New information from home care providers, hospices and managed long term care plans (MLTCs) is revealing even more detail about the systemic stresses they are facing in the pandemic to meet the needs of patients in their communities.
HCA recently conducted our third pandemic-era survey of providers since March, this time netting almost 80 responses from these home and community care organizations across the state.
Amplified Workforce Shortages
Of immediate and urgent concern, the overwhelming number of agencies (85%) said that structural workforce shortages — especially the limited numbers of nurses, home health aides (HHAs) and/or personal care aides (PCAs) — have been greatly amplified by COVID-19, and these shortages are a primary obstacle to admitting patients, including for persons needing to be discharged from the hospital.
In one important step to help overcome these shortages, the state Department of Health has opened the door for allowing a partial path to online training of HHAs and PCAs, amid the suspension or downscaling of in-person training programs. (Until now, all elements of aide training were required to be in-person.) The Department’s new directive, however, is very prescriptive and procedurally intensive in the face of time-sensitive COVID-19 urgencies. It requires an application process and layered conditions for approval of hybrid training programs. HCA had recommended a hybrid model that combines online training and in-person clinical components; but the Department’s version is far more exclusionary, making key parts of the overall training regimen ineligible for online delivery, continuing to complicate matters.
More work needs to be done, across all areas, to address these shortages. Indeed, approximately 43% to 45% of home care and hospice agencies have experienced a decrease of 11% or more in HHA and PCA workforce capacity since March 7, 2020, according to our survey. And this understaffing adds to existing and widely reported shortages, attributable to long-running factors as diverse as Medicaid cost-containment, labor-market competition factors, and more.
Impact on Consumer Access and Hospital Discharge
Simultaneously, home care and hospice providers have reported a major increase in referrals from hospitals and other settings, illustrating just how much the entire system relies on this community-based safety net.
Hospitals, physicians and other long term care settings depend on home care in ordinary times — but especially so during an emergency — to accept patients and generally support systemic discharge-planning needs while also helping to provide relief in the event of medical surges. We witnessed that kind of overwhelming surge in the springtime, with a continuing wake of rising COVID-19 cluster regions and other impacts.
According to our survey, 65% of home care agencies in New York State saw an increase in referrals to home care from hospitals and other settings since the onset of the public health emergency. Yet, alarmingly, 76% of agencies have reported challenges in accepting these new referrals, mostly because of reduced workforce availability.
Even now, well after the springtime coronavirus surge, most organizations (63%) have not fully recovered their normal patient counts (called their “census”), with 42% of providers remaining “somewhat below” and 21% still “substantially below” pre-pandemic census levels. Half of providers experienced an overall decline of 10% or more in their patient census since the start of New York’s public health emergency.
Home care and hospice financial viability also remains a critical concern, with almost all providers (94%) projecting a financial loss due to COVID-19. A plurality (40%) expect losses of 11% to 20%, with some reporting even higher impacts.
In Sum
HCA will provide further detail on these findings and additional data points in the coming weeks as we advocate for critical supports — like provider stabilization funds and policies to stimulate workforce capacity — at both the state and federal levels.