who can be cared for at home are served by multiple agencies due to workforce shortages. This can reduce continuity of care and add complications for families trying to coordinate schedules around multiple agencies.
Toscano said Bayada focuses on ensuring it has sufficient staff to provide quality care through a single agency.
“These families build trust in their caregivers by having the same person around,” Toscano said. “They know the child, and that relationship is especially important in high-acuity situations. However, ensuring the match aligns with the family’s situation or home environment is crucial. That is the beauty of home care – every single client and family is unique, and we strive to create tailored care plans for each one, as it’s not a one-size-fits-all approach. We’re caring for sick kids who need us, and we have to give our best every day.”
In the battle against workforce shortages, home health care agencies are competing with health systems that can offer their skilled nurses higher wages due to different reimbursement rates. Therefore, Bayada is increasing its focus on workforce development programs to boost its employment numbers.
“We have a new graduate nursing residency program,” Toscano said. “This year, we will graduate over 500 students. That allows us to bring in nurses and start them with lower acuity clients, building their skills. We have simulation labs in 95 offices, and we can put them through those labs. That’s another way we offset the workforce shortage that we face now and will probably continue to see. The demand for pediatric and NICU services continues to grow.”
For Bayada, the return on investment goes beyond just dollars and cents, Toscano said. The health system can free up capacity and care for another sick child; home health care offers a more cost-effective option for payers, and it is “fundamentally the right thing to do” for clients.
“The money part of it is secondary,” she said. “It’s all about how we get these children home and keep them home safely when they are ready for discharge so that they don’t have to celebrate their first birthday in a NICU when they could have gone home six months ago.”
Moving forward, Toscano said she sees an opportunity to advocate for clients, families, caregivers and clinicians to help payers and politicians understand the importance of home health care.
“Imagine not being able to hold or parent your child because while they’re in the NICU, you are a visitor,” she said. “Our opportunity is our ongoing passion for advocacy, ensuring that we are all voices for those who cannot speak for themselves.”
Toscano stated that feedback on the NICU program has been overwhelmingly positive, as evidenced by client satisfaction surveys.
“Their genuine appreciation for the focus, thought and training that has gone into making sure these nurses are bringing their child home and are competently providing the same level of care their child received in the NICU really comes through,” she said.
Dermatology visits in the home
The number of home-based dermatology visits has increased by 600% since the onset of the COVID-19 pandemic, according to Medicare data. At-home visits make up only a small portion of approximately 17 million dermatologic procedural services provided nationally, but the increase indicates a growing trend, according to a new study in the Journal of the Academy of Dermatology.
The number of home-based dermatologic procedural visits – about 57,000 – is small compared to the total of 17 million dermatologic procedures, according to study author Feng of the UConn Health Department of Dermatology. However, researchers observed a clear pattern of increasing home-based dermatologic procedures since 2019, and they expect this trend to continue.
Feng said that patients who have difficulty accessing the clinic would benefit the most from home visits, whether due to their medical comorbidities, transportation issues or lack of social support. Safety is paramount in providing care regardless of the service setting, according to Feng.
Feng said the most significant benefit of home-based dermatology service is serving as an initial triage, allowing medical professionals to visit patients at their homes when they have difficulty traveling to clinics. Some minor procedures, such as liquid nitrogen cryotherapy, and moderately complex procedures, like biopsies, can be effectively performed at home for both treatment and diagnosis.
If barriers, including regulations and financial limitations, can be overcome, such in-home offerings could be critical for patients, Feng said.
“The challenge will be the financial and regulatory requirements to provide home-based care,” Feng told HHCN. “One can see many more patients and provide a much wider range of procedures safely in the office. The opportunity is that there are likely many patients who would benefit from home-based care, and there is recognition of the need for this kind of service.”
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