They reported that program required the agency staff to learn those skills, create new protocols, and implement the program during an already demanding situation. Informal education was also an important initiative for providers as they communicated with staff and shared resources on a variety of topics, such as the epidemiology of the virus, proper hand washing techniques, and the safety of the vaccines. 5 Ways to Ease Staffing Shortages Now and into the Future Stakeholders also commented on the promise of continued remote delivery of staff training and some client services. Infection control practices. Specifically, the effect of COVID-19 on those working in home care and home health agencies is of concern because of the potential impact on staffing shortages and a growing need for services. What new federal and state assistance, policies, and practices have been implemented to address challenges in home care and home health agencies as a result of the COVID-19 pandemic? The COVID-19 pandemic has affected home care agencies -- including home health agencies -- and their staff in several important ways. As testing became more widely available, some providers required their staff to be tested regularly. This policy will provide for special handling of staffing and attendance and leave issues. Jasmine Travers: A number of studies show that when staffing is low, Advocates and large organizations with agencies across states commented that state-specific policies varied widely and were difficult to manage and roll out training for in some cases. Despite this, home care and home health agencies continue to face obstacles. 60 percent of nursing home providers said their workforce situation has worsened since January. Most US nursing homes are understaffed, potentially compromising State Medicaid and Other Guidance That May Affect Home Care/Health Agency Staff During the COVID-19 Pandemic, https://www.medicaid.gov/state-resource-center/downloads/ak-combined-appendix-k-appvl.pdf, https://www.medicaid.gov/state-resource-center/downloads/ar-combined-appendix-k-appvl.pdf, https://www.dir.ca.gov/dlse/Comparison-COVID-19-Paid-Leave.html, https://www.medicaid.gov/medicaid/section-1115-demonstrations/downloads/de-dshp-appendix-k-appvl.pdf, https://dhss.delaware.gov/dhss/dms/caresact/hha.html, https://ahca.myflorida.com/COVID-19_Medicaid.shtml, https://ahca.myflorida.com/Medicaid/pdffiles/provider_alerts/2020_03/Medicaid_Coverage_During_SOE_COVID-19_20200316.pdf, https://dch.georgia.gov/announcement/2020-03-25/important-notice-fingerprint-background-checks, https://dhs.iowa.gov/sites/default/files/DHS_COVID19_Home_Visitation-Guidance.pdf?120220202101, https://chfs.ky.gov/cv19/HomeHealthClinicalDefinitions.pdf, https://www.medicaid.gov/state-resource-center/downloads/md-combined-appendix-k-appvl.pdf, https://www.medicaid.gov/state-resource-center/downloads/ma-combined-appendix-k-appvl.pdf, https://www.michigan.gov/documents/mdhhs/L_20-26_689145_7.pdf, https://www.health.state.mn.us/facilities/regulation/homecare/docs/licensingwaiver.pdf, https://www.medicaid.gov/state-resource-center/downloads/nv-combined-appendix-k-appvl.pdf, https://www.dhhs.nh.gov/dcbcs/documents/dltss-covid19-guidance-2.pdf, https://www.health.ny.gov/health_care/medicaid/covid19/docs/2020-03-14_guide_chha_lthhc.pdf, https://medicaid.ohio.gov/Portals/0/COVID19/Home-Care-A-Guide-for-Face-to-Face-Visits-During-COVID.pdf, https://www.governor.pa.gov/newsroom/wolf-administration-grants-hazard-pay-to-front-line-workers-in-life-sustaining-industries/, https://www.health.pa.gov/topics/disease/coronavirus/Pages/Guidance/Home-Health-Home-Care-Hospice.aspx, https://www.tn.gov/content/dam/tn/tenncare/documents/CHOICESAndECFCHOICESCOVIDRelatedPayments.pdf, https://dvha.vermont.gov/sites/dvha/files/documents/News/Hazard%20Pay%20Grant%20Program%20Guidance%20v1.pdf, https://dcist.com/story/20/10/15/virginia-hazard-pay-home-health-workers-covid/, https://www.dhs.wisconsin.gov/covid-19/hcbs.htm, TABLE 1b. All agencies we interviewed implemented processes to monitor any positive tests and ensure that their staff would be able to safely quarantine for the required 14 days. Source: https://www.kff.org/coronavirus-covid-19/issue-brief/medicaid-emergency-authority-tracker-approved-state-actions-to-address-covid-19/. Staff felt unsafe using public transportation, and clients were uncomfortable having people in their homes if they had been on public transportation. Staffing shortages have led to home-health and home-care agencies turning patients away and developing waiting lists. HEALTH For example, staff have been required to wear both a mask and gloves at all visits during the pandemic, but they may have only worn