By Bob Smith, CEO at Priority Care Solutions, a division of Genex Services
When employees sustain complex, severe or catastrophic injuries, they may require home health services. Today, there are significant challenges facing home health, which could affect our industry’s ability to meet the home care needs of injured employees. We must be aware of these issues and be prepared with strategies to minimize resulting risks.
Today, 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.1 These caregivers looked after 7.6 million in-home clients in 2007 – and this number could rise to 28 million by 2030.2 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 one million new home health aides by 2026.3
Home health aides work under the direction of nursing or medical staff, and they’re responsible for a myriad of 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 (“agencies”) – of which there are well over 17,700 in the U.S.4
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.5
Meeting the needs of injured employees
While staffing shortages persist and grow, meeting the home health needs 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, caring 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 will spend a significant amount of time with these caregivers and need to feel comfortable with these individuals, typically over a long duration.
What a quality ancillary service provider 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 nurse case manager will immediately notify the ancillary service provider to make its home care coordinators aware of the impending date, so they can set up 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 nurse assistant (CNA) or home health aide (HHA). If necessary, home care coordinators will speak to the treating physician or nurse case manager to get clarification on patient needs. They will actually assess and facilitate total home and care needs 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, a wise 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 be able to fit into the overall family, home and caregiver-team dynamic. Over time, the ancillary service provider may consult with the treating physician and nurse case manager to see if 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
In light of staffing shortages, a big part of quality is ensuring that cases are staffed and home care professionals show up – or that a process is in place to substitute staff if a caregiver calls in 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 the medical care and personal assistance they require. In addition, constant switching of home health staff could disrupt continuity of care, and ongoing turnover could result in patient dissatisfaction.
To proactively nip such issues in the bud, organizations should partner with a quality ancillary service provider 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 ancillary service provider will also ensure that agencies it works with have a track record of dependability and consistency, and policies in place requiring 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, an ancillary service provider 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, organizations can avoid the scenario where a claims adjuster receives a frantic call from a family saying a nurse or home health aide has not shown up. Instead, gaps and disruptions in home care are avoided.
About Bob Smith
Bob Smith is CEO of Priority Care Solutions (PCS), a division of Genex Services. With more than 30 years of experience, he is highly influential in the workers’ compensation industry. Bob oversees sales and marketing, the development of new products, and evaluates potential acquisitions that would enhance the company’s overall growth while supporting the corporate vision. Prior to joining PCS, Bob served as senior vice president of RSKCo., a division of CNA Insurance, where he was instrumental in developing RSKCo into one of the industry’s leading third-party administrators. He also held senior leadership positions at leading ancillary service companies within the workers’ comp industry, including Healthcare Solutions, TechHealth and Universal SmartComp.
About Priority Care Solutions
Priority Care Solutions (PCS), a division of Genex Services, is a leading specialty managed care services and network provider for the workers’ compensation industry. The company draws on the cumulative experience of its executive team with an average of 20 years in all areas of workers’ compensation. The company has used this experience to create unique, proactive solutions that mitigate risk, create operational efficiencies and reduce costs, while providing compassionate, exceptional, and timely care to injured employees.
Based in Tampa, Florida, PCS works to meet the ancillary service needs of carriers, third-party administrators, self-insured employers, government agencies and managed care organizations. Its comprehensive set of solutions has helped to tackle the industry’s most pressing challenges. The results are faster, more efficient and cost-effective claims resolution and injured employees who receive the care they need.
1Kardish, Chris, “Are Home Health Workers Worth More Than Babysitters?” Tribune Regional News, March 1, 2015.
2Baron, Sherry, “Protecting Home Health Care Workers: A Challenge to Pandemic Influenza Preparedness Planning,” American Journal of Public Health, 2009.
3Rolf, David, “Life on the Homecare Front,” American Society on Aging, Spring 2016.
4Baron, Sherry, “Protecting Home Health Care Workers: A Challenge to Pandemic Influenza Preparedness Planning,” American Journal of Public Health, 2009.
5Baxter, Amy, “Where the Home Health Aide Shortage Will Hit Hardest by 2025,” Home Health Care News, May 6, 2018.