Market Research on United State Home Healthcare Market

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United States Home Healthcare - Utilization

Some important insights into current utilization in home healthcare in the US include: most senior citizens use home-health nurses, home care services utilized are utilized mostly by women, short-term injuries spark a need for home health care, lifestyle illnesses is a big driver for home healthcare, demand may outpace supply for home caregivers, people spend a lot on home healthcare and it is set to increase, and the introduction of telehealth. All these insights are spoken of in more detail below.

Most senior citizens use home-health nurses

Home care services are utilized mostly by women

Short-term injuries spark a need for home health care

  • According to the CDC, of the 12,400 home health agencies in the US that cared for 5 million people in 2014 (which is the most recent data available), many of the individuals needed short-term assistance after coming home from a hospital stay. Some of these conditions include illness and injury.
  • Ongoing assistance is needed for more chronic conditions such as age and cognitive decline, as is seen in many senior citizens.

Lifestyle illnesses is a big driver for home healthcare

  • Conditions that require home health care most frequently include diabetes, heart failure, chronic ulcer of the skin, osteoarthritis, and hypertension.
  • For senior citizens, the medical conditions that cause them to require home care are a bit different. According to the Home Instead Senior Care's survey of home care professionals, their clients had at least one of these problems: mobility issues (61%), frailness (48%), some type of dementia (43%), Alzheimer's disease (29%), and the after-effects of stroke (22%).

Demand may outpace supply for home caregivers

  • According to the Bureau of Labor Statistics, from now until 2026, the growth of jobs in healthcare settings will be at 18%. However, demand for home health and personal care aides will outpace the sector's growth, with an increase of 41%.
  • This growth in demand is because of a shift in the age of the American population. The US Census Bureau predicts that by 2030, Baby Boomers will outnumber children for the first time in history. The population that will be of retirement age will be 1 in every 5 residents. Currently, 69.1% of those who receive home health care are over the age of 65.
  • As the population gets older, people of retirement age prefer to get care in their own homes. 90% of seniors want to stay in their homes as long as possible (source 1). This effect has been observed recently, as 2015 was the first time more money was spent on home care than nursing home care.

People spend a lot on home healthcare and it is set to increase

Future services: Telehealth

  • Because of the impending dearth of workers in the home healthcare industry, agencies must now find ways to utilize technology to make up for this problem.
  • One way agencies (HHAs) are currently looking into solving this problem is by way of telehealth technology. This technology helps agencies monitor, record, manage, and share data from the patient without the need for any in-person interaction.
  • Even though older adults are more resistant to new technology, surveys have shown that senior citizens are open to telehealth. One survey points out that 66% of seniors were willing to use telehealth technology, even though only 8% currently had it.
  • New features of telehealth will include telemedicine, where a doctor can remotely diagnose, monitor, and treat the patient, tele-education, monitoring devices such as fall protection belts, activity monitors, etc. A lot of it will be powered by AI.

Research Strategy

To first look for insights into the utilization in home healthcare, we first sought to answer the questions that we were given to explain, such as future projections on the services that will be provided in the home and disease categories that drive most utilization. To answer these, we focused on each individually and used healthcare-related websites such as those belonging to the Health Department of the US, as well as publications such as US News, CNBC, and Home Healthcare News. After answering these questions, we sought more insights by reading up on the present trends and insights into modern home healthcare int he US. We picked topics based on the article using the word "utilization", as in the case of the insight "Home care services are utilized mostly by women." Others we judged eligibility based on if that factor directly affects how someone utilizes home healthcare. We were successful with this approach.
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United States Home Healthcare - Seniors Opinions

Our research suggests that seniors consider home healthcare as helpful and convenient while providing the feeling of safety towards seniors and their families. However, the fact that a homemaker can potentially abuse unsupervised elders could also cause worry among seniors.

What Seniors Think About Home Healthcare in the US

Research Strategy

To determine the insights surrounding what seniors think about home healthcare in the US, we started our research by seeking any quantitative data related to the inquiry through senior-focused websites and government websites, such as and U.S. Department of Health & Human Services. We found that most of the statistical data mostly covered demographic or financial data with a minimal trace of how the senior population perceived home healthcare.

