This article is brought to you by AlayaCare. The article is based on an interview that took place during a live panel discussion with Adrian Schauer, Founder and CEO of AlayaCare; Vicki Hoak, Executive Director of Home Care Association of America; Todd Austin, Chief Operating Officer for Home Care Pulse; and Shiwan Chung, leader of MedTec Healthcare. The panel took place at the Home Care Conference in Chicago held on December 9, 2021. The interview has been edited for length and clarity.

HHCN: We’re going to be taking a look at the trends shaping home-based care in 2022. Before we do so, I thought I would start by asking Todd, Vicki, and Shihwan about the trends that have shaped 2021. Todd, what have been the key threads shaping home care this year in your view?

Todd Austin: When we talk about staffing and education challenges, I think that shaped a lot of this year. One of the interesting things, too, is probably what has not changed this year, it’s probably easier to answer than everything that has changed this year in a care setting.

HHCN: Vicki, I know you talked to home care leaders on a daily basis, what are the key themes?

Vicki Hoak: I think the first thing I would say is that home care has come out of the shadows in 2021. I think that I’ve been in this business representing home care and advocating and I never in my dreams thought that I would be sitting listening to one of our sitting presidents using the words home care and that happened. I think that is a shift that has a lot of other things that come with it. Definitely, out of the shadows.

We had a board meeting about a month ago, and everyone around the table said, “This is our time. This is home care’s opportunity to now really blossom and take advantage of all this new attention that home care has.” I think, as a result of that, another shift that we’re seeing across the country is this thought that perhaps our caregivers can do a little bit more than we thought they could. We’re seeing that in Illinois. We’ve got some chapter leaders.

They did a great job taking a look at their regs and saying, “You know what? We can do more.” We’re seeing that in California, we’re seeing it in Connecticut. People are looking at their license and saying, “You know what? I think our caregivers can do more, but more importantly, our families need us to do more in order to keep their loved ones at home.”

HHCN: Shihwan, you have a real on-the-ground perspective with operations here in Illinois. For folks in attendance, I overheard that you’re also in the adult day space, too.

Shiwan Chung: Yes.

HHCN: What have you seen across MedTec?

Chung: I would say it comes as a surprise to nobody, but recruiting has just been really hard. We’re a local Chicago land-based provider and never in my wildest dreams would I think we would be competing with Amazon and Walmart for talent. I think that we’ve been able to grow ours, which is great, but we haven’t been able to grow to the extent that we want. I think everybody in the room wants their businesses to grow, just because of challenges. The lifeblood of our business is recruiting, training, and retaining our home care aides.

That continues to be a challenge and based on what we’ve heard before, it probably will be a challenge going forward as well.

HHCN: Adrian, I think over the past two years, it’s been really fun for you and I to talk about the trends shaping home-based care in the coming year. What do you foresee impacting the home care industry come 2022?

Adrian Schauer: My top three would be and no surprise, number one is related to staffing because I come at these questions with a technology lens. On the staffing side, there’s a lot to do on how we recruit caregivers. I think Tim gave a pretty specific example of how you can reduce that time from first application to first paycheck. I think there’s a lot to do there that’s important. I think it’s important to look at the overall attractiveness of a job in personal care.

I think the previous paradigm was very much around, “Oh, I need to fill these shifts. I have to staff these cases.” My immovable point is the demand and I got to get someone to the client’s home. Now, I think we have to adjust to say, “Okay, I need my caregivers to have consistent work that fits into their preferences, so how do I shape my demand into that supply?”

HHCN: Earlier today some others have touched on how it wasn’t necessarily compensation that was the top thing for staffing, but it was that flexibility that home care naturally has.

Schauer: Yes, that’s an important theme. Second theme, I would say is there’s a lot of public reimbursement coming into this space, and how that plays out is not fully defined. I think more money will definitely lead to more demand, so we’re going to have to solve the supply problem. The other thing I think that’s going to become more important is making sure that we’re speaking the language that the rest of the health system can appreciate. Things like the change of condition reporting at the point of care and how you bring data to the rest of the continuum.

