Turnover, Tiny Homes and New Technology: 2021 Predictions from 14 Home Care Executives

The U.S. home care industry is at an inflection point.

Prior to the COVID-19 pandemic, an increasing number of payers and health care providers began to recognize the value of non-medical home care, particularly when it comes to chronic disease management and preventative care. That recognition has grown even stronger in 2020, with home care often playing a leading role in emerging care delivery models, including hospital-at-home and SNF-at-home programs.

That momentum will continue in 2021, most home care executives believe. To stay relevant, though, agencies will need to embrace new technologies, invest in staffing and boldly go where no home care operator has gone before.

For a clearer picture of home care’s future, Home Health Care News asked 14 executives to look into their crystal balls and describe what lies ahead. You can read their predictions below, edited for length and clarity.

HHCN previously shared our executive forecast for the home health industry on Dec. 14.

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We all know that 2020 was unarguably one of the most difficult years in recent history. One aspect of the pandemic that influenced senior care is that aging in place as well as the demand for home care accelerated. And it will continue to accelerate in 2021. We predict that there will be a significant change in the mindset of seniors to favor aging at home instead of in congregate residences such as long-term care facilities, plus assisted living and independent living communities.

This influx of demand for home care will come with its own challenges, mainly the need for additional qualified staffing. As home care industry leaders, we need to ask ourselves, “How can we make caregiving a profession that will attract the ‘best’ talent in the coming years?” Regardless of the hardships that the pandemic caused, we need to view these challenges as potential opportunities in both business and in life.

— Mario D’Aquila, COO at Assisted Living Services Inc.

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Demand is running high for caregivers and senior homes. We believe we’ll see a wave of ingenuity and innovation in senior living solutions. We’ve seen the tiny home movement model on TV that’s popular with millennials; we think we might also see that with seniors as well to help combat the loneliness epidemic. The idea is that older adults have their own bedroom, bathroom and living space, but they’ll walk down a short path to join others for meals and engagement.

The tiny home park allows caregivers to operate more easily because the seniors are aggregated more so than they are in a traditional neighborhood home. This model allows seniors to maintain their independence but also offers much higher engagement with others.

Companies will try to bust that loneliness and isolation bubble we’re seeing so much of, which has only been escalated in 2020.

— J.J. Sorrenti, CEO of Best Life Brands

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Heading into 2021, the need for home care will drastically increase as a result of the COVID-19 crisis. Over the past year, it has become evident that in-home care is a much more attractive option for families looking to care for their aging relatives, without needing to place them in a restrictive or possibly unsafe nursing home or long-term care facility. They’ve learned that there is a huge difference between aging at home while being in your own community and aging in a facility where you have little to no control.

Individuals don’t want to put themselves or family members into a situation where they are restricted from their family. This lesson has been burned into the minds and psyches of people who are aging — and their search for non-medical home care and assistance with daily living activities is going to strengthen the home care industry in the coming years.

— David Savitsky, CEO of CareBuilders at Home

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Personal Care benefited from amazing positive awareness in 2020. I predict that there will be a divergence in 2021 — of agencies who stay the course, and those who capitalize on this awareness and press the advantage for greater utilization within the health care continuum and attention from payers.

I foresee this divergence also spreading to include agencies that innovate on how they recruit, retain, train and incentivize their caregivers, and those that continue to struggle with enough staff. I feel we will look back on this time as a watershed moment in home care, where we truly saw advancement in the industry. 2021 is the year to truly make that a reality.

— Jeff Wiberg, CEO of Family Resource Home Care

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While we can’t wait for 2020 to end, 2021 probably won’t be much different for the first half of the year. We are looking at 2021 being a bifurcated year. More of the same for at least the first quarter and probably most of the second quarter, but we should start to see some significant relief from the virus by late spring of next year as the vaccine hits our communities broadly. Nonetheless, we have to prepare ourselves for potential glitches in the role-out of the vaccine and that helping hospitals discharge COVID-positive patients may consume more of the year than we hope. We are continuing to stock up on PPE and hire and train aides for COVID cases, but it would be great to get to a point where we are throwing away PPE in 2021!

— John Bradshaw, CEO of Georgetown Home Care

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After a year like this one, where every business and employee has had to adapt, I expect 2021 to continue to drive innovations that bring care to the consumer, leverage new technology and increase our talent pools.

From hospital-at-home programs to home care agencies innovating their offerings, each will bring solutions that increase independence and the ability to live at home longer. Integrated solutions bringing care and support to the home will enable consumers to be more compliant with care plans and will enhance revenues.

I predict this innovation will come from two approaches. One, strategic partnerships will help optimize the consumer experience and reduce redundancies. Second, technological solutions that help manage a consumer’s ongoing care and anticipate changes in health proactively.

My final prediction: We will experience new candidate pools for positions across the health care continuum. Those companies with strong training programs will be able to differentiate themselves and will see faster growth. By retooling workers from other service industries into meaningful, needed roles in health care, home care especially may see dramatic improvements in staffing and quality.

