The Collapse of Home Healthcare

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The Collapse of Home Healthcare

Imagine, if you will, you have a family member that is 90 years old, living alone, and all of a sudden, the person who comes to their home to help them bathe, cook, clean, and take medications stops coming. They are left hanging out there, trying to figure out how the hell they are going to make it work. This isn’t pie-in-the-sky thinking; it’s a harsh reality for millions today as our informal home healthcare system collapses. What’s especially cruel is that those who need this care the most – our seniors and those living with disabilities – are paying the price the most. So, what’s behind this disaster? What does it spell out for all those who depend on these services? Perhaps most importantly, “ the 1.3 trillion dollar deficit. So, what’s broken, exactly? What’s driving the deficit? And how can we fix it?

Home healthcare means having nurses, aides, or therapists come to your home to deliver medical care or assist you with normal, everyday activities. It’s a crucial lifeline that helps keep millions of Americans out of nursing homes. At the moment, it's buckling beneath a perfect storm of issues. Consider this: Would you apply for a position where you’re compensated so poorly you can’t pay your essential bills with what you are paid? And in many instances, the job can get quite grueling. That’s why so many home health aides and nurses are leaving the workforce. They’re demoralized, overwhelmed, overworked, underserved, and unsupported, primarily due to the conditions that the COVID-19 pandemic so clearly exposed. Who could not understand that? That means there aren’t enough caregivers to go around, and the remaining ones are stretched thinner.

Most of all, there’s that pesky money issue. Agencies are now at the mercy of a double-edged sword: reimbursement rates from Medicare, Medicaid, and private insurers haven’t matched inflation. It’s similar to the experience of operating any business where the cost of what you need to provide keeps increasing while revenue doesn’t change at all. Looking at home health care profitability, most are running a 1 – 2% profit margin. Agencies have little capacity to raise their employees’ pay, but agencies cannot retain a better quality workforce without increasing pay. This vicious cycle is driving too many agencies out of business. On top of that, there’s a stack of bureaucratic rigmarole. If you are a a social worker or hospital discharge planner, you know exactly what home healthcare agencies deal with on a daily basis. Their time and energy spent creating regulations instead could be focused on actually helping patients. For small agencies, it’s going on a marathon with ankle weights strapped to your legs.

The pandemic compounded all these issues. These caregivers were on the front lines, working long hours and risking their own health, often without adequate personal protective equipment. Their work nearly doubled as hospitals discharged patients prematurely. It’s little surprise that many burned out or quit. The industry is still reeling from that sucker punch. Technology might help, but virtual doctor visits are wonderful in theory, but they don’t really work for low-income seniors. For most patients, particularly seniors or those living in rural communities, it’s equivalent to getting a smartphone when you’ve only ever used a rotary phone. They don’t have the devices or know-how, and their caregivers may not, as well. Even worse, this potential lifeline isn’t getting to everyone who needs it.

It’s important to hear from the very real people who have been trapped in this crisis. Consider Mrs. Smith, a 75-year-old woman who recently had surgery on her leg. Without her home health aide, she is unable to get out of bed or cook any meals. She is frightened that if she falls, she’ll return to a hospital. Or think of Mr. Johnson, who needs his caregiver not only to dress and bathe him, but to provide companionship. Losing that essential connection, Mr. Johnson says, has left him feeling cut off and despondent. When home care falls short, hospitals are suddenly overwhelmed with patients who could have remained at home with adequate care. All this does is clog up the system, cost a pretty penny, and place undue strain on each and every single person in the equation. On top of all that, it deprives Americans of their freedom—the very thing we treasure above all else.

Here’s the catch: it’s a fix that doesn’t exist. Today, let's give appreciation to the home healthcare workers. It’s time to do more than appreciate caregivers; let’s start paying them what they deserve. These are the workers who protect, nourish, and care for our loved ones. These workers should earn a living wage, good health care benefits, and adequate paid time. It’s more than equitable — it’s intelligent. Healthy, happy, well-paid workers tend to stay longer, and do higher-quality work. Second, enough with the red tape already. Cut the red tape so providers can spend time caring for patients instead of filling out forms. Consider the impact if your doctor could spend more face time with you and less time on paperwork. Physicians, patients, and payers all benefit. Third, do telehealth right. First, ensure that the people who need telehealth can actually use it. Move devices beyond the walls of the clinic and into the hands of people who need them and offer basic training. It’s similar to teaching someone how to ride a bike. Once they learn, they’ll be off to the races. Fourth, mobilize your community. Neighbors, churches, and volunteers can help out through meals, rides, or simply a check-in from a friend. It’s less about the rides and more about being there for one another. Fifth, prioritize training and skills development. The more educated our caregivers are, the better care they provide. Through simple, direct instruction — not just in clinical settings but in the classroom, too. We can instill these skills among families and empower them to contribute to the cause. Last but certainly not least, let’s get loud and reach out to legislators, urging more substantial investments in home-based care. Your voice makes a difference, and together, we can enact change.

Our home healthcare system is in crisis, and real lives are suffering as a result. We can change that for the better. By respecting caregivers, making the complicated more easy, welcoming tech innovation with smart approaches, relying on our communities, and advocating for change at the policy level, we can create the system we need. By 2030, the number of older adults in the US needing home healthcare will grow significantly. If something is not done now, it will become a disaster for our industry. This is not only about rescuing an industry. It’s about restoring millions of people's dignity, independence, and quality of life. Change starts at the grass root level. Together, we can do this.