Get the home health forecast from in-the-field experts
Get the home health forecast from in-the-field experts
Will the industry find sunny days or gray skies?
The home health care industry is expected to be "one of the fastest growing occupations through 2008," according to the U.S. Department of Labor in its Occupational Outlook Handbook, 2000-01. Translated, this means that employment projections are expected to increase by 36% or more during this period.
Of course, some of the job openings come as a result of high turnover, due in part to an industry that demands a great deal of physical and highly emotional work from its employees and rewards them with long hours and little pay. Even so, don’t overlook the projection of substantial growth throughout the industry as today’s baby boomers become tomorrow’s elderly.
As the number of seniors (70 and older) increases, so too will America’s need for in-home health services. The Department of Labor called this trend the result of "efforts to contain costs by moving patients out of hospitals and nursing facilities as quickly as possible, the realization that treatment can be more effective in familiar surroundings rather than clinical surroundings, and the development and improvement of medical technologies for in-home treatment."
Hospital Home Health spoke with leaders in home health care to see what their predictions are for the industry.
HHH consulted Gregory Solecki, vice president of Henry Ford Home Health Care in Detroit; Gary Thietten, president/chairman for Idaho Home Health and Hospice in Twin Falls; and John C. Gilliland, a health care attorney with Locke Reynolds LLP in Indianapolis. Will there be a workplace shortage, especially in the area of nursing? Will the industry grow as a result of demand? Will hospital-based home care distinguish itself further from independent agencies? Here’s what those experts had to say:
HHH: Will there be a significant growth in home care and to what would you attribute this expansion?
Solecki: "We used to hear so much about home health care being the wave of the future, and for awhile, we really did see rapid growth. I’m not necessarily referring to growth in numbers of visits, but rather growth in patient admissions to home health care.
"I strongly feel the growth was due to the nature of the service. Aside from the convenience and comfort factors that are part of the home care experience, nurses have an amazing degree of respect in our communities. They are viewed by many as the heroes who attempt to stay true to their mission despite the change and confusion that exists in the health care industry.
"Having a skilled health care professional come to your home, truly listen to your concerns, provide you with one-on-one care, and teach you and your family members about your care without interruption(s) is a very powerful, patient-focused approach to care. In any other sector, such dedicated customer service would result in strong market demand, which would translate into growth and success. Unfortunately, the Medicare-certified approach can often be a barrier to growth and customer satisfaction.
"I think that despite this, the ability of home health care to grow is currently limited by staffing challenges, and recruitment of staff is limited, in turn, by the regulatory and paper burden imposed on Medicare-certified agencies. In fact, it’s quite ironic that one arm of the federal government is predicting something that another arm of the federal government is restricting."
Thietten: "From what I understand, it is likely that the Department of Labor is calculating its employment projections based on prior [interim payment system]/PPS [prospective payment system] statistics. While I think there will continue to be growth due to a variety of factors, including an aging baby-boomer population and an increased focus on healing at home, certainly this growth will be at a much slower pace than the Department of Labor is forecasting."
HHH: Where do you see the biggest demand for employment?
Gilliland: "I feel employment opportunities will increase greatly in home care, but I think the increase will be in the home health aide and attendant/personal care types of jobs rather than skilled. That is where the demand is greatest — simply to gain assistance with activities of daily living and respite. The problem is simple: Where are the workers for those jobs going to come from? Those jobs are not particularly well-paid, nor do they offer opportunities for advancement. It may very well be a situation of society having a great demand for the services but being unwilling to pay sufficiently for them to attract enough qualified workers. I think this will be the same situation for hospital-based as for independent agencies."
Solecki: "Since baby boomers comprise the largest generation along the age continuum, employment demand appears to be a matter of mathematics. The problem is simple — there simply aren’t the numbers in subsequent generations to fill the need. But more than that, of those numbers, fewer people are choosing to pursue health care careers. We have seen that with all health care professions, but especially with nursing. A nursing employment gap already exists due to low nursing school enrollment in the ’90s. Even though nurses are the heart and soul of home health care, why would they choose a career in home health care in its current state? There are too many regulations, too much paperwork, and not enough patient care, which, I hope, is the primary motivation for pursing a nursing profession in the first place. "The difference in staffing during our earlier growth periods vs. any future projected growth period is that the regulatory burden and paper intensity have increased, and enough nurses have now experienced home health care and have told their colleagues about the downside. Perhaps, we will have to explore alternative staffing models that keep nurses at the forefront but free them from the minutiae."
Thietten: "While it appears there is and will be a nursing shortage, I see nurses attracted to home health for a variety of reasons, especially the fact that home care is a more independent practice and gives you some freedom in scheduling."
HHH: Where does hospital-based home health fit into all of this? Will it continue to prosper or will most agencies become independent?
Gilliland: "To me, the key behind the future success of hospital home health is for hospitals to recognize that home care is a different business from a hospital and to allow it to be run as a home health agency rather than as a hospital. I would expect most successful agencies (meaning profitable in their own right) will be structured to be independent from the hospital. Hospital management will have difficulty understanding the importance of that."
Solecki: "I don’t think we can make a generalized prediction about hospital-based or freestanding home health care agencies. Agencies that stay true to their mission, embrace quality care and customer satisfaction, and maintain their integrity will prosper regardless of auspice. I’m sure some hospital-based home health agencies will spin off and become freestanding. That’s not the model we have chosen for many reasons.
"However, I strongly feel all successful home health agencies will be linked to a hospital or system in some way, whether loosely or tightly. There are too many white spots along the health care continuum where we see patients fall through the cracks. The transition between spots on the continuum, whether from hospital to home or home to hospital, requires closer and more significant collaboration. We like to do this within our system. Others may prefer to do this outside a system. Nevertheless, I think the hospital, the home health agency, and the patient will all be better off when we work more closely on some form of integration.
"Having said all this, I am certain our industry will somehow continue to grow. Our communities are now beginning to see what we on the inside have seen for the past few years, and the pendulum will swing back. As patients, families, and community leaders advocate our position more vehemently, we will see a more reasonable approach to the Medicare-certified model. If we don’t see more reasonableness, I am convinced the industry will grow in other than Medicare-certified ways. We provide too valuable and meaningful a service and one that the customer demands."
Thietten: "Concerning hospital-based home care agencies vs. independents, I think we will continue to see a combination of competition, closures, new agencies, and mergers. In fact, under PPS, good managers may be looking at even a broader range of cost-sharing and joint-venturing methods. PPS may influence a local hospital-based agency and a proprietary freestanding agency to enter into new types of cost-sharing engagements. For example, they might opt to share software/ hardware or even divide referral territories to maximize savings."
[For more information, contact:
• John C. Gilliland, Locke Reynolds LLP, 1000 Capital Center South, 201 N. Illinois St., Indianapolis, IN 46204. Telephone: (317) 237-3214.
• Greg Solecki, Vice President, Henry Ford Home Health Care, One Ford Place, 4C, Detroit, MI 48202. Telephone: (313) 874-6500.
• Gary Thietten, President/Chairman, Idaho Home Health and Hospice, 200 Second Ave. N., Twin Falls, ID 03301. Telephone: (208) 734-4061.]
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