There’s little question that demand for home care will continue to surge for the foreseeable future. The aging population, of which nearly one-quarter will be over 60 by 2050, and value-based payment models are driving the need for more caregivers and their services in a sector that is already struggling to keep up.

When looking at the big picture, it’s clear that a two-part approach will be required to overcome the challenges ahead. The industry must be people-centric, focusing on the well-being of caregivers and members, and it must keep innovating with the help of new technology. Here we examine these two approaches in more detail and explore how they may manifest in 2023.

Part I: The Personal Approach

First and foremost, the home care industry must put people first — both clients and caregivers. Much of what we expect to see this year likely will capitalize on personal elements, from the continued shift to person-centered care to the calls for better compensation and empowerment of caregivers. Here are our people-centric predictions for home care in 2023:

Prediction No. 1 – Courage to demand livable wages will spread like wildfire.

Home care has historically been an inadequately compensated, stressful job, with caregivers logging more than the typical 40-hour week, yet still making minimum wage. Because the services they provide are important to ensuring value-based care, there is a push to increase caregivers’ pay to help retain employees and encourage recruitment. Many have heard about the new law increasing the minimum wage to $17/hour in New York City, Long Island and Westchester, and $15.20/hour for the remainder of New York state. Similarly, Los Angeles county is pushing for higher wages for caregivers to $20/hour, compared to the current citywide minimum wage of $16.04. This is only the beginning of what will be a movement for the ages.

Wages must reflect caregivers’ inclusion as part of their clients’ overall medical team. A lack of recognition, fair compensation, coordination and standardization makes it seem as if caregivers are outsiders to a client’s journey, rather than instrumental participants. When paid adequately, a caregiver’s status as essential to a member’s overall treatment plan is solidified and appears genuine.

Prediction No. 2 – Mobile tools utilized for EVV compliance will empower caregivers to take decisive action leading to improved outcomes.

As more people seek home care alternatives, caregivers will play a prominent role in members’ recovery and the well-being of those in their care. Caregivers on the front lines are adjusting to EVV compliance and using the electronic platforms required. Many of those platforms are equipped with additional tools making it easier for caregivers to record observations during visits, such as medication adherence, dietary habits, home environment variations and other day-to-day aspects of members’ lives — all of which factor into their overall health. Knowledge gained from caregivers’ personal interactions combined with enhanced remote data collection capabilities and artificial intelligence (AI) gives physicians and care teams better insights into members’ well-being.

Empowering caregivers creates a significant opportunity to reduce healthcare costs, improve outcomes and increase satisfaction for members and their families. After all, they are the ones in the home providing care. They’re the ones in the most obvious position to take action when it is required. They should feel comfortable doing so.

That means agencies must convey their trust in caregivers’ abilities to do their jobs and detect when something isn’t quite right. It means taking their reporting seriously when they raise red flags and reacting accordingly when an issue is disclosed. When caregivers feel supported, they’ll have the desire and confidence to go one step further, to scrutinize more closely, to send up alerts when needed — all with the knowledge that their critical observations and actions are a welcome addition to regular caregiver responsibilities.

Prediction No. 3 — The shift to person-centered care will gain real momentum.

Due, in part, to CMS [Centers for Medicare & Medicaid Services] prompts and requirements, healthcare practices will continue shifting toward a person-centered care delivery model, affecting Medicaid recipients and dual-eligible beneficiaries. This approach takes into account needs and preferences as described by the individual receiving care, in collaboration with their family, friends, and other care team members. From this information, plans are developed to ensure members receive the covered services in ways they prefer, enhancing the member’s overall experience.

Home care providers play a critical role in this coordinated effort, since they have a well-rounded view of a member’s physical, mental, and behavioral health and can track a wide spectrum of the individual’s needs. When those needs are tended to proactively as opposed to reactively, negative outcomes can be avoided or reduced.

Family members and caregivers working collaboratively as part of a therapeutic alliance to prioritize and thoroughly address all aspects of a client’s care has been proven to result in better responses to critical symptoms and warning signs, yielding better results.

For some time now, data has confirmed the fact that members prefer to be treated and cared for in their own homes, if possible. While those requiring care and their families have largely supported the movement for some time, healthcare leadership wasn’t quite as receptive. However, the well-documented effectiveness of such programs has prompted an increase of buy-in from health system executives. Hesitancy stemming from liability concerns and risk factors has been assuaged by the noticeable traction of hospital-at-home programs, which are indisputably effective in reducing complications while cutting the cost of care by 20% or more, with many programs showing higher satisfaction ratings among patients, providers and family caregivers.

