Home care (unlike nursing homes) represent a growth market. Home care agencies are showing solid revenue growth according to the National Private Duty Association (NPDA). Seventy-one percent report that revenue increased from 2008-2009, despite a poor economy and 83% indicate that they are hiring in 2010. Meanwhile, nursing home beds are disappearing. And whether it is the CLASS act component of the health care bill or a trend to be named later, policy will eventually align to enable those who have long-term care coverage to receive that care in their preferred location -- at home, not in a skilled nursing facilities. So we have the result that all profess to have wanted for years. As with all 'this is what we wanted' trends, the law of (un)intended consequences prevails.
Home care agencies use technologies as management tools. A recent preview of the Fazzi National State of the Home Care Industry offers up a few statistics that can be very useful for vendors and others examining this market. For example, 23% of home care agencies use telehealth systems, but nearly 40% of large agencies and 50% of small agencies have telehealth units that are not in use. 50% of agencies with revenues of $5 million or more use a smartphone, half of those are using a BlackBerry. More than 72% of agencies reported cost-cutting initiatives, with most focused on enhancing productivity in the field. Although Electronic Medical Records (EMRs) have penetrated 65% of all agencies, 88.1% still maintain some paper charts.
Contrast what consumers and families want with agency focus. The Home Care Technology Association published a survey of stakeholders in the home care industry. On the consumer side, the priorities "include:
- Receiving high quality care
- Keeping costs at an acceptable level
- Having access to care
- Receiving wellness and prevention education
- Maintaining a high quality of life
- Aging in Place
And for the agencies:
- Providing high quality care to patients
- Organizational efficiency and effectiveness
- Growing the business, increasing market share
- Attracting and keeping high quality workers
- Attending to the cost of providing services
- Regulatory compliance, e.g., licensure"
Overlap is good -- quality and cost control. It's great that consumers, AARP, and agencies are aligned on desire for quality of care and control of costs. And of course, related to quality of care, the importance of keeping high quality workers who could provide continuity of and commitment to providing care. And home care on the surface appears to cost less -- the NPDA fact sheet notes that "20 hours of companionship home care costs $1500/month or $18,000 annually."
Who is watching the watchers? Telehealth system usage (or non-usage) aside, when just considering home aides who are not involved in healthcare, the coverage of 20 hours of companionship care leaves 148 hours per week with no companionship. To what degree are home care agencies considering augmenting those 20 companionship hours with any form of activity monitoring? Do they know about, resell or recommend PERS devices or passive fall detection? Do home care agencies regularly utilize web or security cameras? I have looked, but find no evidence that they do.
Industry is booming, but the workers, not so much. One reason for the growth in hiring, agencies must replace departed workers. According to the Bureau of Labor Statistics, "Occupations with the most replacement openings are usually large, with high turnover stemming from low pay and status, poor benefits, low training requirements, and a high proportion of young and part-time workers." Count home care workers as fitting that profile -- at $8.92/hour for companionship workers, according to NPDA -- even while most reporting turnover rates of '50% or less'.
Improve the quality of life for care recipient and worker. The ability to obtain great care, have an acceptable quality of life that enables aging in place outside of a nursing home at a lower cost to family, care recipient, and society -- it's what all say they want. But this is tough to achieve and demands continuity of oversight and care, not to mention a ready supply of competent and screened workers. That means that gaps of time without 'companionship' care are filled with monitoring and communication with a care recipient. It means that gaps in management oversight are filled with monitoring and interaction checkpoints for companionship aides -- extending well beyond a voice response system. It means that aides and care recipients should use telephone and pre-configured computer systems and software to power up their interactions with others -- outside the home.
History is very instructive. If you watched the growth in regulatory oversight of nursing homes over the past 20 years, it appears that many of the regulations are the result of serious risk to residents -- bad management, lack of oversight, incidents of endangerment. Let's make sure that doesn't happen with the home care boom. As the home care industry landscape grows and matures, hopefully we will see home care agencies broadly and actively seeking to deploy technologies that shore up well-clarified standards of care and communication -- between management and staff, among staff peers, and between staff, family members and care recipients. Then we can say with confidence that 'aging in place' with the support of home care really works.