Research conducted by Interim HealthCare has found that 82% of adults ages 18 or older would choose to receive care in their homes as they near the end of life. However, misconceptions about home-based care among providers in other settings could pose a barrier for some patients, who typically need a referral to seek out those services.
Interim’s Home Health Insights Study was designed to assess the knowledge and evolving mindset regarding home-based care among both consumers and licensed medical professionals — and how those may have changed during the pandemic. Researchers interviewed 2,070 adults. Of those,186 were health care professionals. Interim collaborated with the market research company The Harris Poll on the study.
Interim is a subsidiary of Caring Brands International. The company is a franchise that offers a continuum of care in the home, including home health, senior care, hospice, palliative care, pediatric care and health care staffing services through more than 330 locations in the United States and internationally. Private equity firm Wellspring Capital Management recently acquired Caring Brands International for an undisclosed amount.
Additional key findings include data showing that 71% of licensed medical professionals have considered a career shift to home setting; 67% of people in the United States have thought differently about their health care options due to the pandemic, and 67% indicated that their fear of dying alone has intensified during the outbreak.
Hospice News spoke with Jennifer Sheets, CEO of Interim HealthCare and Caring Brands International, about these findings and what they mean for hospice and palliative care providers.
What would you say are the most significant takeaways from the data you’ve collected? What is the story behind the numbers?
The survey results largely reinforced what many of us in home health care have already been witnessing over the years and, and certainly since the onset of COVID-19. Consumers are taking more control of their health care options and increasingly exploring ways to improve their quality of life as they age.
There’s still a widespread lack of understanding around home health care and hospice, which was a little surprising to me given how much more aware people are because of the pandemic. It was obvious that we still need to provide more education on both the prescriber and the patient side about the benefits of home health care services; 79% of seniors aged 65+ say that their quality of life would be significantly better if they could receive health care at home rather than in a hospital or nursing facility. We need to be reaching the health care decision makers for these individuals to ensure that their wishes are being met.
Another big takeaway was that the survey found that only 32% of licensed medical professionals believed that home health care is an option for acute illness, specifically an illness like COVID-19. That surprised me, as did the finding that 62% of Americans don’t know that home health care is an option for medically complex individuals. We’re taking higher and higher acuity care, certainly over the last 10-to-15 years in the home setting.
Home health care is customized, patient-centered care that caters to individual’s needs more effectively. It boosts emotional health and mental acuity. It’s also the setting where in the midst of a pandemic transmission is most minimized. It’s where the outcomes are better. It’s where people want to be, including improving overall kind of spiritual well being and quality of life with family interactions.
Home health care supports a wide variety of health care needs from from our very lowest acuity patients, the companionship, 24 hour live-in care, all the way through very high acuity, very complex [intensive care unit (ICU)] level of care at home, and then ultimately into palliation and hospice. It provides the same level of care outside of something like open heart surgery or something extremely acute, and it provides better outcomes than a hospital or long term care setting. So that was a lot. When I read the report, I thought, my gosh, we’ve got to educate more.
[Sheets told Hospice News that in this context, her use of the term “home health care” includes the full continuum of services in the home, including hospice and palliative care.]
One of the major findings was that 82% of patients prefer to reach the end of life at home. Do you think that the health care system is currently equipped to serve them in the way they need at this point?
The challenge in the home setting is always going to be ensuring there is enough supply to meet the demand as more and more people are aging and living with comorbid conditions and needing home health care services.
Speaking for Interim HealthCare, we’ve continued to meet consumers’ increasing demand for home care and hospice services through specialized programs, our development of home life enrichment, and our patient-centered care philosophy. Since the onset [of the pandemic], we were one of the first home care companies to say that we will take care of COVID-19 patients.
Since the onset of COVID, all of our business lines have have grown. The demand is stronger now more than ever. Our hospice business continues to grow, and we’ve also seen hospitals increasingly use home services the way they should be used. That is one positive trend certainly coming out of the pandemic. It’s always odd to say something is positive about the pandemic, but people are more aware of what’s being done in the home.
We’re seeing hospitals refer more appropriately to hospice, for example. We’re not seeing them refer right when death is imminent, which is a disservice to the patient and the family because the [Medicare] hospice benefit is one of the most beautiful benefits that we have at our disposal. It can provide care for months, including preparation and support for the family up to 13 months after somebody dies. We’re seeing them take advantage of the services the way that they should in a better way.
Do patients and families receive enough education about hospice and all that palliative care as well to to make an informed decision about their health care?
I think that depends on who’s doing the educating. The challenge with palliative medicine and hospice is that oftentimes people aren’t thinking about or having these discussions with their physicians or their family members until they’re in the middle of a crisis. It’s really hard to start thinking about what’s best for your family member if you’re not informed without all the emotion of a crisis.