The third trend for me is about how we increase more demand than supply by looking at adding capacity. Some of the biggest latent capacity out there in our community is the family caregiver. From a technology point of view, we’re looking at extending our secure messaging tools out to the family and get them more involved in the circle of care. We’re looking at telehealth and delegated acts, and thinking how can an individual effectively leverage the family caregiver into the circle of care?

HHCN: Would anyone like to weigh in on any of those trends thus far?

Hoak: Of course, the workforce is always top of mind, but I think the other one that did resonate with me, Adrian, was the family caregiver role. I don’t think we have begun to tap the potential of having a good family caregiver, not just to be your partner in delivering the care when your aid isn’t there, but just the advocacy. When we look at today’s market and commerce, it’s all consumer-driven, it’s about reviews, yelps, and everything like that. We haven’t even mentioned if you have a wonderful experience with a family, that that family is yours forever and they become an advocate.

I think the other thing is just having that partnership that families do want to be involved in the care, and we have to do a better job communicating that. I think about a home care pulse study that I remember talking about at the height of the pandemic, we had the greatest degree of satisfaction with our caregivers and our clients. You pause and you think, “Well, gee, why is that?” I think it was because we were communicating so much.

You all were doing such a great job talking about, “Here’s the most recent CDC guidance, here’s infection control training, and you’ve got to do this, and we’ve got your back.” That’s just another indicator that we’ve got to make sure that a circle of caring is our families and our families need to be part. I always think that the best experience a family can have when they have home care is when that family caregiver and our professional caregiver are partners.

They just work, they know what happens when they’re not in the house. Then when the caregiver comes in, she or he knows what happened that night. I just think we need to do a better job communicating with our family caregivers.

Schauer: It’s part of the recipe for meaningful work. Not just the respect you get from your employer but also from the community.

Hoak: Absolutely.

Austin: The campaign is the employment brand and then the employment brand is extended to the family caregiver. For this to happen, not only do we have to communicate at a more sophisticated level, it can’t just be transactional or tactical, it’s got to be meaningful. That’s the difference that we’ve all done as we’ve attracted and retained caregivers. It’s connected to the why.

It’s not a campaign that is a one-time instance, it’s ongoing, and that goes for the caregiver, the clinician, along with the family caregiver, and that education has to extend to them in order for us to impact all the way through the delivery model.

Chung: Yes, I agree with that. I think at the same time though, we talk about how home care could do more, but I also think that we can do more as an Industry for home care aids. The reality is that we have a vested interest in it from a retention standpoint. If you think about the home care aids job, especially in the time of COVID, it is incredibly challenging. They’re isolated and it can feel very transactional for them at times and it’s basically figuring out ways to engage with them more and to figure out ways to make them feel like they’re part of a team, and also to drive a culture.

I think it’s going to lead to not only higher satisfaction for the home care aids, but better quality. It’s going to be a virtuous cycle for everybody where we deliver better care, we have better retention, and we have a much happier workforce.

HHCN: I want to ask a quick follow-up question to you, Vicki, because you mentioned how exciting it was to hear President Biden talk about home care. One of my fears as a reporter for Home Health Care News is that we have built back better on the brink of passage while I’m on stage. What does that mean for the home care industry? What kind of excitement does $150 billion going to home and community-based services mean for HCOA members?

Hoak: A lot of that money goes to training our workers, which is good. Again, let’s keep our fingers crossed that the $150 billion stays there. I think that’s something we’ve all talked about as a recruitment effort that we have to do a better job in training so there’s lots of money in that $150 billion for training home care workers and displaced workers. There’s also expansion in the Medicaid field, folks that are doing Medicaid. However, it stopped short on making home care an entitlement, like nursing home care.