Although we managed to collect several valuable insights that provided statistical data from the previous strategy, we decided to dive deeper into the topic by looking through reports, studies, research, and journal articles from reputable sources, including NCBI; Statista; and J.D. Power, to gather valuable information to be added to our findings. However, we also found that the home care satisfaction survey which included senior population as the main participants was either older than 24 months (deemed as outdated according to AskWonder standard) or held in countries outside of the US. Therefore, we couldn't use the data to be added to our research. After extensive research on numerous platforms, we concluded that an updated survey related to seniors and home health care wasn't readily available.

As for our last strategy, we attempted to find the biggest causes of mortality or morbidity in the elderly government reports, including Centers for Disease Control and Prevention and National Council on Aging. Then we also sought information in various senior home healthcare websites regarding the services that they offer. We found that most of the caretakers were trained, skilled, and able to drive. Utilizing the insights collected from both sources, our research team selected the mortality and morbidity causes that could be prevented through using the home healthcare service. Even after we used three strategies, we still didn't manage to find any updated commentaries from any senior population that could directly illustrate what seniors think about home healthcare in the US.
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United States Home Healthcare - Home Care Referrals

According to the Affordable Care Act, only physicians, nurse practitioners, clinical nurse specialists, certified nurse-midwives, or physician assistants can recommend/ issue referrals for home healthcare (HHC) in the United States. Between 2001 and 2012, the instances of home healthcare (HHC) referrals that followed hospital-based acute care increased by 65% to 3.7 million. More women and older people get referred/covered by home health care.


  • In line with the terms of the Affordable Care Act, physicians are among the professionals that can refer or send a patient to a home health care service only "after meeting the patient" via a face-to-face (physical) setting.
  • The number of patients referred for HHC in the United States solely by physicians is not available to the public.
  • All home healthcare services rendered by Androscoggin "require a physician's order" as well as an established plan of care.
  • Androscoggin offers home healthcare and hospice services and is Maine's most significant independent home health and hospice agency. It serves the HHC need of 122 municipalities, plantations, and territories. In 2015, Androscoggin's home healthcare and hospice catered for about 8,732 patients as well as their families.

Nurse Practitioners

  • Nurse practitioners are among the group of people that allowed to refer or send a patient to a home health care service following a face-to-face (physical) meeting with the patient. These nurses can refer patients who need nursing-like care to home healthcare services after evaluation through a physical encounter.
  • Between 2001 and 2012, home healthcare (HHC) referrals after hospital-based acute care increased by 65% to 3.7 million.
  • The use of HHC has surpassed that of nursing facilities. It is the most frequently used care option for post-acute care by Medicare beneficiaries.

Clinical Nurse Specialists

  • According to the provisions of the Affordable Care Act (ACA), Clinical Nurse Specialists can refer or send a patient to a home health care service only "after meeting the patient" via a face-to-face (physical) setting.

Certified Nurse-Midwives

  • Certified Nurse-Midwives are among the group of people that allowed to refer or send a patient to a home health care service/procedure following a face-to-face (physical) meeting with the patient.

Physician Assistants

  • Assistants to physicians (known as physician assistants) can also refer or send a patient to a home health care service only "after meeting the patient" via a face-to-face (physical) setting. This regulation is according to the provisions of the Affordable Care Act (ACA).

HCH Referral: Older Patients, More Females

  • Older people are more likely to be referred to home healthcare services in the United States than younger people. A recent study examined about 1.1 million discharged Medicare patients aged over 65 years. It revealed that patients referred to home health care following discharge from a health facility were "more likely to be older," and live in an urban location, with lower incomes, and are associated with a longer length of stay.
  • The study also revealed that the group of 1.1 million referrals affected more female patients with a "higher illness severity scores." Typical diagnosis cases were heart failure or sepsis, and the region of hospitalization occurred more in New England when compared to the Pacific areas of the United States.

