The start of a new year is an opportune time to reflect and prepare for changes to come. From operational challenges brought on by COVID-19, to new regulations to comply with, 2021 put homecare payers and providers to the test. But with difficulty comes growth, and if there is any silver lining to the past two years, it is that they brought to light just how critical home and community-based services (HCBS) are.

Before the pandemic, homecare and self-directed services were sometimes under-appreciated, largely under-funded, and often not considered part of the health and wellness continuum. Now, these services and their providers are finally being recognized for the value they bring not only to the members they serve, but to our overall healthcare system. Discussions involving significant investments in HCBS funding at the federal level reflect this shift.

So, let’s look ahead. What opportunities can your organization leverage in 2022? What challenges should you be ready to tackle? We’ve gathered insights from the HHAeXchange leadership team to help you plan for greater advancement this year.

Prediction #1: The demand for home and community-based services (HCBS) will continue to increase.

The desire to age in place has been growing for years, and COVID-19 only accelerated this trend. According to a recent report from AARP, more than 80 percent of adults have expressed a preference to remain in their homes and communities as they age and favor a home setting over a nursing home or other institutional setting.

And for good reason. Staff and residents at long-term care facilities were particularly hard-hit by the first year of the pandemic, accounting for 31% of all COVID-19 deaths in the U.S. as of June 30, 2021, the Kaiser Family Foundation (KFF) found. Furthermore, deaths attributable to COVID-19 increased at a faster rate in nursing homes than among all others in the community between July and August 2021.

From increased safety to the ability to maintain freedom and independence, homecare offers a multitude of benefits. With the demand for care shifting toward home-based services, both payers and providers are positioned to thrive – as long as they can adapt to the new climate.

Prediction #2: Caregiver shortages.

The growing demand for homecare – combined with the persistent challenges of retaining caregivers and climbing turnover rates during the pandemic – has resulted in a caregiver shortage that has already deeply impacted the entire homecare system in 2021 and will continue in the year ahead.

PHI’s 2021 annual report, Direct Care Workers in the United States: Key Facts, noted that long-term care employers will need to fill an estimated 7.4 million job openings in direct care from 2019 to 2029. This figure includes 1.3 million new jobs to meet rising demand, and another 6.1 million jobs to replace workers who leave their positions.

Having faced a sky-high caregiver turnover rate of 64% and above for the past several years, providers are no strangers to the demands of recruitment and retention. But through proactively employing innovative strategies to attract potential candidates, investing in ongoing employee training programs, and implementing new technologies that make caregivers’ lives easier, they can break the cycle and conquer these challenges.

Keep in mind that homecare providers are not the only ones impacted by the caregiver shortage. Payers will need to manage growing lists of members that may be eligible for services but without in-home services to meet the need. The lack of availability of traditional caregivers could push more individuals into self-direction programs, with family members, friends, or other selected peers working as their paid caregivers.

Prediction #3: Continued growth of self-direction programs.

Self-direction (also referred to as consumer direction or participant direction) has become an increasingly popular option for individuals wanting more control over their healthcare. Since 2016, self-direction has grown at about twice the rate of traditional HCBS.

2022 may see even greater growth for this service delivery model. If the Build Back Better program – the largest federal investment program in history – is approved, states would be eligible for a 6 percentage point increase in their Federal Medical Assistance Percentage (FMAP), with an additional 2 percentage-point increase for HCBS during the first six fiscal quarters throughout which the state has implemented a program to support self-directed care, an Ancor news article notes.

An increase in federal funding, combined with a shortage in traditional caregivers, is likely to result in more individuals opting for self-direction. The model offers numerous benefits for both participants and payers – from more choice, flexibility, and control over when, where, and how services are provided, to reduced hospitalizations and overall costs of care.

Prediction #4: New technologies will be embraced by homecare payers and providers.

As more care becomes home-based, communication methods and data collection must evolve to ensure ongoing effectiveness and a consistent quality of care.

HCBS providers are seeking technology that provides efficiencies and connectedness for their staff and clients. For example, many will implement solutions that allow them to quickly and seamlessly fill shifts through algorithms and broadcast technology, saving them the time and effort of countless phone calls and emails back-and-forth.