I think that’s something we have to work for. I think that the attention is good and we just have to keep it up because when we go to the capital now, the senators understand home care. Our job now is to explain the differences among the sectors of home-based care. How many times do you have to say, “Oh, that’s home health,” “No, that’s Medicare”?

The other thing that’s happening is home care is being recognized as something that Medicare should look at and pay for, but choose home legislation. The 360 hours of personal care, in that bill, is recognition that medical care, it’s just not about medical care, nursing care, OT, PT, it’s about personal care, which is so important.

HHCN: A quick side note, Vicki, to your point, this just happened yesterday. I got an email from somebody on the communications team for one of the biggest insurers in the United States, asking me to define home health and home care and all the other different terms for them because they weren’t sure.

Hoak: We’re fragmented. That’s another thing about this industry. We don’t have national standards. Depending on if you’re in Illinois, you do this. Nebraska, only Medicare-certified home health agencies can give baths, folks. It’s just insane. We’ve got to take a look at that moving forward too.

HHCN: Adrian, I know that there was a lot to digest there and follow up to your trend predictions for 2022. Anything that you would like to comment on before we move on?

Schauer: I think it’s an operating model change that the industry is digesting now. With the caregiver experience having primacy now, I think there are many ways to slice how you evolve that experience because there’s that type of caregiver that’s disposed to stable, full-time employment, and a type of caregiver who’s disposed to the gig economy. I don’t think everyone will take the same strategy and there are different personas out there. The focus on the caregiver experience, I think, that’s very good for the industry.

HHCN: We know that the pandemic is accelerating the importance of home care and support for the industry. Todd, Shihwan, and Vicki, what advice would you share with some of these other organizations in attendance on how to use their data to support increasing demand? Also, how to boost outcomes for both clients and the organization as a whole?

Austin: I think the first bit is actually tracking the correct metrics. As an industry, are we tracking outcomes? Digesting that is really step one. Now, many in the room are probably doing that, but last year, only 32% of home care agencies were actually tracking what outcomes were. I think there’s a foundation that needs to be built and we can build this, it needs to be led by the individuals here that are investing in the future too.

Then from there, it’s about execution and understanding what the impact of each one of these data points are. There’s a lot of great practices shared but most of this is not new. Many of you have heard about employment brands. Many of you have been working on your employment brands. The difference is coming down to execution around who can actually digest the data, track the data, and execute on it. I think it extends into the ADLs. I think that’s really important, considering what the data means to the activities of daily life for the clients. Then, thinking about how to align strategically with the caregiver to make sure that is impacted as well.

HHCN: Shihwan, what are the key types of data that you’re looking at in MedTech, and how are you acting on it?

Chung: To step back for a second, this is a very highly fragmented industry with big players that have sophisticated data teams to mom-and-pop shops that just spend their evenings doing the books themselves. I’d say that the experience curve is pretty steep, it’s pretty long, and people are all across the gamut on it. When I think about us in MedTech, quite honestly, we’re pretty early in that stage.

We have a pretty new management team that came in to take a good business, and professionalize it. The data we’re tracking is just basic blocking and tackling at this point and it’s basically figuring that stuff out. In the time that my team and I have been at MedTech, I’d say there’s just a couple of things in terms of big lessons that we’ve learned. One is, you can’t lose sight of it.

It’s so easy to fall into the day-to-day and be in the weeds, and just live there but if you don’t step back and think about the data that you have, or the day that you need, and start tracking it and start executing on it and making decisions, you’re going to make suboptimal decisions, and you’re going to potentially find yourself going in a direction that doesn’t match with a strategic vision of what you want to accomplish. I’d say, another thing, too, is understanding that everyone is aspirational to tracking quality, but you have to start somewhere.

Being comfortable with whatever systems that you have to pull from and to think critically to Todd’s point of what’s the data that we really need to track? What are the things that we really care about? What are the indicators that allow us to have a better view of the business and to manage it better? I’d say the last piece is you don’t have to reinvent the wheel.