Home Healthcare Referral/ Use Rate

  • According to the CDC, home healthcare has a high annual-use rate (which reflects high referral rates) for long term care among adults aged above 65.
  • The use rate of home health agencies for those older than 65 years is "75 per 1,000." The study assumes that referral rates to home healthcare are higher than or equal to actual use rates. The study also assumes that home health agencies are those offering home healthcare services.

HCH Referral: Medicare/Medicaid Statistics

  • Under laws specific to Medicare, "only physicians" (medical doctors) can certify or refer a patient to home healthcare. Thus, Medicare requires that "no other" providers or professionals other than physicians to "certify" or send a patient to home healthcare.
  • According to the CDC, the largest single-payer covering long-term nursing charges of those referred for home care services is Medicaid.

Research Strategy

The research investigated insights surrounding referrals for home healthcare in the United States. Resources reviewed include scholarly/academic journals of the United States National Library of Medicine, National Institutes of Health. An investigation to uncover laws on professions/individuals that send/refer patients to home healthcare included legal articles published by Project HOPE. Project HOPE is a global health and humanitarian relief organization. Insights on home healthcare state laws revealed that anyone among clinicians such as a "physician, nurse practitioner, clinical nurse specialist," physician assistant, or certified nurse-midwife could refer/send a patient to home healthcare after a physical examination. Further investigations to uncover the rate at which the various disciplines send/refer patients to home healthcare did not yield relevant statistics. The article did not discuss such implementation details. Insights revealed that under Medicare regulations, only physicians are permitted to send patients to home healthcare.

The study also covered government agency publications such as CDC publications and other resources. The study investigated the number of Americans that are admitted and discharged from home healthcare every year. CDC disclosed that about 12,200 home health agencies offered services in 2016 to residents of the USA. It also revealed that approximately 4,455,700 patients were by home health agencies in 2016. Further investigation to uncover if these patients got these services from the comfort of their homes (in line with home healthcare policies); this strategy also investigated profiles of the professionals that referred them. Such details are not made public. CDC reveals that the use rate of home health agencies is "75 per 1,000." This study assumes that referral rates to home healthcare are higher than or equal to actual use rates. It also assumes that home health agencies are those offering home healthcare services.

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United States Home Healthcare - Home Care Company Attrition Rates

In an attempt to determine five insights surrounding how many customers a home care company typically loses annually in the United States, no direct answer was found. However, using various research methods, a triangulation of different factors led to the conclusion that the main causes of loss of customers for home care companies include: shortages of caregivers, seniors desire to age at home, higher expenses for home care companies, lowering quality of home care facilities, government regulations.

Government Regulations

  • Some of the greatest challenges facing the home care industry are the federal government's continuing attempts to cut Medicare, changing documentation regulations, and Innovative technologies.
  • New federal regulations are expected to cost home health care agencies $293 million the initial year, and $234 million every year after.

Shortages of Caregivers

  • In 2018, the average caregiver turnover rate was 82% according to Home Care Pulse.
  • According to Home Care Pulse, "different hours, better management, and new clients are among the top reasons caregivers leave a lot of their agencies."
  • In a 2018 study, 21% of caregivers stated they chose and agency because it was a positive working environment.
  • The average caregiver cost $2,600 to replace.
  • The average annual caregiver turnaround cost home care companies $171,600.
  • In 2017, caregiver turnover was at an all-time high average of 66%.
  • Caregivers are shifting to retail and food service because the pay is higher.
  • Over the past year, 12% of caregivers have either interviewed or are taking jobs with Amazon.
  • According to the Bureau of Labor Statistics, Home Personal Care aides ranked as low as fourth for the fastest growing occupations.
  • In spite of high turnover, the home care market has still seen nearly 40% growth since 2014.

Higher Operating Expenses

  • According to accounting and advisory company Marcum LLP, "While providers may meet their minimum obligations, the ability to react to unexpected circumstances and cost or to invest in technology and innovations either does not exist or is very restricted."
  • The top properties head in operating margin of only 4.5% in 2018.

