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Challenges Faced by Home Health Care Services

It’s no secret that the home health care industry is booming. In fact, it’s one of the largest growing trades nationally and internationally, with individual and franchise businesses popping up all across the country. But it’s also one of the most difficult business opportunities to get a handle on. Partly because of the tremendous growth and partly because of the numerous fundamental changes occurring simultaneously, the home healthcare industry could be classified as particularly volatile.

As a result, it’s expected that many different challenges will rock the industry this year, though some of these are carry-overs from years past. A few will shape the way the industry grows for at least the next decade. Here are some of the heaviest hitters:


Increasing Demand


Most countries, including India and the United States, are home to an aging population. By 2020, an estimated 17% of the entire population of the US will be 65 or older. That’s 50 million men and women who will be increasing their reliance on the healthcare industry as a whole. Recent AARP survey results show that nearly 90 percent of those over 55 plan to stay in their homes (though roughly 20% will be forced to transfer into nursing homes or assisted living facilities). But that still leaves up to 70% – 35 million people – aging at home and reliant (at least to some degree) on home health care. Those figures are staggering. India, which has a population of 1.3 billion has a senior citizens population comprising roughly 10% of this total, which, to put it simply, would mean that the demand here is far greater than even in the States.



Finding Qualified Staff

Given this increase in demand, home health care agencies will face the challenge of finding qualified staff. Unfortunately, current estimates show that demand for capable individuals (which is already far above the supply) will continue to lag behind growth for at least the next five years.

But there is hope. There are an estimated 1.3 million home health aides currently in the process of entering the job marketplace and 50% growth is expected on top of that figure by 2018. That makes this job one of the fastest growing fields in several parts of the world today.


Regulation/Classification of Health Care Agencies

Another challenge facing the industry today is the continued (and, to some extent, increasing) battle over classification and certification. While it might be comforting to think that many of these home health aides are certified nurses or nurse’s aides, the truth is they are all too often “regular” folks who have gone through a non-standardized training program created by the company that hired them. This leads to plenty of confusion regarding just what these individuals can and can’t do.

Unfortunately, many home health care agencies are being somewhat deceptive in their advertising. By marketing themselves as home health care solutions, they’re creating the image of a medical professional available in the home. The reality may be that the only activities the aide actually does are to help a senior with daily life – including such tasks as dressing, meal prep, housekeeping, medication reminders and the like.

Many agencies, on the other hand, do hire nurses or at least have a floating nurse that visits a certain number of clients, a certain number of times each week. This has led to a push for both government agencies and private organizations to require some sort of standardization and regulation process to classify agencies and their employees – a challenge that agencies in this industry can expect to face in the future.


Advances in Technology

The home health care industry is in the middle of a tremendous technological revolution. In fact, figures released by Lucintel predict over $29 billion in growth by 2017. Older, outdated systems are being replaced with faster, less-intrusive and more powerful equipment. From home health monitoring systems that integrate with hospital networks to mobile pharmaceutical administrations units and beyond, technology is expanding at an ever-increasing pace…

And the home health care industry is struggling to keep up. Learning how to correctly and effectively use these new gadgets takes a considerable investment of time and effort. While some agencies are leading the pack, others are lagging behind – put off by either the added cost or the added hassle.



Keeping Qualified Staff

Despite challenges in this area, payment is the key component to building a qualified staff for many home health care agencies. Shocking figures reported in the Lubbock Avalanche-Journal last year show that nearly half of all home care workers live at or below the poverty line and many of them earn lesser than fast-food workers do.

That cannot be allowed to continue, but many agencies simply cannot afford to pay more. While technology may be able to pick up some of the load (at the cost of individual jobs), there remains no clear cut answer as to how to build better wages for the backbone of this industry.



The Lack of a Continuum of Care

While it is estimated that 60% of people 65 and older need some type of long-term care, a full 90% of older adults live in their own homes and therefore spend most of their time away from inpatient settings or providers. New solutions are needed that bring affordable, continuous care to these populations when they are in their homes and away from their providers, so that they can follow best practices and plans of care in preserving their health as well as obtaining and using health care services.


