This article appeared in the Lane Report.
While some Americans in their 60s and older may have a vague memory of doctors making house calls with their black medical bag, home healthcare in the 2020s is starkly different than that slice of Americana from the 1950s.
In 2024, home healthcare is not only a growing trend but a growing trend with a purpose, something that is evolving to not only maximize resources, but keep patients as comfortable and secure as possible while achieving maximum outcomes.
Why is the need for home healthcare growing? It’s because the world’s population is aging. The World Health Organization reports that between the years 2015 and 2050, the proportion of the population over 60 years will grow from 12% to 22%. Meanwhile, people aged 80 years or older are expected to triple between 2020 and 2050.
Additionally, a John A. Hartford survey from 2021 indicated that 71% of older adults would be unwilling to live in a nursing home. Throw in a shortage of healthcare workers along with emerging technologies, and that’s a recipe for a new wave in healthcare. And it looks promising in Kentucky.
Kentucky’s Cabinet for Health and Family Services currently lists roughly 80 entities holding Medicaid provider identification numbers for home health. They range from most large healthcare providers and systems in the state to the Breathitt County Health Department.
A MedicalTechnologySchools.com report projects nearly 8,000 home health and personal care aide jobs being added in Kentucky between 2020 and 2030, a growth of more than 35%. And in a Stacker.com list of most in-demand nursing jobs in the state, home health nurse sits at the top, even over registered nurses and nurse practitioners.
What services can home health offer?
For a patient to qualify for home health assistance, per Medicare guidelines, they must have difficulty leaving the home (such as needing a walker), have been recommended by a doctor not to leave the home due to a medical condition or it simply requires too great an effort.
Telehealth—consulting with a healthcare provider online—has gained a great deal of traction since the COVID pandemic. What once was a trip to the doctor’s office for a follow-up check could turn into a virtual video chat. That not only keeps the patient at home, but it also eases strain on understaffed doctors’ offices.
“There were some services that were not allowed through telehealth that now are,” said Elizabeth Rhodus, a researcher and assistant professor at UK’s Sanders-Brown Center on Aging and the Center for Health, Engagement and Transformation. “If you think about healthcare at home, you can do telehealth anywhere in the state.”
Another development is home-monitoring technology. For instance, if a patient needs ongoing observation for a heart condition, that can be assessed from their own couch versus through a hospital stay or repeated doctor visits. In such a case, the patient may have an in-home unit or wear a biometrics device that monitors vital signs and transmits data in real time.
“We have (remote monitoring) units that connect to the arm and monitor vital signs all day,” explained Stephanie Henry, home care director of business development for Baptist Health, one of Kentucky’s biggest providers. “If there is a reading that is alarming, nurses would be alerted and they can intervene by calling the patient, making a home visit or reaching out to the physician.”
Home health agencies are now equipped to handle everything from surgical recovery to end-of-life care. For example, a patient literally could have hip replacement surgery at a hospital, go home the same day, and then rehab at home through follow-up care and rehab in the home. The same could be true for rehabbing an injury or a variety of physical ailments. And home healthcare services can range from 24-hour-a-day in-home care to something as simple as scheduled medication and meal drop-off.
What are the benefits?
In short, the benefits healthcare providers are looking for through home health services are better outcomes. The industry is currently in the process of learning when home healthcare might be a better option than clinical care, and Rhodus said the pendulum is still swinging.
“We’re in this shift in healthcare to figure out the right balance to make sure we’re supporting the patient with what they need and not just check a box, so to speak,” Rhodus said.
The ongoing shortage of healthcare workers has had an impact on that as well. Those shortages have led to patients being sent home from hospitals too quickly, Rhodus said, and they then end up being readmitted, which stresses both staffs and facilities. In addition, if a patient is readmitted, hospital reimbursements are lower for readmitted patients—another issue driving the move toward home health services.
Lastly, in general people simply prefer to be treated or to rehab at home whenever possible.
Finding that ideal balance while trying to build the workforce to help make home healthcare services feasible is a current challenge for the entire industry, not just in Kentucky but nationwide. Finding that balance will not only ease stress on healthcare systems but will more effectively get the patients what they need.
“It’s really a focus across the nation on value-based care,” Henry said. “Agencies are focused on positive patient outcomes. Our goal is to help our patients remain in their homes as long as they can, independently; minimize hospital readmissions; and focus on care transitions, not operating in our silos but making sure that we’re collaborating and making sure patients transition from one health setting to the next.”
Training more healthcare workers
Healthcare staffing shortages have been a problem for many years. In some states, including Kentucky, it might be considered critical. And Rhodus points out that it’s not just about finding more healthcare workers—medical facilities in rural areas of the state have been closing while many doctors’ offices are being purchased by large corporations. So, an elderly patient in a rural county may have to drive 45 minutes to get to a doctor’s visit.
This is where home health can make a huge difference. Having home health agencies in these rural areas could ultimately help create better outcomes for these patients. Of course, as the population ages and requires more care, staffing them is one of the challenges at play.
A recent development is aimed not only at building Kentucky’s healthcare workforce but training new healthcare workers to help make the balance of clinical healthcare and home healthcare most effective. Last month, the University of Kentucky board of trustees approved an initiative called the Advancing Kentucky Together Network.
The initiative will invest millions of dollars in resources to help shape a new path forward for effective healthcare.
Per an announcement by UK Healthcare, the Advancing Kentucky Together Network is designed specifically to “focus on supporting partners that become part of the network by sharing expertise in tracking, measuring and documenting patient outcomes, enhancing educational opportunities for Kentucky’s workforce, research and training, and expanding community outreach for more patients to access as much of their care as close to their home as possible.”
In short, the initiative speaks directly to the balance healthcare providers currently seek. Keeping people as close to their homes as possible is one of the key goals, as is as figuring out the best way to do it effectively.
“Patients want to receive care at home; they do well at home,” Henry said. “There is a greater need for home care. Value-based care and optimizing care delivery is the trend—the right level of care at the right time. If it’s possible for the patient to be successfully treated at home, certainly the patient would rather be at home for those services