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News not all bad for home health during tough economy
Bad housing market, shaky job market open doors for HHAs to succeed
No industry is completely recession proof and home health agencies are facing challenges as the country deals with the current economic crisis. But there is a silver lining in this economy for home health.
"People continue to get sick, even in a bad economy," points out Vicki Karlovich, LPN, CEO of Sacred Rose Healthcare, a Springfield, MO-based home care provider. "We've seen a slight increase in referrals for Medicare patients. But I don't know if we're doing a better job marketing our agency or if we're getting the referrals from word-of-mouth recommendations," she admits. The bottom line is that Medicare coverage for home health means that the agency will be paid, she says.
The staff members at Dunn Memorial Hospital Home Health also are seeing an increase in referrals, says Bonnie Dixon, RN, BSN, director of the Bedford, IN, agency. Although patient census does typically go up and down throughout the year, the number of admissions is higher than normal for this time of year, she says. "We do seem to be getting new referrals from commercial insurers in addition to referrals for Medicare patients," she says.
Although increased referrals are good for the agency, Dixon points out that a patient with coverage from private or commercial insurers requires more staff time to coordinate the admission, coverage determination, and plan of care. "Different calls need to be made to verify coverage, determine benefit limitations, and get approval from a case manager," she says. Multiple calls to multiple departments requires time and additional documentation, so agencies need to be prepared to handle the extra steps needed for private insurance, she warns.
Increasing patient volumes also mean an increased need for nurses, aides, and therapists, but home health agencies are not experiencing retention problems, says Karlovich. "People are less likely to change jobs in this economy, because they lose their seniority when they go to another employer," she says. "Even the hospitals in our area are laying off people, so our agency is seen as a good place to stay," she adds.
Patients want to avoid co-pays
"We are also seeing more patients who choose home health care over care in a nursing home, because the Medicare nursing home benefit has a co-pay," says Dixon. Patients are watching their money carefully, and if they can avoid paying out of their pocket, they do so, she says. "Traditional Medicare coverage of home health does not require a co-pay, but we are seeing more patients who opted for Medicare HMO coverage and they do not understand that this means they have a co-pay," she says.
Dixon's staff spend a lot of time educating patients at their initial visit about the difference between traditional and HMO coverage, something that wasn't always explained to them at the time of purchase, she says. "We had one patient who bought the policy from a family member, and that family member didn't realize there was a co-pay required in the policy she was selling," she says. "A 15% co-pay can be a significant amount of money, so we have had patients choose not to use home health after they realized how much they might have to pay," she adds.
Her staff also worked quickly with one patient when a staff member discovered that the patient had switched to a Medicare HMO policy during the episode of care, says Dixon. Staff members found out during the 30-day period that the patient had to change her decision, so the patient was advised to cancel by phone and by letter, so that the cost to her would be minimized. "We lost money on that patient's care, because we had to switch from traditional to HMO coverage for a couple of weeks, but it was not as much of a financial burden on the patient as it could have been," she says.
One reason that patients may be looking for home health care more often is a desire to stay in their paid-off homes, says Karlovich. Some of these seniors in different areas of the country may have trouble selling homes to move into assisted living or nursing facilities, so they may need additional assistance during the day, she says. This often means private duty care, she says. "We are very selective about the private duty clients we admit," she says. If a private or commercial insurer covers the patient, the client is usually admitted, but private-pay patients are not always accepted, she says. "We have written off more bad debt for private pay patients than any other patients," she says. "It is hard to collect, and often families will just change agencies every few months so they don't have to pay," she says. Private pay patients that the agency accepts are usually patients for whom the agency has provided other services, so a relationship already exists, she says.
Although Home Instead Senior Care, a national network of locally owned private duty home care franchises, saw a 15% growth in 2008 and is projecting another 15% growth in 2009, individual clients are making changes in the frequency of service, says Dave Banark, vice president of business performance for the company. "We are seeing some clients cut the number of days of service from five to three, but most clients are staying with the agency," he says. Individual agency owners also are reporting that new clients are "smaller," meaning that they initially select fewer days of care than clients in the past, he adds.
This is an excellent time for all home health agencies to market their services, says Banark. He encourages managers to stay in front of referral sources and the community, so that their agency stays top of mind when people do need home health. "Even though the economy may keep people from seeking home health today, if you build strong relationships now, they will become clients in the future."
Another reason that clients may be starting service with fewer days of care per week than in the past is an increasing trend for adults to move their parents into their own homes, says Banark. "Our company's research shows that 43% of family caregivers are providing that care in their own homes," he says. This often means that three generations live under the same roof, he points out. Although family members may not consider private duty care as necessary when the older parent lives with them, it can be an important respite tool, he adds.
Overall, the strategy to surviving during a tough economy is simple for home health, says Karlovich. "Just take everything day to day and be aware that even when other industries are struggling, there are opportunities to succeed in home care."
For more information about home health trends in today's economy, contact:
Dave Banark, Vice President of Business Performance, Home Instead Senior Care, 13330 California Street, Suite 200, Omaha, NE 68154. Telephone: (888) 484-5759. Fax: (402) 498-5757. E-mail: firstname.lastname@example.org.
Bonnie Dixon, RN, BSN, director, Dunn Memorial Hospital Home Health, 1530 23rd Street, Bedford, IN 47421. Phone: (812) 276-1245. E-mail: email@example.com.
Vicki Karlovich, LPN, Chief Executive Officer, Sacred Rose Healthcare, 1736 E. Sunshine, Suite 712, Springfield, MO 65804. Telephone: (417) 887-2121 or (866) 772-2121. Fax: (417) 882-3966. E-mail: firstname.lastname@example.org.