Quality Of Facilities

  • Facilities with three star and above rating scores by Centers for Medicare and Medicaid Services (CMS) had a positive operating margin, while two Star and under facilities were in the red.
  • One star facilities had an occupancy rate of only 79.3%, while five-star facilities were at 88%.

Preferring To Age At Home

  • An AARP study claims that 90% of people over the age of 55 plan to age in place.
  • In a study of almost 700 home care companies, which represent $1.6 billion in annual revenue, a leading cause for lack of business is older people's preference to age at home.

Research Strategy:

The initial strategy was to look for the number of customers home care companies loss annually and the reasons for losing them. However, we were unable to find the required information with this strategy. Therefore, we then searched for factors that might cause home care providers to loss revenue. After not being able to find information directly about the number of customers that were lost, looking into the reasons of why companies were losing money was the next logical step.
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United States Home Healthcare - Risk Models

Six insights into the risk model applicable for home healthcare in the United States include partial or full risk for cost of services, caregiver liabilities to patients, the advent of tech in American homecare, the opioid crisis among homecare patients, CMS regulatory pressures on caregivers, and Medicare integration for ACOS in homecare.

Partial or Full Risk for Cost of Services

  • Many of the United States organizations providing home healthcare have to bear full or partial financial risk for the costs of healthcare services.
  • This high-risk factor limits their operational capacity targeting existing patients and future investment in specialized healthcare management programs, on-the-job training, or medical equipment.
  • Recent surveys show that only 33% of the American ACOs have complex care programs due to financial constraints occasioned by inadequate funds.

Caregiver Liabilities to Patients

  • The American healthcare industry is one of the best regulated globally in terms of caregiver liability to patients.
  • Therefore, caregivers such as those offering home healthcare must face additional risks associated with professional negligence, seriously ill patients, medical malpractice, or treatment errors.
  • Such caregiver liabilities have a two-fold impact on America’s home healthcare industry where quality improves but caregivers take on additional operational risk.

The Advent of Tech in American Homecare

  • Technological innovation has impacted many aspects of the American healthcare industry including its home healthcare sector.
  • Resources such as the Electronic Healthcare Record Management Systems, modern diagnostics equipment, and remote treatment options relying on the internet of all things continue to optimize the home healthcare sector as evidenced by the fact that more than 10 million patients receive home care in the US.
  • However, these technologies, like most others, are prone to malfunction exposing the sector to additional risks of malpractice suits and even fatalities.

The Opioid Crisis Among Homecare Patients

  • Patients falling under the category of post-acute care (PAC) often find themselves under the home healthcare regimen.
  • Herein, some of these patients require opioid-based medication for pain relief and management which has recently been witnessed in the United States to cause significant risk of addiction and abuse.
  • The CDC reported that up to 25% of patients in home care treatment programs relying on opioids exhibit withdrawal symptoms after treatment.
  • Consequently, the home healthcare industry has witnessed increased cases of some of its patients and even caregivers falling victim to the opioid risk factor.

CMS Regulatory Pressures on Caregivers

  • The CMS recently implemented an incentive-based program targeting caregivers who often use Electronic Health Record Management Systems.
  • This initiative, dubbed the Meaningful Use program, has exposed home healthcare practitioners and organizations to financial risks such as penalties that drive up operating costs while affecting ratings and customer perception.

Medicare Integration for Acos in Homecare

  • The Medicare Advantage recently optimized its integration with home healthcare service providers by introducing various financial and organizational incentives.
  • One of these incentives is the cost cap introduced in American healthcare institutions meaning premiums would be reduced from $46 to $40.
  • However, such financial incentives attached to the health insurance cover expose home healthcare providers to liability risks when malpractice or liabilities require compensation.

From Part 03
  • "Congress also took steps to curb fraud and abuse in the home health industry, by way of a provision of the Affordable Care Act (ACA). It requires any one of a variety of clinicians—physician, nurse practitioner, clinical nurse specialist, certified nurse midwife, or physician assistant—to evaluate whether home health care is medically necessary only after meeting the patient “face-to-face.”9"
  • "Within the United States, home health care (HHC) referrals after acute care hospitalization increased by 65% to 3.7 million between 2001 and 2012."