In the past year, home and community-based service offerings have been relatively flat or tanked among most of the largest nonprofit providers for seniors.
While senior housing providers remain generally committed to these services, they have been difficult to manage due to several factors, including staffing issues.
That and other findings agree with the LZ 200, an annual report by LeadingAge and Ziegler Healthcare Investment Banking that examines the nation’s 200 largest nonprofit multisites for seniors, government-assisted housing multisites, and unique campuses.
Of those senior housing providers, 42% offered some form of care in the home and community. That could include home health care, home health care, adult day care, continuing care in the home (CCaH) programs, and Programs of All-inclusive Care for the Elderly (PACE).
“Overall engagement with HCBS has generally held steady in recent years, even with the impact of COVID,” Lisa McCracken, director of senior housing research at Zeigler, told Home Health Care News in an email. “However, we know that staffing pressures have absolutely affected the ability to grow these platforms.”
Staffing pressures have forced health care providers across the board to reconsider launching new lines of service or investing in existing ones, but “the numbers show a relatively consistent commitment within LZ 200 to home care and home health. home,” Katy Barnett, director of home care and hospice policy and operation at LeadingAge, also told HHCN in an email.
Headquartered in Washington, DC, LeadingAge is an advocacy group comprised of nonprofit organizations serving the aging population. Meanwhile, Chicago-based Ziegler is a private investment bank that specializes in home health care and senior housing, among other areas.
The largest providers in this year’s LZ 200 included Trinity Health Senior Communities, Presbyterian Villages of Michigan, St. Paul Senior Services, Holland Home, Concordia Lutheran Ministries and Brio Senior Living Services.
Specific service line trends
While there are slight drops and increases in the figure shown above, they can also be attributed to discrepancies in respondents from year to year.
For example, CCaH, which has been gaining in popularity in recent years, fell from 10% to 8% among providers. But that’s probably not indicative of a larger trend. In fact, the opposite trend is likely to occur.
“The composition of the LZ 200 varies slightly from year to year depending on who moves in and who merges,” McCracken said. “I would say, even beyond CCaH within the LZ 200, that we continue to see a commitment to that model within the nonprofit sector.”
In fact, LeadingAge has seen more nonprofits launch CCaH over the past year, and has heard from others who are considering launching the program, according to Dee Pekhrun, director of policy and community services for Life Plans at LeadingAge.
On the other hand, the adult day model is still struggling. After severe issues related to COVID-19 since the beginning of 2020, many providers had to start from scratch when the pandemic finally subsided.
“Adult day providers are still navigating a series of unclear regulations around reopening congregate settings,” Barnett said. “That, coupled with reimbursement rates for these services from a Medicaid standpoint, a major issue, can make it difficult for some providers to justify keeping these lines of service open.”
Regarding home health care, experts from LeadingAge and Ziegler doubted that an environment of uncertain rates would lead to fewer providers offering services.
However, staffing can still be a challenge in home health care, making joint ventures popular in the space. Nearly 35% of LZ 200 organizations are involved in a formal JV with another provider, a health system, or a home health or care agency. That’s an increase from the 29% who were in such an association in 2021.
McCracken also mentioned that there are providers that can look to technology to solve some of the staffing issues they’ve faced.
“I think noticing the role of technology in this space is significant,” he said. “It can help reach people to a greater extent than was possible in the past. It can also help with some of the challenges related to staffing. Technology and services in the home really do create some of the best platforms out there.”