With more eyes than ever on the home care industry, experts are trying to read the tea leaves to determine if greater standardization will eventually follow.
Once considered the “youngest kid” in the larger health care continuum, home care has been ushered into the spotlight over the past couple of years. A few things have activated home care’s growth spurt, Vicki Hoak, executive director of the Home Care Association of America (HCAOA), told Home Health Care News.
“In response to the pandemic, there has been much more attention paid to this particular sector of personal care, home care, but also let’s take a look at Medicare Advantage (MA) plans,” she said. “A couple of years ago when they were permitted to pay for personal care in the home, we saw a slow uptick in that. Now, Medicare Advantage plans are increasing in numbers and offering more personal care.”
Whenever a payer, such as an MA plan, enters the conversation, it’s only reasonable to expect that the sector will begin to see more standardization, according to Hoak.
Plus, home- and community-based services were on the Centers for Medicare & Medicaid Services’ (CMS) radar last year when the agency sent out a request for information asking what metrics should be used to evaluate the sector.
“Personal care is an industry that is growing by leaps and bounds, but it’s also an industry that is fragmented due to state licensure,” Hoak said. “What are our standards? How are we proving our value? Before we can prove our value, we’ve got to have set standards that everyone’s operating by.”
Indeed, home care is an extremely fragmented market made up of independent operators, corporate affiliates and franchise-backed offices. Some states have licensure requirements, while others do not.
Additionally, there is no uniformity among states that do have a licensure requirement.
In Connecticut, for example, there is no license but there is a registration process for businesses. On top of that, providers are not permitted to use any kind of medical terms in their marketing.
In Nebraska, meanwhile, home care agencies are not permitted to assist clients in bathing.
“Every state is so different that if you do anything at the federal level, it’s impossible,” Hoak said. “We have about 28 states with a license for home care. Some are so prescriptive, where they require a certain number of hours to train our home care aides. While another state, such as Pennsylvania, just requires you to demonstrate competency in certain areas, like assisting people with bathing and getting dressed.”
Among home care providers, there are specific areas where many would like to see a set standard for the industry, such as the onboarding and vetting of caregivers.
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“Who you choose to be a caregiver is the most important decision any home care company can make,” Neal Kursban, CEO of Family & Nursing Care, told HHCN. “Should there be a minimum amount of experience before they can apply to be a caregiver? It’s a debatable question. Do they have to be a certified nursing assistant or not? I think businesses have a responsibility to be much more diligent on the caregiver side.”
Maryland-based Family & Nursing Care is one of the largest private-pay home care companies in the Washington, D.C., area.
Kursban also pointed to the need for a set standard around reference checks, background checks, credit checks and social security verification for caregivers.
Jeff Salter, CEO of Caring Senior Service, said he believes that home care standardization should be focused on improving the quality of care for clients.
“There is already a lack of available caregivers. We do have to look for ways to develop more caregivers, and doing that means you’re going to have just a lot of people that are inexperienced in this industry,” Salter told HHCN. “Having standardization for the kind of training someone should have will be important.”
Founded in 1991, Caring Senior Service is a San Antonio, Texas-based personal care company that operates across 49 locations in 17 states.
Additionally, Salter sees a need for standardization when it comes to the delivery of care services.
“Not every state requires a care plan, a list of items that are supposed to be completed by the caregiver, to be established,” he said. “Many companies don’t necessarily have the caregiver complete progress or visit notes to show what work they’ve completed. Clocking in and out electronically is something to verify the caregiver was there. Those types of things are important.”
That said, any type of push for a greater standardization for home care should not come from government regulators, according to Kursban.
“Sometimes there are regulations and laws passed that don’t show an understanding of the client experience,” he said. “There are a number of accrediting bodies that I believe should be the difference-maker of these private-pay home care companies. For example, [the National Association for Home Care & Hospice] has a private-duty home care certification program.”
On its end, HCAOA has been vocal about leading the charge for national standards, as well as the difficulties that surround this.
“The challenge of establishing national standards, of course, is that delicate balance of having standards that absolutely go to care, while being careful not to put on additional administrative burdens on home care organizations,” Hoak said.
Recently, HCAOA released a code of conduct and standard of care for its members.
HCAOA views this as “best practices” for its home care member organizations. Providers that sign it are attesting to compliance with state and federal regulations, maintaining a plan of care, maintaining the appropriate insurance coverage and caregiver assurance, meaning criminal background checks and training.
“This is another way that we’re promoting some form of standardization,” Hoak said.
Ohio is a state that recently implemented new standardization and oversight measures.
Before this year, agencies providing either home health or home care didn’t always need a license to stay in business. Beginning July 1, 2022, all in-home care agencies will require a license issued by the Ohio Department of Health.
