WHEB Commentary

The role of home health in the pandemic and beyond


The COVID-19 pandemic has put enormous strain on the healthcare sector globally. In England alone, there are almost 5.5 million patients waiting for routine hospital treatment.[1] The elderly in care homes have been hit especially hard by the coronavirus. Many now fear moving into a care home, having seen the elevated mortality rate at care homes due to COVID-19.

During the pandemic, home health has been promoted to pick up non-critically ill patients so they can be discharged from hospitals faster and have care at home instead. “Hospital at home” is another emerging trend, which gained traction as hospitalisations have risen. It enables some patients to receive acute care in their homes, rather than in a hospital.

Home health is a preferred option

People prefer to receive treatment and care at home. 9 out of 10 people aged 65 or above would choose to be supported at home, rather than in a care home.[2] COVID-19 has further exacerbated this preference given the frightening impact of the pandemic on care homes. Home health services offer a variety of care regimens. These include physical therapy, occupational therapy and speech therapy. Several studies show that home health improves clinical outcomes and reduces hospitalisation rates. Dementia patients particularly benefit from care at home as they need familiarity. Those who live at home have a better quality of life, better social contact and higher levels of physical activity than patients in nursing homes.[3]

It’s not just the patients themselves who want to stay at home. Hospitals and health insurers are increasingly recommending home health over other care settings. The major reason is cost. In the US, home health is the most cost-effective setting for treatment, nearly three times less expensive than care in a skilled nursing facility.[4] For this reason, home health has become a larger proportion of post-acute care patients discharged from hospitals over the last decade.

With an ageing population, the demand for home health is expected to grow significantly. Under this favourable backdrop, we recently initiated a position in LHC Group. LHC is a national provider of in-home healthcare services in the US. There are two critical metrics in the home care industry: quality and patient satisfaction. LHC demonstrates strong performance on both these metrics. More than half of its home health locations across the US were named among the nation’s best as part of an independent industry ranking, HomeCare Elite. According to the Centers for Medicare and Medicaid Services (CMS) Five-Star Quality Rating System, LHC achieved scores significantly above the industry average.[5]

Will policy changes catch up with technological changes?

We have previously discussed how a range of healthcare technologies have helped tackle the COVID-19 pandemic. In the early days of the pandemic, patients were anxious to let nurses into their homes for in-person visits. Hence, the use of telehealth and remote monitoring increased enormously during the past 18 months. A lot of these technologies were already available pre-COVID, but the pandemic has significantly accelerated their adoption. Nevertheless, insurance coverage remains the major hurdle for wider adoption. Based on our conversation with the management at LHC Group, new technologies are unlikely to be adopted widely unless they are covered by the CMS. For example, LHC provides a free personal emergency response device which can detect falls and automatically notifies LHC’s response team. It also provides vital monitoring systems to some high acute patients so that more hospital patients can get their care at home. Unfortunately, these services will remain at a small scale until reimbursement policies catch up with technological changes and support their wider adoption.

[1] https://www.theguardian.com/society/2021/aug/12/record-number-of-nhs-england-patients-waiting-for-routine-hospital-treatment

[2] https://www.ukhca.co.uk/mediastatement_information.aspx?releaseID=236253

[3] https://bmcgeriatr.biomedcentral.com/articles/10.1186/s12877-016-0312-4

[4] http://s2.q4cdn.com/960461372/files/doc_downloads/2021/01/AMED_JPM-Presentation-v.16.pdf

[5] https://lhcgroup.com/newsroom/lhc-group-earns-top-marks-in-latest-cms-star-and-homecare-elite-performance-measures/

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