The Benefit of Autonomy and Control: A Positive Characteristic of the Home Health Aide Position

Home Health Aides’ (HHAs) are one of the fastest growing workforces in the country, yet the industry struggles to recruit new aides into the field and retain current workers. This study explored HHAs’ experiences with the level of autonomy and control granted to them within their day-to-day work. Findings from six focus groups with 37 HHAs showed that many aides select home care because of the control and independence the positions offer. Interacting one-on-one with clients and being able to self-structure their daily tasks were major benefits that drew HHAs to the field. Additionally, the HHAs highlighted the control they have over their schedule and the flexibility the position offers to enable them to accommodate other responsibilities, like childcare or other jobs. Being able to decline a client because of travel distance, the hours required, or not feeling that it is a “good fit” was also a welcomed aspect of the position. Despite complaints about the job, such as low pay, lack of benefits, and limited support, many of the HHAs admitted staying on in their positions because of the flexibility, autonomy, and control provided. Findings highlight the value that HHAs place on autonomy and control and the potential benefit that these job qualities have for promoting greater recruitment and retention of the home care workforce. Amplifying opportunities for these aspects of the job may thus entice new individuals to pursue a career as an HHA, as well as help to maintain those individuals currently in the position.

“Less is Better” Philosophy Decreases Home Health Aide Utilization to Increase Reimbursement in Medicare Home Health

There has been a 75% decline in home health aide visits between 2000 and 2016, the only Medicare home health nonskilled service. A literature review indicates no studies addressing reasons for the decrease. This study summarizes interviews of nine executives from three for-profit chain-owned Medicare-certified home health agencies. Results indicate agreement on three themes: Medicare home health uses a medical model, focusing on intermittent skilled care; the Medicare home health prospective payment system exacerbated the focus on skilled care by rewarding higher reimbursement for skilled care–based episodes; and a “less is better” synergy has evolved regarding utilization of home health aide services and reimbursement. Policymakers are urged to use the forthcoming Medicare home health Patient-Driven Groupings Model Reform and recent Medicare Advantage changes covering nonmedical services to encourage greater utilization of home health aides and other nonmedical services addressing patient and caregiver social needs affecting care.

HOME CARE EXECUTIVES SAY MEDICARE HOME HEALTH PAYMENT SYSTEM ENCOURAGES LESS-IS-BETTER PRACTICE

There has been an increasing trend for Congress and the Centers for Medicare and Medicaid Services (CMS) to add non-skilled services to coverage under Medicare Advantage and Medicaid inpatient hospital. At the same time there has been a 75% decline in home health aide visits, the only Medicare home health non-skilled service, as a percentage of all Medicare home health visits from 2000-2016. A literature review indicates no studies addressing the potential factors accounting from these seemingly contradictory trends. The present study is based on interviews of five Chief Executive Officers (CEOs), five Chief Financial Officers (CFOs), and eight Chief Nursing Officers (CNOs) from Medicare-certified home health agencies between October 2017-July 2018. Results indicated agreement among interviewees on three themes: the Medicare home health relies on a medical model which focuses on intermittent skilled care; the Medicare home health prospective payment system (PPS) exacerbated the focus on skilled care by rewarding higher reimbursement for skilled care based episodes; and a synergy has evolved of “less is better” regarding utilization of home health aide services and reimbursement. Policymakers are urged to consider adding coverage of non-skilled services under Medicare home health, similar to Medicare Advantage, by funding demonstration projects with appropriate changes in reimbursement.