— Emma Dickison, CEO of Home Helpers

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In 2021, providing home care is going to be harder but the quality of care will be much better. It’ll be harder since COVID-19 isn’t going away, but it’ll also drive improvement in care quality through better infection control, faster restaffing when a caregiver reports flu-like symptoms and other innovations that pay dividends into the future. This means the bar to operate becomes higher. Home care companies will have to invest more in technology and tools to deliver the new level of expectation — likely leading towards further consolidation in the industry

— Seth Sternberg, co-founder and CEO of Honor

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2021 will be all about people and technology. Every industry webinar talks about the need to create an engaged and empowered workforce. It’s no longer a talking point — industry survival depends on it. Every company without a specialized caregiver engagement focus will lose. Business models that address caregiver wages will win.

This year has demonstrated more than ever the need for “touchless” strategies to serve the customer and the employees. Virtual onboarding and virtual visits will become the baseline. Stakeholders will expect real-time interventions.

— Andrea Cohen, co-founder and CEO of HouseWorkers

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COVID has been a catalyst for a major shift in how we serve seniors. 2021’s opportunity lies in more data, analytics and partnerships. Isolation is fatal! Providers need to start moving their models away from high-touch-only, to high-touch and high-tech. There is tremendous opportunity to connect to value-based opportunities, which require more analytics to provide better care across integrated delivery systems and prove efficacy. High-tech augments high-touch and intelligently and thoughtfully supports our ability to address workforce demands, cost, and meet the growing need for effective whole-person community-based options.

— Joel Theisen, CEO of Lifesprk

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In 2021, as we transition out of the COVID-19 pandemic into a normal way of life, we will begin to see the marriage between the “old way” of how traditional home care was done with the “new way,” including technology-process integration. As home care agencies are looking to stay ahead, we will see a major shift toward telehealth services over traditional aide services while we look to continue placing an emphasis on keeping patients both healthy and happy in the comfort of their own homes. 2020 has taught home care clients the necessity of including a tech component within their homes. As patients have become more comfortable with this change, we will continue to see an increasing number of seniors seek out home care technology alongside an aide as part of their home care solution.

— Josh Klein, CEO of Royal Care and Emerest

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After an unprecedented year in 2020, home care needs to stay the course on its momentum prior to the pandemic and the tailwinds after. The desire for seniors to age in their home has increased even more since the pandemic, and the best news is that the health care system is supporting that as well. Home care agencies must look to data-driven outcome strategies to help families understand their loved one’s ability to age safely in their home. Agencies who embrace partnerships and technology solutions will enable this to happen. 2021 offers a bright future for those agencies that adapt to a value-based care environment.

— Peter Ross, CEO and co-founder of Senior Helpers

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In 2020, we asked, “Who or what is essential?” Our caregivers were heroes before 2020, but the year brought their heroics into the spotlight. The goal in 2021 and beyond is to never forget this fact. As more and more baby boomers become senior citizens, they will require companionship and assistance at home or at a facility, not just clinical care. We must focus on recruiting and retaining by attracting new caregivers and welcoming back the heroes sidelined due to the pandemic. We will also need all in the non-medical care industry to embrace existing and emerging technological services, such as those designed to connect receivers with loved ones or doctors. We saw tremendous success among our own receivers and expect the efficiency and quality of these systems to improve and grow in popularity in 2021.

— Howard Algeo, director of business development and training at Seniors Helping Seniors

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In 2021, I think the home care industry will see proof that the private equity groups that are consolidating the industry are creating huge competitive advantages over smaller independently-owned businesses and franchisees. Any home care agency that operates in a top-20 market and is under $15 million in revenue in their local market will continue to struggle in caregiver recruiting, online marketing and operational efficiency. Our industry is just starting to see what can happen when you scale a business nationally, with geographic concentration of caregivers, clients and referral sources in local markets.

— Jim Kimzey, CEO and founder of Tender Rose Dementia Care Specialists

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Home care has long been an underappreciated element of health care. The vital role it has played during COVID-19 reminded the industry — and society — of the value of providing quality in-home care to keep vulnerable populations safe. In 2021, I predict that home care will ride this momentum by supporting managed care organizations to reduce overcrowding in hospitals and extend their ambulatory care management bandwidth while lowering costs. I predict an increase in Medicare Advantage plans that offer home care as a supplemental benefit. Because of the compelling data and positive outcomes that demonstrate the holistic benefits that home care provides to its members and the plans, it’s a no-brainer to meet this demand similar to what we witnessed in the past with outpatient physical therapy (PT) and hospice care.

— Ryan Iwamoto, president of 24 Hour Home Care

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Only 25% of Home Care Agencies Track Hospital Readmission Rates

Hospital readmission rates are one of the most important markers of success in the post-acute and long-term care spaces. But a large number of home care agencies still don’t keep track of those metrics.