gloves on a regular basis before the pandemic began. The five research questions shown below guided this work. But in other states like Kansas, it's still critical. Staff showing symptoms of illness must not be permitted to remain at work or visit patients and must not return to work until completely recovered.20, Provides payment parity for electronic service delivery.1,2, Coverage of additional medical supplies, equipment and appliances over and above those in the state plan and training for PPE.1,2, Increases payment to family caregivers to provide certain waiver services.2,4, Participant screened for COVID-19 prior to any home-based visited by a provider.21, Relaxes provider (re)enrollment requirements.1, Temporarily modifies annual provider qualifications by extending current verification. The legislation will ensure that workers are not forced to choose between their paychecks and the public health measures needed to combat the virus, while at the same time reimbursing businesses.1, CMS waived certain screening requirements, postponed all revalidation actions, and expedited any pending or new applications from providers.2, CMS waived the HHA requirement for a RN to make an annual onsite supervisory visit for each aide and conduct on onsite visit every 2 weeks.2, CMS modified the requirement that aides receive 12 hours of in-service training in a 12 month period.2, CMS waived the requirements that rehabilitation skilled professionals may only perform the initial and comprehensive assessment when only therapy services are ordered. Services Sedgwick Healthcare & Living Center provides extended-stay nursing care to seniors with varying levels of Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7390796/. Some policies were more successful than others, according to stakeholders. WebU.S. From the perspective of many stakeholders, the primary remaining challenge is getting home care workers recognized as essential workers, which would allow them easier access to PPE, testing, and vaccines. The Health-Care Staffing Crisis Is Bad and Getting Worse. to 18/hr. 1 3 During the Omicron wave, the US Department of Health and Human Services has reported critical staffing shortages in 24% of US hospitals, 4 and military medical personnel have been deployed to assist Reportedly, there was also wide variability among states in how they adopted telehealth for home care providers. Shortages have been at their worst this year, peaking between mid-December and mid-January, during the omicron surge, when 39 percent of nursing homes reported a lack of nurses and/or aides. Most agencies we spoke with said this was primarily done telephonically and did not involve adding telehealth infrastructure. Home Health However, as previously noted, telehealth reimbursement for health care services remains a challenge in most cases for home care and home health agencies. There are far more policy gaps than those that hold promise, according to stakeholders. In other cases, the pandemic worsened long-standing challenges in the industry. Kathy Hochul has announced a plan for filling them. Federal government websites often end in .gov or .mil. The state's [5] More recent reports have highlighted how home care agencies have rebounded and are now viewed as an important means for reducing institutional care and preventing hospitalizations. The need for these workers will grow over the next five years to around 10.7 million. WBUR Many stakeholders stated they hoped a bright spot from the pandemic would be increased availability of HCBS and increased appreciation of home care and home health workers for the essential role they play in keeping clients in their homes and communities. According to one federal official, many more states have exercised this option during the pandemic. Nursing home staff networks and COVID-19. State of Home Health Staffing Its no secret in the industry that caregiver shortage is a worsening problem nationwide. The home health aide shortage is the biggest healthcare staffing issue See https://dcist.com/story/20/10/15/virginia-hazard-pay-home-health-workers-covid/. To help agencies maintain staffing, new policies allowed for increased rates, hazard pay, and retainer payments. Many of their clients were also being cared for by family caregivers, and so providers used technology to communicate and support family caregivers when agency staff was not able to go into the client's home. National Academy for State Health Policy (NASHP): States Use of Appendix K and Emergency Waivers to Support Home- and Community-Based Services in Responses to COVID-19, updated December 18, 2020. According to stakeholders, there are far more policy gaps than those that hold promise. In addition, inconsistent training requirements made it more difficult to recruit staff from other health care sectors due to different training and certification requirements. