Staffing, Hospital Partnerships and Disaster Prep: Providers Share 2021 Spending Priorities

Similar to most companies this time of year, home-based care organizations are going through their budgeting and planning processes for the next 12 months.

Budgets are thoughtful, strategic financial frameworks that are decided upon annually, with an eye toward the future. But this time around, providers are making spending plans with the insights gained from the COVID-19 emergency in mind.

For many home health and home care financial leaders, investment in recruitment and retention remains crucial, especially as the public health emergency rages on. As cases continue to surge across the U.S., providers are looking to ramp up their staffing efforts to keep up with the demand for care.


In fact, in a survey of more than 350 in-home care professionals from Home Health Care News and Homecare Homebase, 41% of respondents said they expect “staffing changes” to be their biggest COVID-19-related expense in 2021.

In-home care companies are investing in strengthening their staff in a number of ways. Some providers have plans to increase the size of their staff, while others have set their sights on front-line worker education.

Sunrise, Florida-based Interim HealthCare Inc., for example, plans to beef up its staff in order to play a role in the COVID-19 vaccination process.


“Challenges with COVID-19 in 2020 have led us to really expand our services,” Jennifer Sheets, president and CEO of Interim, told HHCN. “We provided testing sites across the country for communities and large organizations. We want to do that same thing in 2021, as it pertains to … vaccine distribution.”

Interim — a home-based care franchise company with more than 300 locations across the U.S. — isn’t an anomaly when it comes to investing in staff. As part of its budget for 2021, American Advantage Home Care Inc. has dedicated funds to employee development. 

“We’re going to spend a lot of energy and effort on the professional development of our clinicians in view of not only the pandemic, but really just sharpening their tools and skill sets,” Cleamon Moorer Jr., president and CEO of American Advantage Home Care, told HHCN.

Dearborn, Michigan-based American Advantage Home Care is a provider of home health care and rehab services, plus specialty care and medical social work. The agency operates across nearly a dozen Michigan counties.

In particular, American Advantage Home Care’s training dollars will go toward educating its clinicians on wound care, cardiac management, diabetes management and infusions, according to Moorer.

Over the past couple of years, American Advantage Home Care has become more intentional in regards to training. This is reflected in the company’s budget, as opposed to categories like marketing efforts or office space.

“I think our shift from 2019 to 2021 is more internal, [meaning] internal growth and internal development, as opposed to external awareness,” Moorer said. “Part of that is based on our growth. We went from 13 patients or so to roughly 140 within 19 months. We’ve experienced a 1,000% growth spurt.”

At Trinity Health At Home, investing in recruitment and retention means putting forth a solid salary and benefits package to help entice new candidates and maintain current staff, Mark McPherson, the company’s president and CEO, told HHCN.

“I think one of the things that has been really challenging with COVID is the incredible demand for nurses it’s created,” he said. “There simply aren’t enough of them to go around. Right now, it’s kind of a feeding frenzy for nursing talent.”

Trinity Health At Home is a member of the Catholic health system Trinity Health. The Livonia, Michigan-based company is one of the largest home health providers in the country.

Because of staffing shortages across health care, nurses are being given additional opportunities to take on temporary assignments, McPherson noted. This has, in turn, made it more difficult for providers to maintain a stable workforce.

Similar to American Advantage Home Care, there are areas where Trinity Health At Home will be spending less. The public health emergency forced the company to take a closer look at some of its fixed costs and determine if the company could better optimize.

One of the changes that has come out of this examination is the decision to bring the company’s coding in-house, according to McPherson.

“We found that we can do it as accurately as the external coding services,” he said. “And it’s less expensive for us.”

For another in-home care organization — EvergreenHealth Home Care — the public health emergency only validated its previous investments in disaster preparedness.

“EvergreenHealth has been sending leaders to train at FEMA’s Center for Domestic Preparedness in Anniston, Alabama, for years,” Chief Home Care Officer Brent Korte told HHCN in an email. “This investment has paid off in numerous circumstances, though particularly when the pandemic arrived at our doorstep in late February last year. We will continue to invest in advanced disaster preparedness training for our leaders moving forward.”

Kirkland, Washington-based EvergreenHealth Home Care, a part of EvergreenHealth, is one of the largest home health and hospice providers in the Pacific Northwest.

New ventures

When mapping out a 2021 budget, many companies are earmarking funds for new ventures as well.

At Interim, this means going after more hospital partnerships.

“That’s a crucial area, in order to really break down the silos across the continuum of care,” Sheets said. “The pandemic put in perspective how far we have to go with breaking down those silos. Hospitals are pushing to discharge patients to free up increasingly impacted health systems, so fostering partnerships with hospitals allows us to step in, take the patient sooner and help reduce the risk of transmission of COVID-19 and other infectious diseases.”

To this end, the company is working to develop programs that connect acute care to the post-acute world.

Other in-home care providers are focused on hospital partnerships, too. Of the more than 350 professionals surveyed by HHCN and Homecare Homebase, 32% said they hoped to boost referrals from hospitals this year.

For American Advantage Home Care, this means launching a hospice service line. The main inspiration for this move was the socio-economic and awareness divide in the metro Detroit area, as it relates to hospice services.

“It seems as though there’s a lot of families that aren’t well educated on hospice being a means to assist their family member or loved one at life’s end,” Moorer said. “I think closing that geo-demographic gap for metro Detroiters is a great opportunity for us.”

Overall, most providers believe that their spending for 2021 will further position their organizations as problem solvers across the health care continuum.

“Home health is absolutely the answer,” Sheets said. “It’s about continuing to focus on, ‘How are we a part of the solution?’ Not sitting back and saying, ‘Oh, here’s the big problem. Who’s going to solve that?’ We want to invest in solving the big problems and responding to the needs that are out there.”