As I said, MedTech is pretty early in the process. there’s a lot of vendors out there with stands that are really excited to talk to you about the possibilities. In the short time that we’ve been a client, I’d say that we’re starting to get access to things and we’re able to see things much more clearly and much more easily. It’s been very powerful for us.

HHCN: Just to contextualize a little bit, when you say basic blocking and tackling on the staffing side, does that mean tracking things like call-off rates, and then on the outcome side, does it mean like readmission rates?

Chung: Yes, I think quite simply the system that we had before, there was a big-time lag, just real-time data to understand, and to be able to react much more quickly to be much more proactive in how we think about things. Being able to see things in real-time to manage your workforce in real-time, it sounds really silly. That’s powerful.

I’d also say that having a platform that has business intelligence tools, where you think about Readmissions is obviously something that everybody is aspiring to do, but I’d say things as simple as, understanding the recruiting pipeline and making sure that you’re using all the authorized hours for Medicaid waivers, and very basic things like that are things that we’ve had to initially cobble together and now we have a tool that allow us to do that a bit more efficiently.

HHCN: Vicki from HCAOA’s perspective, what’s the role of data sharing, data collecting, and acting on that data in home care today?

Hoak: Well, I think the association has recognized the need for data for this particular sector. We do have a committee that is looking at establishing a demonstration. We’re just looking for a funder right now, but I think it’s only a matter of time. Kanu, you talked about the data. We’re going to have to have data to prove our value. Gone are the days that you can say, “We’re the best quality home care out there.” I want to see the proof.

I think with Medicare Advantage Plans, even though I know they’re not where we all want them to be as far as hours and payment, it’s only a matter of time. The plans are tripling in the number of people that are going with Medicare Advantage Plans versus the fee for service. In-home support is the most popular service they’re doing. Everyone is going there because they want to see that home care is offered.

I think that in itself is going to make us, sooner or later, they’re going to say, “Show me why I’m paying for four hours of care every other day. Are you keeping my member out of the hospital? Are you improving their well-being?” I think data is just one of our top priorities as we move forward.

HHCN: Adrian, you obviously have great perspective on this topic.

Adrian: My observation echoes one of the things Shihwan said, which is that there’s a real spread of maturity level with respect to how data is used in this industry. We happen to serve the large enterprises and then also the smaller owner-operators. One of the things we’ve had to be thoughtful about is how people approach the value in their data.

In our toolset, you have your standard reports, which we think encompass a set of best practices, things you should be looking at, but then with the ability to then, as you get more mature up that curve, bring in the data science offerings, bring in the KPIs that really differentiate your business and your workflow.

HHCN: Shihwan, what opportunities do you see for MedTec going into 2022? What’s one piece of advice or a tip that you would share with others as a best way to leverage that opportunity?

Chung: I think it’s really easy to get caught up in the challenges of the past few years and really over-rotate towards that. I think there’s a good reason too. If you think about the challenges that this industry has had to face, we can’t provide care over Zoom. We are extremely vulnerable to COVID based on the populations that we serve. I’d also say that recruiting is really hard for our industry for all the reasons that we all know, not to mention the secular trends are unbelievably favorable.

I’m extremely optimistic about the future of this industry, both from the standpoint of demographics being what they are. To Vicki’s point, the awareness and the actual real dialogue going on about the acute need and the value that our industry provides is making sure that we are well-positioned to, weather the storm that we’re in now, but to be positioned so that when things get better, and they will, things can get better very quickly.

Those companies that have the right systems in place, that have the right tools, processes, and culture in place, will disproportionately benefit when things get better. You think about real pain points in organizations, when let’s just say the spigot turns back on, it’s things like recruiting, client intake, scheduling, compliance, all those things. If you’re not an organization that can scale, you’re going to be left behind when things get better.

