John O’Connor

I have a suggestion for skilled care operators who aren’t losing enough sleep due to COVID-19.

Consider home care. As in, consider home care as your next big competitor.

The line of home care enthusiasts seems to be growing by the day. It’s a fairly diverse selection.

First, there are the policy wonks who insist home care will be cheaper, or at least should be. (Although funny enough, the last time this option was pushed hard was during the ’90s. That’s when those who did the math quickly discovered that visiting nurses can be a mighty expensive proposition.)

And, of course, there are the home health agencies. Think they’re not eager to snap off some of that post-acute action?

Nor should we overlook the numerous technological and other innovators who are making home care a more realistic option.

Then there are the patients themselves. And who could blame them? If you had a choice between going home or into a nursing home following a hospital stay, which would you prefer?  Slam dunk, right?

But what if opting for home care meant there was a very good chance you’d never actually receive post-acute care? An outrageous assumption? Well, it may actually be more like the norm.

Says who? Says Jun Li, an assistant professor at Syracuse University. Li and colleagues just released a fairly damning report about what happens to all too many people slated for home care. Their findings are based on nationwide data. They reveal that post-acute caregiving at home is roughly a 50-50 proposition. Unless you happen to be poor and/or a person of color. Then the odds are staggeringly worse.

 “This rate was even lower among Black and Hispanic patients, those who were dually enrolled in both Medicare and Medicaid, and patients who lived in high-poverty, high-unemployment zip codes,” Li noted. You can find the full study here. 

The authors did not speculate on why the odds of receiving post-acute care at home are so miserable. But you probably don’t need to be a sociologist to find some compelling explanations.

For one, many patients coming home from a hospital may not be of the mood or cognitive ability to make sure the home care is delivered.

For another, many home care agencies may be challenged to get workers to places where the care is needed. That may be especially the case if/when the patient resides in what might euphemistically be called a rough neighborhood.

I know of patches in my hometown of Chicago where ambulance drivers dare not go without a police escort. You think an unarmed woman in a high-mileage vehicle full of prescription drugs is champing at that bit?

I’m sure there are other compelling reasons as well. None of which will likely be easy to fix.

To be sure, even the best nursing home is no substitute for being at home. But all things considered, maybe that’s not so bad.

John O’Connor is Editorial Director for McKnight’s