We are facing an unprecedented healthcare crisis in the United States. The number of Americans ages 65 and older will more than double over the next 40 years and is projected to reach 80 million in 2040 (Urban Institute, 2021). Many of those seniors live with multiple chronic conditions, a significant burden on not only our healthcare system, but for Medicare, the nation’s largest payer.
These patients will need unprecedented levels of care, which can take multiple forms. Many family members will shoulder the burden for their care, at a high personal and financial cost. We shouldn’t be surprised to learn that many caregivers spend 40 hours or more per week providing care, according to an Associated Press long-term care poll. For those that work, that’s in addition to their careers. According to an AARP study, unpaid family caregivers can expect to spend nearly 20% of their personal income on out-of-pocket costs related to caregiving. This represents the extraordinary lengths families will go to keep their loved ones at home.
But unfortunately, many more will be moved out of the home and into assisted living facilities or nursing homes. The latest data from the Centers for Disease Control and Prevention (CDC) estimates that there are 1.3 million residents in nursing homes alone, with nearly another million in assisted living facilities. These numbers are rising, and the U.S. Department of Health and Human Services (HHS) estimates that 35% of seniors are likely to go into a nursing home later in life.
But here’s the issue: They don’t have to. How have we come to accept the notion that assisted living and nursing homes is inevitable? That’s what the HHS statistic is suggesting. For one, there is inertia and a precedence by payers to pay for nursing home and assisted living facilities, many of which are for profit organizations motivated to increase enrollment. It’s a $450 billion dollar market, expanding annually. There’s nothing wrong with that, but we need to innovate and find alternative options for seniors who qualify amidst the unprecedented rise in sick seniors.
Focusing our attention on keeping seniors at home
These patients deserve the autonomy to live comfortably at home, and health-related services should supplement their life, not become the focal point of it.
Keeping them at home for as long as possible is by far the best solution and the data backs that. Patients treated in home-based settings have been found to be significantly less likely to be admitted or readmitted to the hospital (American Journal of Managed Care Home, 2019). Home healthcare reduces ER visits and hospital readmissions, but also caregiver burden.
But why do these outcomes differ so dramatically?
A crucial point in the stark difference of readmissions is the level of care received and given. In a long-term care setting, there is a higher chance of patients outnumbering caregivers. Therefore, seniors are more likely to not receive the care they need. In fact, a 2021 staffing report from the Long Term Care Community Coalition stated that most nursing homes (63%) failed to provide sufficient staffing to meet their residents’ needs. Additionally, we have learned that several of these nursing facility characteristics, such as low staff-to-resident ratios, high turnover and high occupancy rates are correlated with higher rates of Healthcare-Associated Infections (HAIs), according to a technical report prepared by Acumen, LLC for the Centers for Medicare & Medicaid Services (CMS) in 2021. In contrast, the home healthcare model, by design, ensures an individual is receiving sufficient and personal one-on-one care.
Do not get me wrong, assisted living facilities and nursing homes are not purposely trying to understaff or provide inadequate care. It’s just financially not possible and skilled healthcare staff are hard to find. These facilities are expensive to operate, and costs are only increasing. During the pandemic, they were also often isolating which negatively impacted the mental health of patients in those facilities.
As for skilled staff, as a company that ensures hospital systems around the country have the best talent available to them, we know this ageing population will tax our system beyond capacity. That is, unless we pave the road ahead with modern solutions, like home healthcare. Home healthcare allows for seniors to receive supportive care from their home, and services can vary depending on individual needs. It is truly more personalized care.
It is important to acknowledge that for some people the decision to reside in a nursing home or long-term health facility isn’t just the safest option, it is the only option. Age, income, familial support, social activity, and functional or mental difficulties are all factors in determining the best care path for the patient. In fact, these facilities are staffed with caring and professional healthcare workers who truly make a difference. They have a role for some, but not all.
A strong alternative
For many, home healthcare provides an alternative that can offer more independence while optimizing individual care. It recenters their healthcare around their life, rather than their life around healthcare. That’s the way it should be.
It is essential that we recognize the benefits of this modern care model and begin providing a more personal level of care to patients through expanding this option to seniors and their families. In fact, I’d argue that home care has come to represent the most important aspects of healthcare in 2021: safety, choices, quality (of care and life) and positive outcomes.
Losing sight of this model of care, means losing sight of what is perhaps the greatest healthcare crisis we will face in our lifetime: The oldest and sickest generation on earth. We need more options, and we need them today.
Pamela Jung is president of the Cross Country Workforce Solutions Group, which works with local and national healthcare plans and managed care providers to coordinate in-home care services, and provides home care staffing, RPO and contingent workforce evaluation.