Overall, 75% of home care agencies did not track readmission rates at all in 2019, according to recently released data from Idaho-based market research and education firm Home Care Pulse.

Historically, home care has largely been focused on activities of daily living (ADLs) and social determinants of health — things that sometimes fall slightly outside of the medical lens. With that in mind, it’s not entirely surprising that one-quarter of home care agencies haven’t been tracking their clients’ readmission rates.

Increasingly, though, home care agencies are taking care of clinically complex, chronically ill individuals, people who are constantly in and out of hospital settings. Additionally, agencies are starting to develop relationships with Medicare Advantage (MA) plans and accountable care organizations (ACOs), both of which seek to curb health care spending and keep their members in the lowest-cost settings possible.

Today, if a home care agency wants to be competitive in the MA landscape or win partnerships with ACOs, it likely needs to have advanced data capabilities, Home Care Pulse CEO Erik Madsen told Home Health Care News.

But it’s not always that simple, he noted.

“It’s one of the challenges,” Madsen said. “The industry is very much relationship-based. And that also brings some downside in my opinion, because companies are slow to embrace technology, they’re slow to embrace data, they’re slow to embrace some of these other areas that other [adjacent] industries have taken more seriously.”

Moving forward with data

Without a doubt, direct relationships between home care agencies and their clients will continue to be important. But without embracing data, even agencies with the most quality relationships could fall behind.

Improved operational procedures could bring agencies to the next level, but they’re not always on the top of their priority lists.

“[Home care agencies] are slower to adopt those operational processes and procedures that they’re going to have to if they want to compete in the next decade,” Madsen said. “It’s just a fact.”

Part of the problem is that a vast majority of home care agencies operate on a smaller scale, with razor-thin margins and relatively small administrative teams.

In these situations, many agencies looking to invest in their data capabilities don’t know where to start. But that way of thinking needs to change, Family Resource Home Care CEO Jeff Wiberg said during HHCN’s Medicare Advantage Summit in June.

Family Resource Home Care is a large, independent home care operator out of the Pacific Northwest. The agency recently invested in new software to collect all sorts of data, partly to prepare itself for more MA business in the future.

“I think we’d really be putting our head in the sand if we don’t start gathering details and information that will help position us as an industry to really demonstrate our value,” Wiberg said. “[That 25% number] — that’s a big wake up call to say, as an industry, we need to be collecting more of this data.”

As one of the home care agencies to embrace data, Family Resource Home Care tracks a whole lot more than just readmission rates, too. It’s other focus areas include tracking emergency room utilization and fall rates for its clients.

Family Resource Home Care additionally keeps tabs on its census and how many clients are living with multiple co-morbidities, among other information. It also separates hospital readmission rates into different categories, including hospitalization rate prior to home care admission.

“Getting away from that pen and paper [system] is going to be key,” Wiberg said.

‘Winning a seat at the table’

Even for the agencies that are collecting hospital readmission data, nearly 40% are using Excel spreadsheets or another less-than-scientific way to track numbers, according to Home Care Pulse.

“The average agency, they’ve just got a couple of people working, between answering the phone and trying to recruit, retain, train and do check-ins,” Madsen said. “Margins are small enough that they don’t have an overabundance of staff. So they’ve got to identify what are those two or three key [data] points that they want to track are and then really dial in on those.”

In 2019, the typical home care agency collected anywhere from $800,000 to $2.8 million, on average. The majority of them have been in operation for over seven years, usually relying on just one location for business.

Omaha, Nebraska-based Right at Home is another home care organization that has invested in data capabilities and tracking client readmission rates. As a franchise system, Right at Home has nearly 500 U.S. locations.

Right at Home had been working to develop its data strategy even before new MA opportunities started to appear. The steps the U.S. Centers for Medicare & Medicaid Services (CMS) has taken to open up MA to home care only accelerated those efforts.

“Let’s make sure that we’re on a path to cleaning up our data and trying to get better access to our data as a system,” Right at Home CEO Brian Petranick said at the HHCN MA Summit. “[The MA tailwinds] gave us some fuel for our message. Now we have [even more reason] … to collect data.”

Among its efforts, Right At Home tracks patients’ changes in condition and takes a special interest in a wide array of social determinants of health.

Cincinnati-based FirstLight Home Care has likewise invested heavily in its data capabilities, according to CEO and founder Jeff Bevis.

“We went ahead and pursued an actual [electronic medical record] and have that component in our software platform now.” Bevis said during the MA Summit. “If home care companies are able to really track that data and go away from pen and paper … that’s going to make all the difference too.”

The top home care providers in the country are becoming more and more intricate with their data collection.

The smaller agencies, with a few simple steps, can kickstart a better system for themselves and paint a brighter picture for home care overall along the way.

“The next decade in home care is going to be just phenomenal as we start to become more mature as an industry [through these processes] and get more opportunity to have a seat at the table,” Madsen said.

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