The frontline caregivers who visit patients’ homes and provide help with their activities of daily living (ADLs) often are the unrecognized helpers, preventing chronically ill patients from heading to the emergency department (ED) or hospital.

As population health initiatives and case management increasingly transition at-risk patients home and keep them out of the hospital, there is a greater need for home-based resources, said Gavin Ward, regional director of strategy and partnerships for 24 Hour Home Care in Los Angeles. Ward, who is certified in readmission prevention and bundled payments, spoke about leveraging non-medical home care in value-based care at the Case Management Society of America’s virtual conference, held June 28-July 2. (For more information, visit this link: https://conference.cmsa.org/on-demand/.)

“This leads to greater opportunities for home care services to help, but the challenge is that it’s typically private pay,” Ward explained. “There’s more home-based care, which is great, but the cost of care for private duty and non-medical care is outpacing inflation.”

A new, positive trend is that an increasing number of payers are including non-medical home care as a supplemental benefit. One example is Medicare Advantage health plans, which offer personal care and respite care as a supplemental benefit.

“If case managers have a patient who is low-income, going home, and can’t afford private duty care, there may be a chance their health plan has a supplemental benefit to pay for short-term care in home and respite care,” Ward said. “Some plans offer up to 80 hours a year of respite care, and certain plans have 150 total hours of care.” This is good news for case management as it expands resources for patients.

Non-medical home care also has adjusted to the COVID-19 pandemic. When the United States shut down most businesses during the early weeks of the pandemic, non-medical home care agencies saw a decrease in demand for their services.

“One reason why the hours decreased is because family members were now able to work from home and care for their aging loved one,” Ward explained. “Or, they were so fearful of having someone come into the home that they were finding alternatives.”

Hospitals, which are a chief referral source for non-medical home care agencies, also saw a decline in their census. There were fewer people they could refer to the agencies. “The pandemic had a significant impact temporarily to companies that may have partnered with hospital systems.” Ward said. “In some rare cases, we did see some families increase the hours. One of the reasons was they wanted one caregiver to just work with them and not work with multiple clients over their fear of infection.”

The effects of the pandemic stabilized, and the biggest need for non-medical care was in senior living facilities, Ward said. When assisted living facilities experienced a COVID-19 outbreak, they asked for non-medical home care workers to supplement their staff. This also posed a challenge, as it was difficult to find staff willing to go into a facility with a COVID-19 outbreak, particularly before healthcare facilities could ensure access to personal protective equipment (PPE).

“We were one of the first to secure PPE,” Ward noted.

In California, the state surveyed non-medical home care agencies to ask if they could care for COVID-19-positive patients, both in home settings and senior-living communities. “They made an alphabetical list of which non-medical healthcare agencies were willing to take on COVID-positive cases,” he added.

Compiling a list makes it easy for case managers, patients, and families to find help for ADLs as the patient returns to the community after days or weeks in the hospital.

In states without that list, it would be helpful for case managers or a resource person to call non-medical home care agencies to see which ones could handle COVID-19 patients. Then, they could provide patients with the list, Ward said.

Caregivers in non-medical home care agencies also could be resources for case managers as they transition patients home. They often see clients more frequently than healthcare providers, and could identify changes in their condition. For example, if a person with congestive heart failure experiences trouble breathing and a severe weight gain, the non-medical caregiver will see this and get the person to a doctor’s appointment, Ward explained.

“That’s a common example of how caregivers can prevent emergency departments and hospitalizations,” Ward added.