Like a shock to the system, the COVID-19 emergency was a catalyst for major changes across the health continuum. Home care providers in particular have been forced to evolve in a variety of ways.
As an industry leader and expert on aging, Dr. Bill Thomas always at the forefront of innovation in home care. Over the past year, Thomas has been particularly active in what he calls the great migration of facility-based health care to a “21st century domestic and community-based system.”
Thomas is the co-founder of Minka, a company that makes 3D printed small houses and communities. He also serves as the independence officer for Lifesprk, a Minnesota-based home care provider that has made a name for itself with its holistic approach to care.
Home Health Care News caught up with Thomas to discuss where home care should be headed in the United States. The highlights from the conversation are listed below and edited for length and clarity.
HHCN: What does it mean for you to provide care in the 21st century? And how does your work last year reflect that?
Thomas: My job has been about building exit ramps, avenues that can help us move from the health system to the health system we need. That might sound big and vague, but it’s what drives me – Development of an alternative delivery system. All the work I do is related to it.
In one example, I work with a company called Lifesprk. Lifesprk has set itself the goal of building an entire health and wellness system that is actually located in the community rather than in a large building. I love this concept and this drive. In the past, one would say that hospitals are the center of the health universe. Home care is like having a remote outpost that you can barely see with your binoculars. I think that in the future it will be much more equal between hospitals and home care.
A lot of acute care is still provided in these large buildings with the fancy lobbies, but most of the actual service and support is provided in people’s homes and communities. That’s the big change I’m seeing.
How has the elderly care industry – especially home care – performed as a result of the COVID-19 emergency?
Every part of our health system has risen to the challenge. In every part of our healthcare system there are people who have lost their lives while taking care of others. Let’s be clear: this was an epic fight.
However, let me point this out. More than 90% of all COVID patients in America have been cared for at home or in the community. The real center of the pandemic was in the home and in the community, and you have organizations that have been placed right in the eye of the storm. Many of them got better, sharper, more effective, and increased their game – as you usually do when faced with calamity. COVID has been a domestic and community-based pandemic, and I think home care providers are really central to getting us through as a nation.
I don’t want to be seen taking anything away from people who work in intensive care units, but that kind ends up on the front page of the newspaper because it’s dynamic and dramatic. But the intensive care unit wasn’t the center of the pandemic.
What lessons should home care providers learn from last year?
As we emerge from this pandemic, the term “home care” seems a bit out of date. This is not our future. We will be at the intersection of all major health and wellness trends in the United States.
I haven’t used the term home care lately. I used “Home and Community Based Services and Support” which is a better description of what this is about. In fact, I would probably speak to your boss and have him change the name of your publication to HCBS News.
The reason we should change the way we talk about home care? The “service and support” is what people need. They are often not a classic medical diagnosis and treatment. Life is more than a prescription pad, more for health and wellbeing than just medical services.
Home care is the link to an intricate network of services and supports that enrich the lives of people in their own homes and communities. We’re going to have super cool technology, and increasingly, companies like Lifesprk are going to be full-fledged healthcare systems partners.
You will be seated at the table with payers and systems. I’m pointing to Lifesprk because I think they’re further afield than some of the other companies in the field in that regard. But I think the whole field has to do that. You need to attend the meetings where decisions are made and home care providers have not attended the meetings in the past.
What are some of the current challenges and opportunities you see in the home care space – or should I say in the home and community based services space?
The obvious thing is to assemble the right people to tackle this challenge. In the entire health care sector, the highest paid professionals work in large hospitals. That is the top, and then there are people below who go to people’s homes to help them.
We must stop providing home care and design, develop, test, and deploy a matrix of services and supports to keep people healthy and independent. This is a different business than, “I did 1,000 hours of home care last month.” The key to finding the workforce you want is in the value proposition. You won’t have people wanting to join you if you are seen as part of a huge industry that is lagging behind. Position yourself as the exciting new frontier between medicine, nursing, therapy, nursing, support, and technology and you can bring in some really exciting people to do it.
Late last month we heard news of Biden’s proposal for an American employment plan that would increase funding for services to individuals and communities. It calls on Congress to divert $ 400 billion for home care. What impact would this have on home care if this happens?
I think it’s like water for a seedling. I think the money would give entrepreneurs and innovators more confidence that this is a direction that will be sustained over a period of time. It won’t be “one and done”. I see it nurturing a fledgling domestic and community based service industry that is not yet fully developed. We are just emerging from the cocoon of home nursing.
The Biden administration is ahead of the game when it comes to identifying this sector as an important sector. I would be careful they didn’t say $ 400 billion for home health care.
In a way, this is a continuation of the Affordable Care Act, which put some pretty important systems in Medicare to reduce over-hospital use among the elderly. What we see years later is greater progress on this front.
This type of funding will, over time, result in more people receiving more services and support at home and fewer people receiving a limited number of acute care services. That’s the swing of the pendulum – and that $ 400 billion pushes a pendulum that’s already swinging
We recently wrote about caregiver hesitation about vaccines. How are home care providers fighting this?
What I mainly see are straightforward public health, education, and outreach techniques that are contained in this book. We already know how to deal with hesitation in many interventions. I think America’s public health system has many proven methods and techniques to combat illiteracy or reluctance to use vaccines. What I see is that most of the organizations are using this playbook.
The main focus is on education, outreach, and cutting back on the number of people who have not yet received the vaccine. I think that’s probably the best approach right now.
In the past, we’ve talked about how home care providers are partnering with companies like Uber and Lyft. What other types of innovative partnerships have you seen lately?
I think private and municipal service providers should really think about partnering with businesses to make it easier for people to get food, fuel and electricity into their homes.
I think this is an area of potential growth. I believe partnerships will be needed with companies that are experienced in a number of things from utilities to transportation, insurance to groceries.
You are also active in the senior living sector. What does the future of senior life look like?
I think you will see home and community service providers entering the senior life.
It almost makes you laugh when you realize that we consider senior living a different business than home and community-based services. Historically, senior life has been a kind of hospitality – a kind of cruise ship ashore atmosphere. That will never go away, but it will take a back seat. Instead, we’re going to think of these environments as really hot, cool, adaptable homes and communities that have already been built and are already sitting there.
When you have this powerful nexus of home and community-based services and support and you join a senior citizen community, you can pop this baby! You’re not trying to run a cruise ship ashore – you’re trying to help people be happy and healthy. We will see home and community service providers enter the realms of senior living, adding wisdom and a great deal of sophistication in terms of delivering services that simply weren’t part of the senior living mindset in the past.