For years, Spank McCoy has relied on health providers' home visits to assist with healthcare needs for his bed-bound wife.
She would receive annual check-ups and visits whenever an issue arose. He said the service has been great. However, last month McCoy received a letter from the provider, Eventus, notifying them that this service would end this month.
"So there are the people that provide the care and then there are the corporate decisions that are affecting the lives of people trusted to the care of their physicians, and it's hard. So I'm also thinking of some other options," he said.
Since then he's been scrambling to find a new provider who could meet the unique needs of his wife. McCoy said so far he's been unsuccessful in finding a provider who both offers primary care home visits and can accommodate new patients. He fears what might happen if he never locates a new service.
"The option now is to call 911," he said. An option he said would not only be costly but challenging given that his wife is bed-bound and transportation back and forth would be difficult. Beyond that, he is also concerned about overburdening ER workers and catching viruses within the ER waiting room.
"I know that people who run healthcare businesses have to make those decisions because the choice is perhaps we'll end up providing no care to anybody. So we can take care of this 75% by letting that 25% go. And that sounds okay until you're in the 25%," McCoy explained.
Eventus told the ABC11 I-Team that of the 35,000 patients they serve across five states, very few receive care in their homes. The spokesperson for the company further explained their decision to only serve assisted living facilities, nursing homes, and retirement communities is partially based on the request of their payors (Medicaid, Medicare, and other insurers) "to participate in the movement to value-based health care in institutional settings."
Another factor in the elimination of home health services the business cited was the tight labor market.
"In a tight labor market where demand for providers significantly outweighs the supply, we constantly face the challenge of having sufficient coverage for our rapidly growing base of assisted living facilities and skilled nursing facilities. Therefore, the decision was made in the spirit of focusing operationally and organizationally on our areas of growth," an Eventus spokesperson wrote in a statement.
The company isn't the only one feeling the crunch of the labor market.
"There's not an access issue to care. However, everyone in health care in the last three or four years is suffering from the workforce shortage," explained Tim Rogers, the president and CEO of the Association for Home and Hospice Health care in North Carolina.
Every sector of healthcare has felt the burden of diminishing staff in recent years. These cuts force some primary care doctors to eliminate services like house calls and also reduce the number of nurses available for other home health needs.
Rogers said in the Triangle there are over 500 home care and hospice agencies, but their capacities have been stretched thin and this can limit the types and number of clients they provide for.
The North Carolina Pace Association has a dozen organizations that provide healthcare services to seniors, many of which are in their own homes. The association echoed this issue.
"There continues to be a shortage of Certified Nursing Assistants (CNAs) in our area and the increasing demand can't be met. Agencies have difficulty retaining nursing staff due to this shortage," explained a spokesperson for the NC Pace Association.
A report from Mercer Consulting estimates in the next three years there will be a national shortage of more than 400,000 home health aides.
UNC's Sheps Center reports the demand for home health and hospice nurses is only slightly higher than the current demand in North Carolina but over the next decade, the state will need 1,500 more nurses dedicated to the field. During the same timeframe, the center predicted a total of 12,000 more nurses will be needed across the state.
To solve this Roger said his members are working to attract more nurses into the home care and hospice field right after graduation. Data from the UNC Sheps Center found fewer than 5% of nurses who graduate from Triangle community colleges go into home health/ hospice after graduation.
Stakeholders are also working with lawmakers.
"We're working hand in hand with the General Assembly and the state of North Carolina and Medicaid, trying to raise the rates and Medicaid homecare and try to prevent cuts and Medicare home health and hospice so that we can try to sustain our workforce and keep it from hemorrhaging anymore," Roger said.
He said these efforts are so important because so many patients prefer home health care and without the option, many would have to turn to the costly option of the emergency room.
"We're all trying to work together to try to fix this problem of trying to get more services in the least costly setting. And the more access to home care and the more access to home health and hospice without cutting rates will be a key success factor in this equation," Roger said.
Patients like McCoy and his wife know this pending reality all too well.
"I hope that staffing issues due to the pandemic are solved. I hope that barriers to health care for everybody in America are lowered. Certainly, people who are on that very edge of the system, and often ignored by the system," McCoy said. "This is really eye-opening. To see how close you can be to a situation where basically, you get sick, you die. There are no other options and that's sobering and disturbing."
Roger said some members of his organization have been assisting former Eventus patients in finding new doctors.
He suggests others who find themselves in need of home health care contact their insurance to get options for providers who make house calls. He also suggested asking other specialty doctors patients might have for recommendations.