Home health industry sees many challenges

Georgia companies getting creative to meet them

Like all healthcare disciplines, the Georgia’s home health industry is rife with hot topics. If you ask Mark Oshnock, president and CEO of Visiting Nurse Health System, the need for clinicians sits high atop the list.

“Probably the most significant topic in the Atlanta market area is the shortage of skilled registered nurses” he said. “For the 35 years I’ve been in health care, we’ve always talked about the shortage of nurses. But it has never been more acute as it is today in Atlanta.”

Oshnock says he’d be the first to tell a young college student mulling over a career path to consider nursing. It’s a sure fire way “of making sure you stay employed for the next 50 years.” That rings especially true, he says in the home health field.

However, according to Antoinette Kilgore, who works in care coordination and account management at Visiting Nurse Health System, solving the home health staffing problem isn’t a simple fix. To tackle the challenge, Kilgore says “We’re having to get very creative. Home health is an industry where you traditionally need quite a bit of experience first before going straight into the specialty. You are practicing alone, so you don’t have a lot of eyes and ears in the home setting to bounce ideas off of or ask questions about a specific patient.”

To remedy the issue, Visiting Nurse Health System will be implementing a RN residency program similar to what a new graduate would find in the critical care areas of a hospital. Although they’re currently finalizing the specifics, Kilgore says it will likely be a 15- to 18-month program for recent graduates. By using video technology, a senior nurse will be able to monitor a new home health care nurse while he or she is working in a patient’s home and offer support and advice along the way.

“So if we can pull it off, it may be a cost effective solution for us to hire bright nurses right out of school,” Oshnock said, “and give them training that they would not be able to receive from any other home health care provider.”

Yet the required skills of home health clinicians keep evolving. While Donna Batts, director of operations at Central Home Health Care in Fayetteville, attended September’s annual meeting of the Georgia Association for Home Health Agencies in Jekyll Island, Georgia, this proved to be one of the more relevant matters at the conference. Today’s home health clinicians need more tech and IT knowledge and skills, she says.

“There are very few things now that aren’t allowed in the home, so nurses who come to home health also have to have a real high skill set,” she said. “And some of those nurses that typically have been in home health don’t have those skills. It keeps them from advancing in their career.”

Home health nurses need to be familiar with an array of technology. For example, a clinician might find herself managing sophisticated cardiac implant devices in patients, something they wouldn’t have been required to do in the past. Other advanced nursing skills needed in the home health field these days, Batts says, includes understanding sophisticated wound care protocols and devices.

Kilgore says Visiting Nurse Health System is addressing these skill needs by creating a retention plan for its staff.

“One of the things we’re starting to look at is trying to offer some sort of tuition reimbursement for advanced clinicians that are ongoing with either an advanced degree or certification in specialties,” Kilgore said. “For example we pay for our clinicians to be certified in ICD-10 coding. We also pay for them to go back and get their certification in wound, ostomy and continence nursing. So we’re looking at how we can retain nurses by helping them advance in their careers. We also provide opportunities for them to get certification in other specialties, including hospice and palliative care nursing.”

As technology advances in the home health field, Medicare-certified agencies face additional changes. According to Batts, it’s difficult for clinicians and their agencies to keep up with ever-changing Medicare regulations and requirements.

“Right now we have a document that we have to obtain from physicians called a face-to-face,” Batts said. “And it seems like every few months Medicare changes the regulations and requirements about those documents. …A fairly new requirement that Medicare has put into place is a specific lab that has to be drawn on all diabetes patients. Whether a physician orders that or not, we have to obtain that order. Those have been challenging for many agencies to stay on top of.”

Home health nurses and their agencies need to be at the top of their game now more than ever before. Another big focus for home health companies is a new star rating system. The government’s Centers for Medicaid and Medicare Services created the Home Health Compare (HHC) website on Medicare.gov as a way to help consumers choose the right home health care provider based on provider quality. Beginning this past July, HHC began publishing its Quality of Patient Care Star Rating for Medicare-certified home health agencies. HHC rates agencies by using OASIS assessments and Medicare claims data.

Quality of Patient Care Star Rating measures the following: timely initiation of care; drug education on all medications provided to the patient and/or caregiver; influenza immunization received for current flu season; improvement in ambulation; improvement in bed transferring; improvement in bathing; improvement in pain interfering with activity; improvement in shortness of breath; and acute care hospitalization.

In addition, HHC will be adding Patient Survey Star Ratings. Beginning in January 2016, HHC will publish ratings based on the patient experience of care measures.

“That’s a new challenge for all of us,” Batts said. “We’d all rather stay in a five-star hotel, right? So people are going to really look at those star ratings for home health agencies.”

While home health agencies strive to provide the best care they can, Kilgore says other challenges loom. She points to the need for a managing physician to be involved in the home health scenario.

“That’s probably one thing that we’ve seen that’s kind of widened the gap between that provider and the patient,” Kilgore explained. “A lot of patients that come into the hospital are being managed by hospitalists. No longer do we see as many as community physicians managing their patients when they become hospitalized. So that poses a challenge when the patient then has to follow up with their primary care physician. And they may not even be aware that their patient was in the hospital.”

