After Nursing Home Push, Home Health Reform Could Be Up Next

With a recently released set of proposed reforms, the Biden administration is placing U.S. nursing homes under greater scrutiny.

And though the reforms are focused entirely on nursing homes, providers in other sectors – including home health care – are wondering if there will be reverberations throughout post-acute care.

On Tuesday, President Joe Biden expressed his intent to improve nursing home conditions during his first State of the Union address. In particular, he called out private equity-owned facilities.

“As Wall Street firms take over more nursing homes, quality in those homes has gone down and costs have gone up. That ends on my watch,” Biden said during his speech.

Earlier in the week, the Biden administration released a comprehensive set of proposed reforms. The aim of the reforms is to “protect vulnerable residents,” as well as health care workers.

The White House briefing also mentions cracking down on “bad actors” in the nursing home industry.

Among other things, reforms include establishing minimum staffing requirements and examining the growing role of PE in the nursing home sector. These actions were developed by the U.S. Department of Health & Human Services (HHS) through the Centers for Medicare & Medicaid Services (CMS), the White House stated.

“CMS is ready to implement this vision and at the foundation is the establishment of minimum standards for staffing in nursing homes,” Chiquita Brooks-LaSure, CMS administrator, said in a press statement. “This new evidence-based requirement will permanently strengthen quality of care by ensuring facilities have enough well-trained staff on duty to provide the services needed by the residents who rely on them.”

This substantial increase in federal nursing home regulation has led some providers to believe that home health could be on the Biden administration’s radar next.  

“It’s just a matter of time before it hits home health,” Peter Miska, regional director of program development at Elite Care Management, told Home Health Care News. “It’s not a question of if — it’s a question of when. [Home health providers] should start preparing for it now, so they’re ahead of the curve.”

Cleamon Moorer, CEO of American Advantage Home Care, pointed to infection control and PE involvement as possible areas for increased scrutiny.

“I firmly believe that as home health care providers, we will continuously be charged with the responsibility of keeping our patients and staff as safe as possible on the other side of the pandemic,” he said in an email. “We can certainly expect some or greater regulations as an attempt to ensure patient choice, fairness and transparency.”

Still, Moorer noted that he did not believe the proposed reforms would negatively affect home health care talent pools.

“The freedom and autonomy that many clinicians and caregivers have come to experience in home health care settings has seemed to fuel a greater number of applicants and ‘expatriates’, if you will, from hospitals and nursing homes,” he said. “However, if the nursing home industry is granted a financial boost or stimulus to recruit and compensate more than other sectors, then this may become a tremendous challenge.”

Similarly, Brent Korte, chief home care officer at EvergreenHealth Home Care, pointed out the working conditions at nursing homes.

“The SNF industry is struggling with a less-than-positive workplace reputation,” he said in an email. “Clinicians are excited about home health and hospice, as we offer an actual connection with patients and the potential to make a measurable difference in our patients’ lives. Many of our new hires are citing frustration with being overworked in congregate settings, having too little time with patients.”

While Korte thinks federal home health reforms are a possibility, in his view, the implementation of the Patient-Driven Groupings Model (PDGM) significantly lowered the likelihood of this happening.

“PDGM was designed to reward home health providers for quality and efficiency,” he said. “In that regard, CMS struck the right balance between building logical guardrails through PDGM that empower the market to operate in a way that rewards good care. If home health [agencies] are understaffing their patients, it will likely show through poor quality and diminished patient satisfaction scores.”