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely. Providing government reimbursement to HHAs for certain telehealth services. when providing services to COVID-19 positive individuals. The Assistant Secretary for Planning and Evaluation (ASPE) is the principal advisor to the Secretary of the U.S. Department of Health and Human Services on policy development, and is responsible for major activities in policy coordination, legislation development, strategic planning, policy research, evaluation, and economic analysis. Healthcare systems worldwide are facing severe staff shortages that can result in significant implications, especially for patients; Digital health solutions can help alleviate staff shortages by taking on administrative and low value tasks, and supporting more efficient workflows February 10, 2023. Nursing Shortage Potentially Impacts Home Health Care All material appearing in this report is in the public domain and may be reproduced or copied without permission; citation as to source, however, is appreciated. Healthcare Staffing Shortages Thousands of Massachusetts' most disabled barred from returning But there are steps that can Typical vendor and supply chains were disrupted, it was difficult to identify legitimate suppliers, and surge pricing was rampant. While they noted some helpful guidance from the CDC, they reported they were often left to fend for themselves to create infection control protocols and policies, including those related to testing for their employees. Workforce. Massachusetts hospitals are struggling to fill an estimated 19,000 job openings, and the staffing shortages are forcing long waits for patients, according to a new report. Many agencies also reported developing tools, such as Apps, to screen their staff and their clients on a regular basis and monitor COVID-19 exposure, symptoms, or any high-risk travel. Many agencies reported updating their training requirements to reinforce their staff's training around infection control. Many reported that because home care agencies were not designated as "essential" they were not prioritized for receiving PPE. For those patients/consumers utilizing services in CHC or the OBRA Waiver program, agencies must collaborate with the designated MCO or Service Coordinator and ensure back-up supports are identified.23, For participants enrolled in certain waiver programs, agencies should work with MCOs and Service Coordinators on service prioritization of participants and to support agency efforts to identify appropriate resource allocation.23, Allows for supportive living services and staffing ratios to be exceeded service limits.1, A HHA may extend its geographic service areas beyond adjoining, surrounding counties. Updated June 19, 2023. 712 Monroe Ave, Sedgwick, KS 67135. See https://aspe.hhs.gov/sites/default/files/private/pdf/264156/COVIDNH.pdf. Ordering of services by non-physician practitioners. home health services grow, staffing shortages emerge, experts For existing providers, the state will suspend follow-up verifications of provider qualifications that come due during the pandemic.2, Temporarily allows initial training for new employees to be performed via other means, such as telephone or webinars.2, Allows for virtual or telephonic service planning and delivery of HCBS.1,2, Rate increases for some services to cover cost of PPE supplies.1, Requires providers to submit incident reports for participants who test positive for COVID-19, and disclose exposure of participant to other participants and/or staff.2, Permits payment to family caregivers to provide certain waiver services.1,2,4, Delays HH face-to-face encounters for up to 12 months after the service starts.4, Increases billable family provided services for certain waiver services.1,2, Allows waiver PCS providers to provide PCS to individuals receiving services through the state plan.1, Temporarily allows flexibilities in providing services across specified programs when other provider unavailable. Hospices Innovate to Build Workforce Amid Staff Shortages It also allowed them to monitor exposure to the virus amongst their staff. Many stakeholders stated they hoped a bright spot from the pandemic would be increased availability of home and community-based services and increased appreciation of home care workers for the essential role they play in keeping clients safe in their homes and communities. Difficulties obtaining PPE caused some workers to leave employment due to fear of becoming ill. As of Dec. 31, 2021, the agency says, that