This article is part of the HHCN+ membership
Home health providers are transforming patient care by incorporating specialized home health initiatives, ranging from pediatric support to dermatology and dental services.
These innovative approaches aim to increase safety, expand access, expand labor shortages, and highlight the evolving landscape of healthcare delivery in the home. Despite the diverse and ultimate benefits of patients, regulatory and reimbursement challenges are likely to hinder the adoption of specialized home care delivery, experts told Home Health News.
“We certainly believe that financial incentives are combined with opportunities to provide care to the inadequate service and home population,” Dr. Hao Feng, an associate professor of dermatology and director of laser surgery and cosmetic dermatology at the UCONN Health Department of Dermatology, told HHCN. “It's true, some services can be provided properly, but I think the regulatory hurdles will prevent the provision of more complicated procedures in a home setting.”
Intensive care for children at home
Each year, more than 300,000 infants in the US are hospitalized in the Neonatal Intensive Care Unit (NICU), and the Centers for Disease Control and Prevention (CDC) reports a 13% increase in NICU hospitalization rates between 2016 and 2023.
To help move these children homes, Bayada provides home NICU care to more than 4,000 clients each week, with 10% of these clients under 18 months. According to Chris Toscano, a skilled president of nursing practice, this type of care accounts for about a third of the organization's total business.
A skilled nurse manages complex cases, including those involving technology-dependent children, with the goal of achieving ultimate independence.
“We take our kids home from the NICU. They may be dependent on technology or ventilators,” Toscano told HHCN. “As they grow older and grow, sometimes we can get them off the ventilator. Sometimes we see them 'graduating' from our services. They are our best days – they no longer need us. ”
Based in Moorestown, New Jersey, Bayada offers home health, home care, hospice and behavioral health services in six countries. Bayada has approximately 32,000 employees in the United States.
Toscano said that some patients will remain at Bayada's services for many years, allowing the ability to continuity of care and build relationships with institutions, helping them flourish and grow.
However, obstacles such as reimbursements and nursing shortages make this type of care difficult.
According to Toscano, nationwide, Nicus is either above capacity. In general, these children are ready for discharge, but there are too few nurses to take them home, she explained. This limits the availability of NICU beds for other children.
Some children who can be cared for at home are served by multiple agencies due to the lack of workforce. This reduces continuity of care and allows for additional complications to families seeking to coordinate schedules around multiple institutions.
Toscano said Bayada is focused on ensuring that sufficient staff are available to provide quality care through a single institution.
“These families build trust in their caregivers by having the same person,” Toscano said. “They know their children and their relationship is especially important in high-level situations. But it's important to ensure that the match matches match with family circumstances and home environment. It's the beauty of home care – every client and family is unique.
In the fight against labor shortage, home healthcare institutions compete with healthcare systems that can provide higher wages to skilled nurses due to different reimbursement rates. Therefore, Bayada is increasing its focus on workforce development programs to increase employment numbers.
“We have a new graduate nursing residency program,” Toscano said. “This year we will graduate from over 500 students. This will allow us to bring nurses, start them with lower vision clients and build skills. We have simulation labs in 95 offices and we can go through those labs.
For Bayada, the return on investment is above dollars and cents, Toscano said. The health system can free up capacity and care for another sick child. Home care offers a more cost-effective option for payers and is “basically the right thing” for clients.
“The money portion of that is secondary,” she said. “It's all about getting these kids home and safely home once they're ready to be discharged.
Toscano, moving forward, said it is seeing opportunities to advocate for clients, families, caregivers and clinicians to help payers and politicians understand the importance of home health care.
“Imagine you can't hug or parent your child while they're in the NICU because you're a visitor,” she said. “Our opportunity is our continued passion for advocacy that ensures that we are the voice for those who cannot speak for themselves.”
Toscano said feedback on the NICU program was overwhelmingly positive, as revealed by client satisfaction surveys.
“They're genuine gratitude for the focus, thoughts and training that took them to take their children home and ensure that they were providing the same level of care they received in the NICU,” she said.
Home Dermatology Visit
The number of home dermatology visits has increased by 600% since the onset of the Covid-19 pandemic, according to Medicare data. Home visits make up only a small portion of the roughly 17 million dermatology services offered nationwide, but this increase is showing an upward trend, according to a new study in the journal Dermatology Academy.
According to research author Feng, the number of procedural visits for home skin (approximately 57,000) is small compared to a total of 17 million dermatological procedures. However, researchers have observed a clear pattern of increasing in-home skin therapy procedures since 2019 and expect this trend to continue.
Feng said patients who have difficulty accessing the clinic will benefit most from home visits, due to medical comorbidities, transportation issues, or lack of social support. According to Feng, safety is the most important thing when it comes to providing care regardless of service settings.
Feng said the most important benefit of home dermatology services is that it serves as the first triage and allows medical professionals to visit patients at home when it is difficult to travel to the clinic. Several small procedures, such as liquid nitrogen cryotherapy, and moderately complicated procedures, such as biopsies, can be effectively performed at home, both in treatment and diagnosis.
Such home delivery could be important for patients if barriers, including regulations and financial restrictions, Feng said.
“The challenge is the financial and regulatory requirements to provide home care,” Feng told HHCN. “We can see more patients and provide more range of procedures safely in our office. The opportunity is that there are likely many patients who will benefit from home care and the need for this type of service is recognized.”
