EvergreenHealth Home Care — one of the largest home health and hospice providers in the Pacific Northwest — is the home health industry’s “pandemic pioneer.”
Affiliated with a local hospital based just outside of Seattle, EvergreenHealth Home Care began caring for its first COVID-19 patients toward the end of February, several weeks before many of its peers were directly impacted by the virus. Since then, the provider has successfully navigated a lengthy list of challenges, from skyrocketing Low Utilization Payment Adjustments (LUPAs) to being shut out of long-term care facilities.
Yet along the way, Evergreen has grown its home health patient census to a new all-time high, Chief Home Care Officer Brent Korte told Home Health Care News.
While that’s partly due to increased demand for home-based care in light of the public health emergency, it’s also because of the Patient-Driven Groupings Model (PDGM), he noted.
“For home health care, we have worked very hard to understand what the right level of care is,” Korte said. “I would say, perhaps, the silver lining to COVID-19 has been that our census has increased pretty significantly.”
As an organization, EvergreenHealth Home Care and its roughly 600 staff members manage more than 11,000 episodes of care each year. As of mid-August, the provider’s average daily census had increased to around 1,450 patients, putting it squarely in “growth mode” despite widespread uncertainty in the health care sector.
“We are within the margin of our highest census that we’ve ever had in the history of our program,” Korte said.
Of the 1,450 or so patients that Evergreen cares for on a daily basis, many are still COVID-19 patients, too. In fact, Korte’s home health and hospice teams actually have more COVID-19-positive patients than the affiliated hospital does, he said.
Evergreen’s home health and hospice teams were caring for 29 patients as of Aug. 14, while the hospital was caring for 16 patients.
“I think the clinicians are really finding their stride when it comes to the appropriate number of visits, or the appropriate balance of maintaining infection control guidelines and social distancing practices while taking care of our patients,” Molly McDonald, EvergreenHealth Home Care’s program manager of quality and regulatory compliance, told HHCN. “They’re really seeing where home care can have a bigger impact than ever before.”
As it continues to grow, Evergreen will keep adapting and learning from its COVID-19 experience.
The biggest challenge to that growth Korte and McDonald see in near term: staffing.
Losing the home health brain trust
Early on in the COVID-19 pandemic, LUPAs were one of the top challenges for EvergreenHealth Home Care.
At one point, Evergreen’s LUPA rate reached a high of 18%, according to Korte. But by effectively communicating about patients’ needs and taking a team-based approach to care, the provider has been able to lower that to about 9%.
Similar to most health care entities, Evergreen likewise dealt with information overload.
To make sense of the fast-paced changes from state and federal regulators, Evergreen was originally conducting regular, organization-wide calls to disseminate information. It’s now being more strategic with that communication, Korte said.
“From a communications perspective, we’re focusing more on individual communications, and communications with teams and pods,” he said. “That’s instead of going house-wide.”
Being restricted from seeing home health and hospice patients in long-term care facilities and assisted-living communities was additionally a challenge, though productive talks with many of Evergreen’s provider partners have recently helped open doors.
“These are our partners, so we need to make sure we work with them,” Korte said. “But prohibiting our ability to provide care puts everyone at risk. It puts the patient at risk, and it puts us at risk from a liability perspective. It puts the adult family home or the assisted-living facility at risk as well, because their patients have a need for focused, skilled care.”
Disruption to staffing is the challenge that’s likely not going away anytime soon.
Specifically, Evergreen is seeing a higher-than-normal number of early retirements, a trend that other home health providers have likewise noticed. It is also seeing some staff members take a leave of absence when they’re not at medical or clinical risk.
“That’s diminishing our staff at our highest census,” Korte said. “Then the rest of our remaining clinicians certainly end up more busy, which means we have to be concerned about burnout.”
Sudden retirements immediately impact operations by throwing a wrench into recruitment strategies, as most providers ramp up their recruitment efforts when they know a valuable clinician is about to leave. On a broader scale, the trend of early retirements puts the industry’s overall knowledge base at risk.
“We’re losing a significant brain trust of our most experienced staff, people who are choosing not to come back,” Korte said. “Staffing is a huge concern for us right now.”
Finding a staff balance
EvergreenHealth Home Care is doing its best to retain its experienced staff members and find new ones when necessary.
That’s true for both its nursing and rehabilitation teams. Unlike home health businesses that opted to cut back on physical, occupational and speech therapy under PDGM, Evergreen has doubled down on those disciplines.
“Where other agencies are laying off therapists in the double digits, we continue to hire therapists. We have had no layoffs to date, nor plans to lay anyone off,” Korte said. “We’re significantly in hiring mode right now.”
Keeping staffing levels robust is a core part of Evergreen’s PDGM strategy. But even before the payment overhaul, the provider always “worked to say yes” to the most clinically acute patients, a decision that has ultimately helped it build strong relationships with hospital partners.
“We have very strategically and purposefully grown our relationships with hospital partners outside of our direct arena,” Korte said. “Most of our growth has come from that because we are the provider that says ‘yes.’ We’ve built a lot of capacity to do so.”
In recent months, therapy has been particularly important because many of Evergreen’s patients are isolated, which could lead to weakness and rehab needs, McDonald said.
“What we’re seeing is some long-term effects of isolation, and we know rehab has a strong role there,” she said. “But when it comes to nursing and therapy, we’ve seen the collective unit taking care of the patients as opposed to one discipline or the other discipline.”
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