Patient Prioritization in the Age of a Nursing Shortage for Home Health and Hospice

    Patient Prioritization in the Age of a Nursing Shortage

Many home health and hospice agencies are having difficulty staffing the large number of patients that require skilled nurses and certified nursing assistants. Nursing shortages have long been prevalent and agencies are actively looking to increase staff retention in home health agencies, particularly since the COVID pandemic exacerbated the situation in 2020.

With these shortages of available nurses, home health agencies are finding it near impossible to adequately institute a sustainable strategy on how to attract nurses and caregivers to home care agencies, resulting in some difficult decisions. Do they send their nurses to the patients that require the most care or to the patients that will give them the largest profit?

Nursing Shortages in Home Health and Hospice Agencies

Nursing shortages have been presenting many challenges such as being unable to staff all the patients that require nursing care. Even prior to the COVID-19 pandemic, many nurses and certified nursing assistants had decided to leave the profession due to the high-stress levels, low compensation comparatively, and safety risks.

Nurses in home health agencies care for patients in their homes so they do not have to live in facilities or stay in hospitals. Unfortunately, if there are not enough nurses available to care for those patients, then some families will not have the means and support that is much needed. This can result in increased emergency room visits and even prevent some patients from being able to stay in their homes.

Patient Prioritization

Home health agencies provide nursing care to patients in the community and work hard to recruit enough nurses, so their patients are cared for. With the nursing shortage, patient prioritization is typically based on several factors.

1.     Alternate Caregivers: Families and designated caregivers reach out to home health agencies for assistance. If a patient requires around-the-clock care and the main caregiver must work, then they must have someone there when they aren't home.

2.    Training Needs: Some patients have a lot of care needs. Family members may reach out to home health agencies to receive training, particularly if they have not received proper instructions before the patient comes home from a facility. Agencies should have tools and procedures in place such as training protocols, an online education portal, home health software for care plan management and communications, and adequate staff to meet training demands.

3.    Rehabilitation and Discharge: Some patients may need care for a short period if they are recovering from surgery or an accident. Other patients may require care, and long-term help and will always need assistance with nursing care, so it’s important to continue providing needed nursing care.

Benefits and Payment Types

There are different reasons families may reach out to a home health and hospice agencies for help. The agency must evaluate the patient’s needs and see what skills are needed to care for them. The assessments built into your home health or hospice EMR should help evaluate the needs of the patients.

·      Care Types

Certain requirements must be met for a patient to meet the qualifications that are required to receive authorization for skilled and non-skilled nursing care. Skilled nursing is when a licensed practical nurse or a registered nurse is needed to care for the patient and is trained in managing their specific care needs. For non-skilled nursing care, a certified nursing assistant is needed to assist the patient with activities of daily living and day-to-day tasks.  

·      Payment Types

There are different ways to pay for home health care depending on the payments that are accepted and the finances of the patient. The most common forms of payment that involve an authorization process are Medicaid and Medicare. Private insurance may also be used depending on the type and plan the patient has. Private pay is another option for families that have the funds and do not qualify for other forms of payment. For patients that are veterans or are affiliated with a veteran, such as a parent, Tricare and VA benefits may be available to pay for home health services.

VA vs Medicaid

Many patients that are unable to pay for home health nursing services out of pocket require the family to apply for coverage. The authorization process to apply for home health benefits will include medical records of the patient to make sure there is a need for nursing care and a letter of medical necessity given from a physician.

Medicaid: Many patients will apply for Medicaid because it is much easier to qualify for. If there are care needs that require a nurse and the patient is unable to pay for home health out of pocket, then the correct documentation can be submitted for approval.

VA/ Tricare: Military insurance benefits are much more difficult to qualify for because if the patient or family is not affiliated with the military then this type of coverage is not available. The correct documentation will need to be submitted and there must be a need for nursing care.

There are different payment amounts agencies will receive depending on the type of coverage a patient has. Agencies will be given reimbursement payments every time a nurse or certified nursing assistant submits their clock-in time to bill the insurance for billing.

When a client’s home health care is covered under VA benefits, agencies will receive a 60% higher reimbursement amount than Traditional Medicaid coverage. This is a significant difference and may influence an agency’s decision when choosing where to send their nurses!

Financial Impact

Home health care agencies not having enough nurses to care for all the patients that need nursing care not only has left some families without needed help but has also caused a financial impact. Agencies do not receive any payment from patients if there isn’t a nurse caring for them, which can create a financial burden.

Patients with military insurance benefits offering over 2x the reimbursement amount of other payment types, can assist with the decreased amount of incoming revenue and offer a way for an agency to become profitable.

Things To Consider

When choosing where to send nurses, consider the needs of the patients while still making the best decisions for the agency. With the nursing shortage, there will be many difficult decisions to make. Always keep the mind the main purpose of a home health agency which is to assist families with care for their loved ones!

More Homecare thought-leadership blogs?

Explore more agency centered articles, tips, home health care white papers, and thought leadership blogs by subscribing to the Home Health Thrive blog.

References

1.     Yang Y & Mason D. (2022) COVID-19’s impact on nursing shortages, the rise of travel nurses, and price gouging. HealthAffairs. healthaffairs.org/do/10.1377/forefront.20220125.695159/