number had dropped to just 56 per cent. Many clients who did not have life-threatening needs, such as those primarily using home care for meal preparation or housekeeping, canceled services. staffing companies driving up costs to unaffordable levels 58% of nursing homes limiting new admissions due to staffing challenges 100% of respondents to CT Association for Healthcare at Home survey turned down between 25-100 cases a month due to staffing shortage Employers applied for up to $1,200 per eligible FTE employee, up to 500 eligible FTE employees per location.22, Retainer payments are provided for some waiver staff.1,2, The home care agency should evaluate capacity to meet participant's service needs in the event staffing is impacted by the COVID-19 pandemic. The purpose of this study was to understand the challenges faced by home care (including home health) agencies due to the COVID-19 pandemic and the policies and practices put into place by the federal government, state governments, and home care agencies themselves to mitigate these challenges through a 50-state scan and interviews with stakeholders. We sought to learn how stakeholders think these policies have worked, as well as what improvements can be made and what policies and practices are promising for the future. Some of these funds were intended to help agencies purchase PPE and other needed supplies. In Alaska, Minnesota and Washington, over 70 percent of facilities reported staffing shortages. We summarized or combined details from multiple sources. Kansas nursing homes hit hard by COVID, staffing shortages | The This is the largest number of vacancies ever reported, surpassing the peak set in The home health aide shortage is the biggest healthcare staffing issue However, many respondents reported that their client load had mostly returned to normal by the time of our interviews in December 2020 and January 2021. See https://www.health.pa.gov/topics/disease/coronavirus/Pages/Guidance/Home-Health-Home-Care-Hospice.aspx. Most agencies reported following CDC guidelines on infection control, and a few also reportedly established their own medical advisory councils to help inform and develop COVID-19 infection control procedures. How effective did states and providers perceive them to be? See https://www.medicaid.gov/state-resource-center/downloads/ma-combined-appendix-k-appvl.pdf. Workforce shortages that have long existed in the home care and home health industries were exacerbated by the COVID-19 pandemic. One respondent described his experience of driving from pharmacy to pharmacy hoping to put a credit card on file so that he could send his staff there to get tested if necessary. Staffing Shortages This brief summarizes the overall findings of the study. Staff training requirements can also vary by state, and the naming conventions used to describe home care agency workers (e.g., caregivers, personal care assistants, personal care aides) also vary across states. In 2019, there were approximately 2.3 million home care workers in the United States. Staffing Shortages There is also variation in the nomenclature used to describes these agencies across states (e.g., home care agency, basic home care agency, comprehensive home care agency). During the pandemic, occupancy went down to a low of 67%. See https://medicaid.ohio.gov/Portals/0/COVID19/Home-Care-A-Guide-for-Face-to-Face-Visits-During-COVID.pdf. Key passages in each transcript were highlighted and these highlighted passages were summarized into key themes. Government staff we spoke to agreed that there was a lack of communication, especially related to relaying information on staff and client exposure. However, that transition required people to learn a new technology and create new resources. Home Anne Herleth, research and advisory principal at The Health Management Academy in Virginia, agrees that there is an experience shortage on top of existing staff shortages. An official website of the United States government. Others have different levels of care with and without licensure requirements. Federal officials clarified this was not a change in federal policy and that providers could use telehealth previous to the pandemic but that it was dependent on state adoption. There was quite a bit of variability in how often testing was provided to staff. Nursing homes gained only 1,600 jobs in February compared to the 20,000 in the home health field and 15,000 for physician offices. Most US nursing homes are understaffed, potentially compromising Nursing Home Staffing Crisis Statistics. Agencies and advocates reported that this contributed to an increase in the number of clients, reversing the losses that had occurred early in the