Hospice education for us has for a long time been a focus of ours. I’ve been in hospice for quite a while, but the two things that I consistently have heard are No. 1: I wish I had known about the service sooner, and that this service really supports the family and caregivers just as much as the patient. I hear that all the time from our hospice patients and families. That’s why I love the hospice benefit.
We really have to close the knowledge gap. The reality is that home is where people want to be. I had two family members that died within two weeks of each other, one with hospice services. She was a retired English teacher, and she had a volunteer reading [Shakespeare’s] Julius Caesar to her. The other was in an ICU on life support, wasting away day after day. That created a mission for me. I am certainly on a mission to ensure that more people know that there’s great options out there for them to receive meaningful care in the comfort of their own home, wherever they are in their health care journey, including palliation and end of life.
Is reimbursement sufficient to meet the rising volume?
The short answer is no. Home care providers and stakeholders have been advocating for decades for more investments in home- and community-based services, including most recently efforts to just simply obtain funding to meet the new minimum wage mandates and state requirements.
Despite these efforts, the results have been obtaining really the bare minimum of funding. It perpetuates stagnant low wages and significantly undervalues the health outcomes that we achieve in the home, brought by millions of direct care workers.
For more than a year, our country’s been dealing with the deadly consequences of the pandemic. Throughout that pandemic, our 3 million frontline home care workers have been rushing into the fire to deliver high-quality cost-effective care. It is frustrating to say the least. It feels like we’re constantly calling for more investment. It makes it hard to recruit enough staff, which leads to this supply versus demand issue that we just discussed.
The home is the lowest-cost setting. The reality is that home- and community-based services play an integral role already and have a bigger role to play. It is the answer to our health care crisis. It’s the answer to access to care in rural areas. It’s the answer to reducing emergency room utilization, hospitalization and length of stay. There are so many profound positive impacts on the health and well being of individuals that receive home- and community-based services. More funding, in my opinion, needs to be flowing to these lowest cost, highest quality, patient-preferred settings.
You referenced the staffing issues. What impact is that having on the industry’s ability to meet this rising demand?
It’s the No. 1 challenge in the home care industry. The ongoing caregiver shortages is obviously one of our very top priorities. We’ve devoted a lot of time and resources into boosting our recruiting efforts to ensure that we can continue providing services to the growing number of individuals that need it. We don’t have a demand issue; we have a supply issue.
Our recruitment campaign is a large part of what we’ve done. That campaign specifically was targeting those that may be looking to make a transition into home health care whether they’re already in health care, or maybe they’re one of the millions of workers that were displaced due to the pandemic-related layoffs. We want to help them realize that they actually are made for home care; they might just not know it yet.
Another data point in the study indicated that 71% of licensed medical professionals have considered a career shift towards home based care. How do you define that term, “licensed medical professionals”?
The survey defines licensed medical practitioners as doctors, physician’s assistants, nurse practitioners, registered nurses, licensed practical nurses, licensed vocational nurses, and physical, speech and occupational therapists.
Do you have a sense of how the number of these professionals that have considered this kind of career shift compares to those who actually pursued a job in home-based care?
I can tell you a little bit of [Interim HealthCare’s] data, which would give you a kind of an idea. We’ve really experienced success with our recruitment campaign that was really focused on helping people realize that they’re made for home care and make the transition into it.
We launched that campaign in Dec. 2020. We’ve had a 33% increase in job post viewings and a 12.7% increase in applications all the way through the process. The quality of applicants has also improved with more than 13% of the candidates being qualified or overqualified for the role that they apply for, which is not typically what you see.
The time to hire has reduced by three days, and the conversions of those folks that apply that meet the qualifications has increased by 4%. So we’re seeing a lot of positives from it.
What does this number mean for home care industries, given the workforce shortage? How do you reconcile that level of interest versus the industry-wide labor difficulties?
In short, the future is very promising for our industry. I think what this survey tells us is that we have more education to do to help people realize what can be done in the home.
On the flip side of that people are already recognizing the value and are looking for a transition. They’re looking for a connection to purpose, and they associate that with the home health care industry. All of that to me is very promising.
Speaking as a former ICU nurse, I was drawn to home health care because I knew it’s where I could best impact the quality of care delivery for people across the world. At the time, I had small children, and [home-based care] is also the place that gives the clinician more flexibility with their hours.
Especially during the pandemic, workers have had to figure out how to manage time and expenses in the midst of homeschooling, a career, time with significant others. I believe that other clinicians that have been in my shoes will find renewed value and purpose by joining this segment of the industry. Certainly Interim HealthCare is working diligently to attract each and every one of those and add as many people as possible to our profession.
