Birmingham, ALABAMA (February 26, 2021)—Private duty homecare providers have a lot of opportunities for growth—but also face significant hurdles, from increased spending on personal protective equipment (PPE) to potential challenges like a $15/hour federally mandated minimum wage and other worker protections, National Association for Homecare and Hospice President Bill Dombi said at a recent panel.

Dombi spoke, along with Angelo Spinola, a shareholder at Littler Mendelson P.C, at the closing session of NAHC’s Private Duty Leadership Winter Conference, held virtually on Feb. 23.

He said the initial weeks and months of the pandemic hit private duty and other homecare providers hard, especially as revenue declined when many patients declined to take all of the care ordered for them; already difficult staffing and scheduling became harder as caregivers were unwilling or unable to report; and agencies found themselves spending as much as 10% of their revenues on PPE.

In mid-2020, the situation stabilized, and in the fall agencies started seeing more services—a trend that’s continuing today, Dombi said.

“The public awareness along with the health care sector awareness of homecare has been exponential, and very important,” Dombi said, praising private duty and other care providers for their flexibility and ability to keep staff and patients safe, even while caring for COVID-19-positive clients. “Payers like managed care organizations are learning more and more about the value of homecare services. We’ve known it was there for decades, and we’ve had a hard time convincing payers that it was more valuable beyond just being cheaper than a day’s stay in a nursing home.”

However, Dombi said, there are “big picture issues” that will especially affect private duty providers—and up first is the possibility of a $15/hour federal minimum wage.

“This is a huge issue,” Dombi said. “We have conveyed to the leadership in the house as well as the White House that it would be great to be able to support your workforce in private duty with better wages… but that doesn’t happen in a vacuum. (Individuals receiving in-home care) are not deep-pocketed individuals. We don’t want homecare to be only available to the wealthy who can afford to pay in an environment where caregivers are receiving $15/hour.”

Additionally, some states and Washington are discussing a “domestic worker bill of rights” that would include home- and community-based services and includes items like requiring written termination notices and employees getting more control of their schedules. Several in Democratic leadership—including Sens. Bernie Sanders, Elizabeth Warren and Chuck Schumer and Vice President Kamala Harris, who sponsored the legislation as a senator—back the effort.

“At some point in time you could expect this to surface as an advocacy issue,” Dombi said. “It’s hard to argue with something called a bill of rights, but it does make things difficult in terms of delivery of home-based services… if it doesn’t happen on the federal level, watch for this to happen on a state level, it’s already in California.”

NAHC has a number of other federal priorities for 2021 and state-based initiatives it is watching, including:

  • Premium pay for frontline caregivers mandated by congress or states
  • Liability protections for workers, patients and families, and business owners; Congress is debating some aspects of COVID-19-related liability, he said
  • PPE access for homecare companies
  • Increasing oversight of Medicare-funded hospices, including potential payment model reform
  • Expected expansion of the value-based purchasing program in home health
  • Requests for health savings accounts to include homecare payments and also for tax credits for private pay homecare patients
  • The possibility of expanding scope of practice for homecare aides in some states