The caregiver shortage hurts agencies and families

A whopping 64% of caregiving hours are provided by family members or friends, according to the Center for Retirement Research at Boston College (CRR). That means that only a little over a third of caregiving hours are provided by home health and home care professionals. 

Capturing more of the growing market share isn’t about outperforming your local competitors or big, private equity-owned chains. It’s about finding a way to serve more patients who currently think they can’t afford or don’t qualify for home health services.

We’re at the very beginning of the Baby Boomer aging curve. This year the oldest turn 80 (about 6 million or so). That’s the age when most adults start to need care. This number will only grow in the coming decades, doubling in 10 years, and tripling by 2060. So even when we factor in the large percentage who will receive care from a family member or friend, there will definitely be more patients to serve.

But we’re already facing a shortage of home health aides. Add to this the current administration’s actions on immigration (the source of more than a quarter of professional care workers) and home health agencies (HHAs) will be scrambling to hire and retain enough home health aides to meet the growing demand. Agencies that get ahead of the curve on staffing will best position themselves for growth. 

Activating a new workforce: professionalizing family caregivers

The good news for HHAs is that those family members who are caring for two thirds of our nation’s older adults are hungry for training, support, and compensation. They’re already performing care tasks that HHAs would otherwise be paid to provide and struggling under the financial strain of caregiving. Many find themselves in this position because the person they care for can’t afford to pay for care out of pocket but doesn’t qualify for Medicaid.

Professionalizing these family health workers is one path to easing the home health aide shortage and lifting families’ financial burden.

Leveraging existing Medicare policy

The other thing working in favor of HHAs, is that Medicare covers home health services for as long as they’re medically-necessary, even if the patient’s condition isn’t expected to improve. While this has been the case since 1965, some patients were being denied coverage based on the premise that their conditions were not improving under that care. This premise was debunked in 2013, with the settlement in the Jimmo vs. Sebelius case. 

Here’s what happened: in 2011, the Center for Medicare Advocacy and Vermont Legal Aid brought a class action lawsuit on behalf of beneficiaries throughout the country who were denied Medicare coverage for home health services because they were not improving. 

In 2013, the federal district court approved a settlement agreement with CMS. The settlement concluded that Medicare covers skilled care to maintain an individual's condition or slow decline. This standard applies to home health care. 

CMS updated its policy manuals and website and issued notifications regarding this settlement. But some home health providers and most families are unaware of this benefit. And HHAs that are aware of the benefit still have that staffing issue to contend with.

HHAs win, families win, Medicare wins

Serving more eligible Medicare beneficiaries by professionalizing the family members or friends who care for them can benefit everyone:

• HHAs can serve more Medicare beneficiaries
• Patients can receive the professional care they need from someone they trust
• Unpaid family health workers can be trained, certified, hired, and compensated for the care they provide
• Medicare saves 22%-25% per member per month on healthcare costs with members who require and receive a high dosage of home health aide services.

How RubyWell helps agencies overcome the caregiver shortage

At RubyWell, we conservatively estimate that 12 million Medicare beneficiaries are eligible for covered home health services on an ongoing basis. But last year, only about 4 million people used this benefit. 

Our technology identifies patients in the community who are eligible for this covered care and creates documentation they can share with their physician to facilitate the home health referral order conversation. 

Meanwhile, if the family member or friend who cares for them is interested in getting trained, certified, and hired to provide covered home health services, we can help them access home health aide training and certification. We then refer both the patient and their family member to a partner home health agency. The agency can assess the patient, interview the newly certified home health aide, and provide care and paid employment to them, respectively. 

In this way, we help patients, caregivers, and care teams work together to safely manage health at home and address the caregiver shortage.

There’s no shortage of articles out there warning older adults and their caregivers to prepare for the astronomical cost of long term care. But all the financial planning in the world won’t help them if there aren’t enough professional care workers to go around. By professionalizing dedicated, experienced family health workers, RubyWell is helping home health agencies meet the demand, grow their census, and serve their communities. RubyWell currently partners with home health agencies in Arizona and Pennsylvania. And we’re expanding to Connecticut, Florida, and Massachusetts this fall. Learn more about partnering with us or schedule a meeting here.