HHCN: Todd, I know you have a great pulse on the home care industry. What’s one opportunity that you’re particularly excited for in 2022 and then what’s the key step to achieving that opportunity?

Schauer: It’s hard to pick one, but Vicki said it, we’re in the limelight. This is our opportunity to take advantage and show the value that we bring. As providers, a lot of times, I’d say, you guys don’t pound your chest enough. You guys do great work, it’s pivotal work. Sometimes as an industry, we shy away from saying, “Look at what we’re doing, and look at the movement we’re creating.” In 2022, that’s going to be a big one. Absolutely, there’s winners and losers.

The winners are likely investing in their individual education, like all of you that are here today. It’s a difference of thinking, feeling, knowing, and understanding. That’s what 2022 will bring in my perspective, is the winners will know and understand, specifically all the initiatives we’ve talked about, and at the same time, not over-tipping the balance of being too one-sided, in a perspective like what was already said.

HHCN: To your comment, even today, I’ve had conversations with folks who are talking about the really innovative things that we’re doing, and it’s just like, “We always need stories. Why haven’t you told me about this before?” Vicki, your thoughts on next year.

Hoak: I think this spotlight that’s honest, means that we also have to be accountable. Now, people are saying, “Okay, tell me more.” That’s why I think the data is just really important, and just establishing a culture of caring, we know that our workers want to work for someone that has that good culture, we’re hearing more about that. The other thing with data, we have to address this fragmentation of our industry, the fact that I might decide this data in this state, but if my license doesn’t require it, I’m not going to do it.

We have 30 states now with some form of personal care license. When I looked at these 30 states, they are just so vastly different. When we go over and speak with a senator, I’ll never forget this right before the pandemic hit, he said to me, “Tell me your standards,” and I said, “It depends on what state you’re in.” If we’re going to grow as an industry, we need to start getting rid of that fragment, and maybe look at national standards, and perhaps look at licensing in the States, and where are we with that license.

We’ve evolved a great deal since the pandemic, we now know that we can do more, and our workers can do more. They can be trained to watch changes of conditions and call the provider. We can provide them with technology that if there is an issue in that home that day, they can call and they can get someone on the phone. The opportunity for 2022 is to continue to improve on personal care to elevate it.

HHCN: Adrian, in the past, you and I have talked about digital tools being technology-enabled, and then shifting to technology-centric. From your perspective, what’s the next stage in this technology-centric care moving into 2022, and how will the client-patient and the family caregiver feed into this continuous evolution?

Schauer: I feel like we’re entering a golden era for the technology ecosystem here. When I look at the sponsors, there are a half dozen companies like Todd’s that we’ve partnered with, that we have integrations with. When you look into how you optimize the various parts of your business, we’re out of this era or we’re coming out of this era, where you need one platform to rule them all, where data stays siloed in a tool or several tools you choose. The ecosystem supporting this industry has made tremendous evolution in the seven and a half years I’ve been in this business. I think that’s a very positive trend.

HHCN: To your point too, it’s not just companies like AlayaCare having a bigger role, but there are companies outside of home care and investors outside in home care recognizing the role that AlayaCare plays and similar companies play. You’ve had a lot of momentum over the past year and a half.

Schauer: We’re lucky beneficiaries of the tailwinds of the industry and also some of us came from outside the domain. I was talking to Shihwan earlier, one of our newest board members is the former CTO of Shopify. It makes me think, okay, well, here’s a platform competing with Amazon to enable the merchants, the independent merchants to fight this fight for the heart of the consumer. Now, all that expertise to come and focus on how technology can do the same in home care, it’s a privilege and I don’t think five years ago, you had that level of attention and capital and talent coming in.

HHCN: Adrian, Todd, Vicki, Shihwan, thank you guys so much for your time. [applause]

Editor’s note: This interview has been edited for length and clarity. To learn more about how AlayaCare can help your organization ensure operations are consistent across multiple locations with real-time information updates for key stakeholders, visit https://www.alayacare.com/.

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