The home care industry still faces hurdles. However, changes are trending in the right direction. Putting people first will help incentivize and retain existing caregivers while encouraging new ones to enter the workforce. With the right support, training, and collaboration with members’ doctors, families, health systems and payers, caregivers can play an even more integral role in delivering proactive care that reduces healthcare costs and results in improved member outcomes.

Part II: Technology and Regulations

Home care in 2023 is expected to assume a new shape, largely influenced by industry developments centered on technology and new legislation. Armed with the right innovative tools and regulatory support, the home care community is poised to rise to the next level. Here are our technological and regulatory-based predictions for home care in 2023:

Prediction No. 1 – Effective home care hinges on the evolution and acceptance of technology.

As the healthcare community becomes more comfortable with technology — including AI and predictive analytics — it will be increasingly integrated into home care and hospital-at-home programs, supporting enhanced communication among providers to allow close coordination around the delivery of higher acuity services in the home. These technologies offer great potential to support proactive care by monitoring individuals and capturing real-time data that can be used to spot trends and improve outcomes, all in the comfort of members’ homes. Connecting home care data to electronic health records (EHRs) and health systems with social services will also help to ensure continuity of care.

Additionally, home care agencies and payers will look to use data insights delivered by simplified reporting to gain greater visibility into industry best practices in order to compete and grow. Benchmarking tools that allow for metric comparisons will enable agencies to see how their peers within the industry are performing so they can establish whether they are behind or in-line with the targets. Using metrics, agencies will look to gauge their progress on a variety of facets, including electronic visit verification (EVV) compliance and caregiver timeliness, authorizations, missed visits, short visits, billing trends, HR and caregiver compliance, and payroll processes.

Prediction No. 2 – New rules and legislation will change the landscapes of integrated care as well as payment and service delivery.

After eight long years, March 17, 2023, marks the deadline for the Home and Community-Based Services (HCBS) Final Rule. It addresses how states may use federal Medicaid funds to pay for these services and reflects Centers for Medicare and Medicaid Services’ (CMS) goal to ensure that individuals receiving support and care through Medicaid’s HCBS programs are able to receive services in the most integrated settings. In order for states to continue receiving federal reimbursement of HCBS beyond the rule’s transition period, they must comply with all criteria regarding settings, as long as the criteria is not directly impacted by COVID-19 pandemic disruptions.

Still in flux, too, is the use of GPS as part of EVV processes. The 21st Century Cures Act established a Jan. 1, 2023, deadline for states to use EVV for all Medicaid-funded home health care services (HHCS), or their full federal matching funds may be withheld. Many EVV solutions being implemented to meet the deadline include GPS features. The proposed Cures Act 2.0 includes a provision prohibiting “the use of geographic tracking features and biometrics within EVV systems” for privacy reasons, despite support from CMS to include GPS capabilities in EVV so that providers can track data, time, location, and types of services being provided.

Caregivers, payers, providers, IT professionals, administrators, researchers, manufacturers and members alike are impacted by this legislation, and all stakeholders must do their part to stay on track with EVV compliance deadlines. Encouraging accountability from everyone involved ensures that members can ultimately receive the care aligned with their assessments, authorizations, and care plans. The best way to do this is by making the proper tools and resources available, thus improving transparency and efficiency while facilitating reliable communication with payers, providers, and caregivers.

Prediction No. 3 – Self-direction will play a larger role in the delivery of HCBS.

Even before the COVID-19 pandemic, states had been working for decades to shift away from facility-based care options and now, there is an even greater urgency to encourage HCB alternatives. Additionally, the rise of consumer empowerment has inspired individuals to become active participants in their own health care. Self-directed programs provide options that give program participants more choice and control over their care. As the population continues to age and individuals become more involved with the management of their own care, interest in self-direction will grow steadily. In addition, the advance of self-directed care could reduce some of the burden on overworked homecare agency staffers. It’s a mutually beneficial approach, so it behooves homecare agencies to equip themselves and their clients with the proper tools and information needed to achieve success.

Increasing technological advancements and regulatory support are proving effective against common challenges in the home care industry, but much work remains to be done. While these encouraging developments are making inroads, the industry requires continued collaboration with policymakers and a constant eye on the future to stay ahead of additional obstacles. Proactive engagement, advocacy and an innovative approach toward the evolution of quality home care will drive improvements the industry has already begun registering.

This article was originally published in McKnights Home Care as a two-part series. The original publications can be found here: 2023 home care predictions, part I: The personal approach and 2023 home care predictions, part II: Technology and regulations.