Member and authorization management, as well as revenue cycle billing and payment processes, will continue to improve as payers and providers adopt technologies that make them both more efficient and allow them to communicate with each other in real-time. With EVV mandates in effect, big data and business intelligence will be utilized by payers for increased visibility and to ensure compliance across their provider networks.

Prediction #5: Enhanced focus on social determinants of health (SDOH) to ensure value-based care.

Research suggests that SDOH, or the societal, economic, and demographic-related factors that may affect a person’s health, drive more than 80% of health outcomes. As the industry shifts to a value-based payment model, managed care organizations (MCOs) will increasingly look to SDOH to reduce healthcare costs and improve outcomes.

Homecare providers are uniquely positioned to evaluate the effects of factors such as food insecurity, social isolation, and housing instability on the health and wellness of their clients. By equipping their caregivers with tools to observe and report changes in member condition, agencies can take action before a condition gets worse. These solutions enable providers not only to monitor member trends, but also to measure hospital readmission rates, completion of scheduled visits, adherence to care plans, and more. The availability of this data allows providers to clearly demonstrate their value, while also providing payers with the visibility they need to evaluate their networks’ performance.

We predict that we will see increased state funding and initiatives to support the shift to value-based care. For example, the New York State Department of Health (NYDOH), contingent upon approval from the Centers for Medicare & Medicaid Services (CMS), will distribute over one billion dollars to eligible NY agencies to develop and implement programs and strategies that assist in workforce capacity building and value-based payment (VBP) arrangement readiness.

Prediction #6: Training caregivers and new staff will continue to be a challenge.

The new variants of COVID-19 and subsequent changes to the healthcare landscape have put providers’ ability to communicate with and train caregivers to the test. In a December 2021 survey conducted by HHAeXchange, 35% of agencies noted training staff and caregivers to be their biggest challenge heading into 2022.

Training is the mechanism that can enable upward and lateral career mobility for caregivers and office staff, yet the industry’s changing regulations and fast-paced nature can make it difficult. From assembling onboarding materials to gauging existing knowledge, it may be hard to balance what has worked in the past with unanticipated changes and challenges that may arise.

HHAeXchange has partnered with eLearning providers who are equipped to handle your caregiver and office staff training needs. Plus, our eLearning solutions are integrated within our mobile app, so caregivers can complete the lessons at their convenience.

Prediction #7: Heightened focus on improving electronic visit verification (EVV) compliance rates.

With penalties for non-compliance under the Cares Act now in effect for Medicaid providers, the need to ensure accurate and effective utilization of EVV has grown more urgent. Home health agencies are feeling the pressure as well, as the January 1, 2023 EVV deadline for home health care services is fast approaching. In a recent HHAeXchange survey, 40% of providers noted improving EVV compliance rates to be a top focus for this year.

A significant factor in successfully implementing any new technology is overcoming workplace hesitation. Change can be intimidating for anyone, and with homecare aides and staff already facing burnout due to COVID-19, it is understandable why they’d be resistant to learning a new system or adapting to a new practice. In addition to partnering with the right vendor, clearly explaining the benefits of EVV – such as easy clock-ins and clock-outs, an absence of paper timesheets, improved quality of care, and more streamlined processes – can help to highlight the positive and diminish the negative in your employees’ minds going forward.


With the passing of the Cures Act and countless operational shifts prompted by COVID-19, 2021 was a transformational year for home and community-based care. 2022 is poised to be another period of dramatic change, growth, and innovation.

The pandemic highlighted the benefits of HCBS and created additional demand for these services. As waiting lists grow and states and other payers work to solve challenges surrounding caring for people in their homes such as housing, food scarcity, lack of transportation and routine medical care, the federal government has recognized the need for additional funding through the American Rescue Plan (ARP). This is a good sign of things to come as more federal investment is pushed to states to use in a way that enhances critical HCBS programs.

As payers and providers become more receptive to technologies in 2022, we are expecting greater alignment in their efforts to improve care quality and lower healthcare costs, which can only benefit the homecare ecosystem and the individuals who most need care at home.