Like a shock to the system, the COVID-19 emergency has been a catalyst for major change across the health care continuum. Home-based care providers, in particular, have been forced to evolve in a multitude of ways.
As an industry thought leader and expert in aging, Dr. Bill Thomas has always been at the forefront of home care innovation. In the past year, Thomas has been especially active in what he calls the great migration of facility-based health care to a “21st century home- and community-based system.”
Thomas is the co-founder of Minka, a company that makes 3D-printed tiny homes and communities. He also serves as the independence officer for Lifesprk, a Minnesota-based home-based care provider that has made a name for itself with its holistic approach to care.
Home Health Care News caught up with Thomas to talk about where home care is headed in the U.S. Highlights from the conversation are below, edited for length and clarity.
HHCN: What does delivering care in the 21st century mean to you? And how does your work in the past year reflect that?
Thomas: The work I’ve been doing has been about building exit ramps, pathways that can help us change from the health care system we have to the health care system we need. That maybe sounds big and vague, but it’s the thing that drives me — developing an alternative delivery system. All the work I’m doing ties back to that.
In one example, I’m working with a company called Lifesprk. Lifesprk is committed to building an entire health and wellness system that isn’t based in a big building, but actually based in the community. I love that concept and drive. In the past, you would say hospitals are the center of the health care universe, with home care like a distant outpost you can barely see with your binoculars. In the future, I think it’s going to be much more equal between hospitals and home care.
A lot of acute care will still be done in those big buildings with the fancy lobbies, but most of the actual service and support will be delivered in people’s homes and communities. That’s the big shift I see happening.
How has the senior care industry — home care, in particular — evolved as a result of the COVID-19 emergency?
Every part of our health care system rose to meet the challenge. There are people in every part of our health care system who lost their lives while giving care to others. Let’s be clear: This was an epic struggle.
However, let me make this point. More than 90% of all the COVID patients in America were taken care of in the home or community. The real center of the pandemic was in the home and community, and you have organizations that were placed directly in the eye of the storm. A lot of them got better, got sharper, got more effective and raised their game — as you tend to do when you’re facing a calamity. COVID was a home- and community-based pandemic, and I think home care providers are really central to getting us through as a nation.
I wouldn’t want to be seen as taking anything away from people working in ICUs, but that kind of winds up on the front page of the newspaper because it’s dynamic and dramatic. But the ICU wasn’t the center of the pandemic.
What lessons should home care providers take away from last year?
As we emerge from this pandemic, it seems like the term “home care” has become a bit dated. That’s not our future. We’re going to be at the intersection of all the most important trends in health and wellness in the United States.
Recently, I haven’t been using the term home care. I’ve been using “home- and community-based services and supports,” which is a better description of what this is about. In fact, I would probably talk to your boss and have him change the name of your publication to “HCBS News.”
The reason why we should change how we talk about home care? The “service and supports” are what people need. A lot of times, they’re not classical medical diagnosis and treatment. There is more to life than a prescription pad, more to health and wellness than just medical services.
Home care is at the nexus of a complicated web 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-on partners with health systems.
They’re going to be at the table with payers and systems. I point to Lifesprk because I think they’re farther down the road on this than some of the other companies in the field. But I think the whole field has got to do this. You have to be at the meetings where things get decided, and home-based care providers have a history of not being at the meetings.
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 is getting the right workforce assembled to carry out this challenge. In the whole domain of health care, the highest-paid professionals work in big hospitals. That’s the peak, and then down toward the bottom are people who go to people’s houses to help them.
We’ve got to stop doing home care, and start designing, developing, testing and deploying a matrix of services and supports to keep people healthy and independent. That gets a different business than, “I ran 1,000 hours of home care services last month.” The key to getting the workforce you want is through value proposition. You’re not going to have people clamoring to join you if you’re considered a lagging part of a giant industry. Position yourself as the exciting new frontier of medicine, nursing, therapy, care, assistance and technology, and you can attract some really exciting people into that.
At the end of last month, we heard the news of Biden’s American Jobs Plan proposal, which would increase funding for home- and community-based services. It calls for Congress to redirect $400 billion toward home-based care. What impact would this have on home care, if it happens?
I think it’s like water for a seedling. I think the money would provide entrepreneurs and innovators with more confidence that this is a direction that is going to be sustained over a period of time. It isn’t going to be “one and done.” I see it nourishing a young home- and community-based services industry that isn’t fully developed yet. We’re just now emerging out of the home health care cocoon.
The Biden administration is ahead of the game in identifying this as an important sector. I would pay attention to the fact that they didn’t say $400 billion for home health care.
In some ways, this is a continuation of the Affordable Care Act, which put into Medicare some pretty important systems designed to reduce the overuse of hospitalization among older people. What we’re seeing, years later, is greater progress on that front.
This kind of funding is going to result in, over time, more people getting more services and supports at home, and fewer people getting a restricted set of services in acute care settings. That’s the swing of the pendulum — and this $400 billion pushes a pendulum that’s already swinging
We have recently written about vaccine hesitancy among caregivers. How do home care providers combat that?
What I’m seeing mostly is straight-ahead public health, education and outreach techniques that are by the book. We already know how to deal with hesitancy around lots of interventions. I think the public health system in America has many proven methods and techniques to tackle vaccine illiteracy or hesitancy. What I’m seeing is most organizations are using that playbook.
The emphasis is mainly on education, outreach and chipping away at 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 talked about how home care providers are teaming up with companies such as Uber and Lyft. What other kinds of innovative partnerships have you seen spring up recently?
I think home- and community-based services providers should really think about partnering with companies to make it easier for people to provision their homes with food, fuel and electricity.
I think that’s an area of potential growth. It will require, I believe, partnerships with companies that are experienced in a range of things, everything from utilities to transportation, to insurance to food.
You’re active in the senior living space as well. What does the future of senior living look like?
I think you’re going to see the entry of home- and community-based services providers into senior living.
It almost makes you laugh when you realize that we think of senior living as a different enterprise than home- and community-based services. Historically, senior living was set up as a kind of hospitality — kind of a cruise-ship-on-land vibe. That’s never going away, but it’s going to fade into the background. Instead, we’re going to think about these environments as really hot, cool, adaptable homes and communities already built, already sitting there.
If you have this powerful nexus of home- and community-based services and supports, and you get into a senior living community, you can make that baby pop! You’re not trying to run a cruise ship on land — you’re trying to help people be happy and healthy. We’re going to see home- and community-based services providers entering into the domains of senior living and bringing wisdom and a lot of sophistication in terms of delivering services that have just not been part of the senior living mindset in the past.