Today, there are significant challenges facing home health, which could affect the industry’s ability to meet the needs of injured employees. We must be aware of these issues and be prepared with strategies to minimize resulting risks.
A key issue is the shortage of nursing professionals across health care in general and a shortage of home health aides in particular. There are an estimated 2 million home health workers across the U.S. These caregivers looked after 7.6 million in-home clients in 2007—and this number could rise to 28 million by 2030. This is because the elderly and disabled populations are growing, particularly with aging baby boomers. As a result, the U.S. may need as many as 1 million new home health aides by 2026.
Home health aides work under the direction of nursing or medical staff, and they’re responsible for myriad tasks, including bathing, measuring vital statistics such as blood pressure, administering oral medications, managing incontinence, moving non-ambulatory patients to avoid bed sores, assisting in personal hygiene, grooming, dressing and feeding patients, as well as performing light housekeeping tasks. It’s no wonder they’re considered the heroes of home care.
While in-home nursing professionals maintain relevant licenses, home health aides often undergo mandatory training and certification. Both professionals are often employed by home health and home care agencies—of which there are more than 17,700 in the U.S.
In the near future, the pace of demand for home health workers will likely exceed supply. The expected workforce shortage will hit 446,300 workers by 2025, according to Mercer, a human resource consulting firm.
Meeting the home health needs of injured employees
While staffing shortages persist and grow, meeting the home health demands of injured employees continues to be a complex, multi-faceted process. An injured employee’s home is a private, intimate setting. Injured employees—as well as family members—want to feel comfortable with the caregivers they invite into this space.
Injured employees may be struggling with a difficult transition—going from function and independence in performing work and daily activities—to now living with a disability and requiring ongoing care and personal assistance. As a result, they need compassionate health professionals, who are also highly skilled and experienced in caring for those who have experienced a severe or life-altering injury. Some injured employees will require 24/7 home care, so they’ll spend significant time with these caregivers and need to feel comfortable with these individuals, typically over a long duration.
What a quality specialty networks organization can offer
Today, claims adjusters already have a full plate of responsibilities, so they need to be able to hand off the home care coordination process. If an injured employee is to be discharged from a hospital or facility, the adjuster or case manager will immediately notify the specialty network organization to arrange services with its home care coordinators, so they can set up home health services in a timely fashion.
The first order of business is to match the injured employee’s medical needs to the appropriate skill level required—whether that’s a registered nurse (RN), licensed vocational nurse (LVN), licensed practical nurse (LPN), certified nursing assistant (CNA) or home health aide (HHA). If necessary, home care coordinators will speak to the treating physician or case manager to get clarification on patient needs. They will assess and facilitate total home care, as well as specialty service requirements, in a comprehensive plan, which may include durable medical equipment, supplies, transportation, and home or vehicle modifications.
If possible, they will also speak to the injured employee and family members to assess social, lifestyle, and environmental factors that can affect the match: Does the family have pets, such as cats and dogs, to which a caregiver might be allergic? Is there a preference for a male or female caregiver? Are there other critical issues or preferences? In other words, the care coordinator will make sure there’s a medical and personality match.
Some states allow injured employees to hire family members to provide in-home supportive services. It’s important that a home health professional fit into the overall family, home and caregiver-team dynamic. Over time, the specialty service provider may consult with the treating physician and case manager to see whether the caregiver skill level can be reduced—perhaps from a nurse to a home health aide—which can help save significant costs, especially over the life of a claim requiring 24/7 care.
Ensuring quality, consistent home care services
It’s important to ensure excellent home health, despite staffing shortages. This includes staffing cases with home care professionals who are dependable. They must consistently attend their scheduled patient appointments. In addition, there must be a process in place to substitute staff if a caregiver is sick or requires personal time off. If no-shows occur at the last minute, family members may not be available to fill in, and injured employees could be left without medical care or personal assistance. In addition, constant switching of home health staff could disrupt continuity of care, and ongoing turnover could result in patient dissatisfaction.
To proactively address such issues, payers should partner with a respected specialty network organization that has a broad national network of home health and home care agencies. This provider will usually collaborate with several agencies in a region to make sure it can cover all of its cases.
The specialty network will also ensure that the agencies it works with have a track record of dependability and consistency, and policies in place mandating staff to provide early notification if they must miss work—otherwise, they could jeopardize the health and safety of injured employees.
Across its many agency partnerships, a reliable specialty network will have access to a deep bench of expert home health professionals, which will enable it to proactively substitute and replace caregivers as needed. Due to the volume of business and favorable terms it provides agency partners, it’s able to obtain prioritized handling of its cases. In the end, payers can avoid the scenario where a claims adjuster receives a frantic call from a family member, saying a nurse or home health aide has not shown up. Instead, gaps and disruptions in home care are avoided.
This post first appeared on workerscompensation.com.
About the author
Bob Smith is the president of Apricus. Over the past three decades, Bob has been recognized as one of the leading executives in the workers’ compensation industry, with a reputation for increasing national sales at several companies by 200–300 percent. He holds a BA from Curry College and an MBA from Heed University, and is a regular contributor to The Sounding Board.