Preventable Events

Studies have shown that 64% of home health care recipients experience medication errors; similarly, falls cause 2.2 million injuries annually in adults over 65—over 18,000 of which are fatal—costing approximately $19 billion a year. The majority of these and other preventable events occur due to failure to attend to significant changes in health status, across clinical (e.g., weight, pulse, blood pressure), behavioral (e.g., shortness of breath, swelling, chest pain), and medication adherence metrics. It is estimated that improper care coordination costs an avoidable $25-$45 billion a year.



Unattended problems can lead to hospitalizations and re-admissions, both of which are highly prevalent in the home health care patient community, signifying the failure of current monitoring practices. A study of home health care patients found that nearly 13% of participants had engaged in one or more emergent care services in the past 60 days, over 87% of which were hospital emergency room visits. Further, over one-fifth of participants reported one or more overnight hospital stays since they had begun receiving home health care services.


Other challenges include, but aren’t necessarily limited to :


  • A continuing chronic problem for the HHC industry is the shortage of both registered & un-registered nurses and home health care aides [HHC aides] due to faster growth in demand and compounded by a high turnover rate. This needs to be addressed especially because this is one industry where expertise and low margins of error are more important than most.


  • Government and regulatory compliance impose cumbersome paperwork adding stress and additional hours for the HHC nurses and aides. Since this is a nascent industry, regulations still cause quite a bit of hindrance to professionals. Policy changes are critical over the next few years as the industry is expected to expand enormously.



  • HHC organizations, nurses and aides are under pressure to balance their commitment to providing quality care with the need to provide cost-effective care. Since HHC is not restricted to Tier 1 cities, the HHC players have to manufacture/offer low cost products and services for the bottom of the pyramid population. The more expensive state-of-the-art equipment that the Tier-1 cities’ populace might be able to afford most likely can’t be afforded by the village populace too. This brings down profit margins for the providers and sometimes, operating in these cities would mean that they run on a perpetual loss.


  • HHC nurses and aides workers often function under difficult conditions in the patients/clients home. Job-related stresses include cigarette smoke, alcohol/drug abuse, unsanitary conditions, air pollution, and even violence and unpredictable behavior of the patients and inmates in the home HHC nurses and aides suffer needle stick accidents, placing them at risk for blood borne pathogens, such as HIV and hepatitis which at times is more than the risk for nurses & aides working controlled hospital venues. This not only requires that more training be provided to the aides to ensure all necessary preventive measures are taken, but a lot of these accidents can’t necessarily be avoided. Safety is a huge deterrent to the professionals themselves, as a result.


  • Given the cost of hospitalization leading to early discharge or discharge against medical advice the HHC nurses and aides encounter very sick and elderly patients at homes and in such cases, only so much can be done.



  • Moreover, HHC nurses and aides in rural areas have to travel long distances to reach isolated clients, so the time and costs of travel adversely affect HHC services, rendering expansion to Tier-2 and Tier-3 cities even more challenging than it is for other industries.


  • Patients and people are still fearful and have apprehensions about using HHC devices at home and this mindset amongst them is a major challenge that the HHC organizations will have to tackle. A lot of conscious effort has to be directed to raising awareness about the industries and its practices itself, so as to reach the entire spectrum of potential clients.



  • The patients & their families are in two minds. They want cost-effective in-Home health Care, but they doubt the accuracy of the results and also fear survival of the patient once taken home. In addition, patients largely prefer to be treated in a hospital where they get comprehensive care under one roof. The stigma associated with this has to be erased.


  • Distribution of products and services poses a challenge and constitutes a major chunk of the cost of HHC organizations. Therefore, they have to focus to create a new cost effective way of reaching technology to patients. Some of the biggest players in the industry invest a large part of their capital particularly in the technology department for this very purpose.



  • The HHC service has a large unorganized sector which raises safety and ethical issues. As organizations grow, it will become increasingly difficult to monitor practices and maintain standards across all employees and contractors.


  • Lack of awareness is the biggest challenge largely restricting the service to metros and Tier I cities in India. The rural populace hasn’t yet begun to admit the benefits of home care and, revenues and profit margins aside, educating them on the insurmountable benefits of HHC will simultaneously be both the biggest obstacle for growth as well as the key to breaking ground in these sectors.






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