Kilgore says that when a home health agency has a hard time connecting a provider back with a respective patient, it often results in delays of home health care service and sometimes a patient will find himself or herself readmitted to the hospital.

“So we’ve been making a lot of different efforts and initiatives to try and loop back in the different providers working with those hospitalist groups. We want to close the loop and help educate those providers on the expectations of what’s required in home health to make sure the patient is successfully managed.”

Even before someone considering a career in home health wades through these and other current issues, Batts suggests starting with the basics. She says it’s very important that before someone enters the industry that he or she does some observation visits. Find an agency, she says, that would allow you to observe a clinician in action.

“We have some people who think home health is easy with a flexible schedule and that you’re able to do your own thing,” Batts said. “But it’s quite different. You have to go into some scary places sometimes and face some difficult circumstances. And you need a great knowledge base as a nurse or a therapist. You’re really relying on your assessment skills.”

Equally important, she says, is that a clinician needs to be approach each patient with compassion, empathy and caring.

“For many of the patients that we see, we are the only people who enter their lives or come into their homes,” she said. “So be willing to truly invest yourself in the wellbeing of your patients.”


The home health industry in Georgia offers promising careers from clinical staffing to administration. So we chatted with the following home health care professionals, each from different backgrounds, about their own unique paths.

John Johnson, CEO

Atlantic Homecare, Waycross

On his journey into home health care:

“My family started in home health in 1978. In the early ’80s, I was in college. I graduated with a degree in accounting and became a CPA. I began working in the business in the early ’80s and have been here ever since. I started off as a staff accountant, then I moved to chief financial officer, and now I’m the CEO. My business has passed through two generations so far through my family.…The industry has always been a dynamic field with the satisfaction of providing care to the elderly. When I started in this field, the home health industry was fairly new. It had a high growth rate through the ’80s and ’90s, and now the market has become saturated in home health care. But I find it a very interesting field. It fit my field as an accountant very well. There are always a number of accounting functions required in this industry. We’re highly regulated by the federal government. You know at the end of the day that you’ve done a good job when you have patients who are satisfied, and you have good staffing satisfaction surveys.”

On his advice to those considering the field:

“It’s definitely a field that has opportunities for both clinicians and business professionals, and there are a number of careers available. There are always positions available in home health, especially in the therapy side. Physical therapy has the most demand, the strongest demand of any discipline of service that we currently provide. …Young people who want to begin as a field clinician and move into management, I think there’s a great opportunity in the home health industry.”

Mark Oshnock, president and CEO

Visiting Nurse Health System, Atlanta

On how he got involved in home health:

“It was actually a bit of the luck of the draw. I left the consulting world. I ran a U.S. healthcare practice for Arthur Andersen. I left that world, and Visiting Nurse was going through a search for a CEO at the time. So I took the job 11 years ago. That was actually my introduction to home health care and hospice end-of-life care. So there was a lot of on-the-job learning from a lot of great people here. And I’ve been here ever since.”

On the most gratifying part of his job:

“I think watching our clinicians get patients on the road to recovery is very gratifying. These days a typical hospital stay is for a very acute patient, and you’re getting discharged very quickly. As soon as you can walk, talk and hold your own, you’re getting discharged from the hospital. And hospitals are doing this to manage their costs for Medicare and for commercial insurance companies to manage their costs. So our patients are more acute than they have ever been. A great example is just three years ago if you wanted to have a big surgery like a knee replacement, you’d be in the hospital maybe three or four days recovering from that. Today that’s often being done on an outpatient basis so you don’t spend a night in the hospital. And we’re seeing you the next day at home doing therapy. That’s a huge change in what’s going on across health care. ..And what we do at home is a much lower cost than what a hospital can do on an inpatient basis. We can do for hundreds of dollars a day what it takes a hospital to do for thousands of dollars a day. And everybody wins. The patient’s at home, they recover more quickly, hospitals are more happy, and Visiting Nurse is happy. So it’s a win-win.”

Donna H. Batts, RN, COS-C

Director of operations

Central Home Health Care, Fayetteville

On how she entered the field:

“About 30 years ago, I was a young RN and I had children. I was looking for some flexibility with my job and home health allowed that. It allowed me to take my children to school, see my patients, then pick my kids up from school, and be home with them on the weekends and at night. So it was the flexibility that attracted me to home health in the first place.”

On what she likes most about home health:

“Right now I’m a director, so I’m not a hands-on clinician anymore. But the thing I like most about home health and my job in general is everyday we get to see that we’re making a difference in people’s lives. We’re allowing them to stay at home and receive care outside of an acute care setting. Most people prefer to be in their homes than in a facility somewhere. …A real focus in the last few years of home health has been trying to center in on what the patient’s goal is. In the past, our goals have been divided into nursing goals and therapy goals. But we’re really looking more now toward the patient’s goal. Our goal might be that they get completely well and back to normal. But the patient’s goal may be something like being able to walk down the hall in their assisted living facility and have dinner, being able to swallow their food or simply speak to their spouse. So we really try to focus on the patient’s own specific goals and what they’re looking for out of home health. And for me that’s been even more rewarding than just general provision of care. It’s great that we’re able to help the patient reach the goal that they’ve set for themselves and that they’re participating in that care.”