pandemic due to fear on the part of existing clients and a decline in referrals for post-acute care after the dramatic decrease in elective surgeries. Source: American Health Care Association Survey of 759 Nursing Home Providers, May 16- 20, 2022 2% Some hoped that increased reliance on home care and home health in the wake of the pandemic would result in positive changes to these long-standing issues. For the purposes of this brief, we use the term "home care" to include workers and agencies in both home care and home health unless information is specific to one or the other. Nurses didnt hold back when discussing their feelings regarding the current state of nursing: 87% feel burnt out. And those wrap arounds include help with transportation, help with daycare, health with food insecurity, which is a big issue for the frontline workforce. The expansion of payments to family caregivers is an additional flexibility that states took advantage of during the pandemic. Agencies have addressed these challenges by changing their policies and practices and by taking advantage of changes to federal and state policies and regulations. This boosted client census after it had dropped considerably and freed agencies from having to chase down physicians when they were busy with pandemic-related responsibilities. Services include: personal care; adult companion/companion; behavioral supports and consultation; expanded habilitation, education.2, Flexibility allowed for paying higher rates for certain waiver services and staff.2, Permanent rate increase for Home Help caregivers who earn less than $9.90/hr.16, Suspend all new applications and in-progress applications for temporary home care licenses.17, Extend existing temporary home care licenses as needed to allow for an initial full survey for providers who have submitted a notice of providing services.17, Increased payment rate for certain waiver services and staff.2, Increased service fee of up to 25% (increased to 30% in a later waiver update) for PCS.2, Allows qualified provider agencies to also provide PCS.2, Allows providers to deliver any necessary PCS even if not listed in plan of care and if not previously approved by the state.1,2, Certain HCBS can be provided in hospitals.2, Retainer payments are provided for certain waiver staff.2, Temporarily waives prior authorization limits and increases the amount and/or duration of certain services, including companion, PAS, non-medical transportation.2, Certain HCBS can be provided in an acute care hospital, critical access hospital, nursing facility or swing bed.2, Retainer payments are provided for certain waiver staff.18, Certain HCBS may be delivered during an acute care hospital stay.2, Retainer payments are provided for certain waiver staff, if no other reimbursable services are being delivered.2, Increased payment rates for certain waiver services and staff.1,2, Increased payment rates 23% monthly, or $581.94/month, for case management staff services.1,2, Retainer payment only if client impacted by COVID-19 (hospitalized or quarantined).1,2, Certain HCBS may be delivered during an acute care hospital or short-term institutional stay.2, Increased payment rates to certain providers and certain settings.1, Retainer payments are provided for some waiver staff, for up to 90 days (3-30 day increments).1,2, Retainer Payments are available when client utilization drops to 80% of the avg. Respondents noted that it was difficult to access PPE at the beginning of the pandemic, but many said availability has since normalized. Workforce Research and Data Advocacy. Although facilities, including senior housing and other congregate living settings, may have been required to screen their own staff, those facilities were reportedly resistant to testing agency staff. DALLAS, Sept. 14, 2021 /PRNewswire/ -- Staffing and workforce development challenges have been shown to have a direct impact on the outcomes of patients who WebSource: American Health Care Association Survey of 524 Nursing Home Providers, December 7- 16, 2022 3 84% of nursing homes facing moderate to high levels of staffing shortages 3%. Respondents noted that it was difficult to access PPE during the first 3-6 months of the pandemic, but many said availability has since normalized. Shortage of healthcare providers, available hospital beds and staffing of ambulance services creates headaches for Washington County residents. There are about 12,000 Medicare-certified HHAs in the United States. About Contact Details Reviews. The state's vaccine mandate for hospital and nursing home workers takes effect on Monday, and officials are bracing for staffing shortages.

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