Emerging Trend: Health at home and supporting caregivers

During the COVID-19 public health emergency (PHE), many families moved a loved one out of a nursing facility and into their home. This created an increased need for Home- and Community-Based Services (HCBS), and also showed many families that with the right support, they could take on a caregiving role for a family member.

Pandemic spurred three caregiver trends

We’ve seen three major changes that have impacted caregivers since the beginning of the PHE:

  1. Compensation for caregivers. Using PHE-related flexibilities, some states have allowed more family members to become paid caregivers. This was largely done to limit the number of people entering a person’s home while still ensuring individuals received the care they needed. It has also supported families who moved a family member out of a nursing facility and into their home at the beginning of the pandemic. The flexibility is temporary in some states, but making the policy permanent would benefit new caregivers and could help the many individuals who are already acting as unpaid caregivers.
  2. More frequent member check-ins. Historically, care management models have required that care managers go into homes to check on patients regularly, evaluate their living situation and monitor their health. While these in-person visits are still necessary, virtual care has allowed care managers to check in and engage with members more frequently. This has allowed us to expand capacity and create additional opportunities to engage with our members.
  3. Improved technology flexibilities, including telehealth. States utilized programmatic flexibilities around technology at the beginning of the PHE. This has given us the chance to see how new technology implementation is working — and where additional focus is needed in home health settings. This technology use has the potential to be viable beyond the pandemic, especially given the long-term implications that COVID-19 will have on health care. Additionally, telehealth adoption has changed how people expect to receive care. While virtual care cannot provide all services a person needs to stay healthy, it does provide opportunities to support monitoring that gives individuals more independence. It also provides reassurance for family members providing care for someone in their home.

COVID-19 changes caregiver infrastructure

The PHE highlighted the critical gap that caregivers fill in the care system. It also spotlighted the increasing workforce shortages that create barriers to caring for individuals with complex care needs in their homes.

Since the PHE, we have seen an HCBS 10% federal medical assistance percentage (FMAP) increase for one year in the American Rescue Plan, which offers additional funding to help build infrastructure and support family caregivers and direct support professionals. Already, we are hearing that some states are looking to use this funding to offer caregiver training and create pathways to onboard new caregivers. Additional options under consideration include supporting direct support professionals with increased pay or benefits, and providing personal protective equipment to families caring for a loved one in their home. We expect to see more of these types of support for caregivers moving forward.

While this funding can help individuals stay in their home or return to their community from an institutional setting, nursing facilities will continue to play a vital role in the continuum of care for the individuals who require — and benefit from — the care provided in these facilities. Maintaining this strong ecosystem will support aging communities and individuals with disabilities over the long term, and help drive improved care quality and health outcomes.  

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