The COVID-19 crisis has uprooted the health care sector and done away with most norms that existed beforehand.

That goes for the workers who make up the sector, too. One developing trend to keep an eye on as home-based care plays a bigger part in keeping at-risk seniors safe is the migration of more nurses into the home setting.

Historically, many nursing programs have prioritized institutional settings, leading students to believe hospitals and emergency rooms were the places to be. After eventually working in the home, many nurses change their views and the biases instilled early on in their careers.

“I think that nursing students may think that way,” Olga Jarrín, a registered nurse (RN) and professor in nursing science at Rutgers University, told Home Health Care News. “Because a lot of the curriculums are very hospital-focused and their clinical rotations are primarily in in-patient settings. [Educating] that pipeline of future nurses to value home health care is still a challenge for nursing schools.”

In the past, this was one of the drivers that left home health providers with nursing shortages. To make matters worse, projections suggest that the industry will need to add a daunting amount of front-line workers in the next decade — anywhere from 630,000 to over 1 million.

But recruitment into the home could be given a boost during the COVID-19 outbreak. In-home care has become increasingly important as both patients and nurses worry about hospitals’ heightened level of risk.

The coronavirus, then, could change the dynamics of the nursing workforce forever — in favor of home-based care providers.

“I don’t believe that we’re ever going to be the same,” Mary Gibbons Myers, president and CEO of Johns Hopkins Home Care Group and president of Home & Community-Based Services for Johns Hopkins Health System, told HHCN. “And I think we have — through this pandemic — demonstrated the ability to care for patients differently in outside settings. [In regards to] education in general, I used to say that within five years, hospitals are going to be critical care settings and emergency departments. This really got accelerated with [the coronavirus]. Right now, many people are trying to avoid institutional care.”

Johns Hopkins Home Care Group is a part of Johns Hopkins Health System’s Home & Community-Based Services division, which includes four Medicare-certified home health agencies, two private duty companies, a large home medical equipment company, and pharmacy services in the home and the community, including outpatient, specialty and infusion services.

Myers’ first claim is indisputable: Americans are increasingly trying to avoid hospitalization, so much so that they’ve been risking their lives to do so in some cases. Her second claim — that the coronavirus is accelerating the shift toward home- and community-based care —  remains to be seen.

Similar to Jarrín, Myers has also called for a refocusing of nursing programs.

“[There was always] this mindset that you had to have all this acute care experience before you can be successful in the home,” Myers said. “But what we’ve been thinking over the last couple years is that we really need to go upstream and look at the institutional or the educational setting, making sure that the curriculum is changed so that instead of focusing people on critical care and hospital settings, [we’re looking] at the entire continuum of care, and see home- and community-based services as a specialty of its own, and prepare people in that way.”

On its end, Johns Hopkins’ Home Care Group has been working with local programs to ready nursing students for home-based care by pairing them with home health aides or certified nursing assistants in the field.

Many of these students never realized such opportunities existed, Myers said. Exposing them to home-based care early on helps emphasize the importance of in-home care. They’ve also formed partnerships that allow nurses who have primarily worked in the hospital to gain experience in home-based settings.

“It is all about messaging and the glorification of each role,” Myers said.

The Coronavirus Aid, Relief, and Economic Security (CARES) Act also gave nurses further access to the in-home care arena. The stimulus package used the framework of the April 2019 Home Health Care Planning Improvement Act to give nurse practitioners (NPs), physician assistants (PAs) and clinical nurse specialists (CNSs) the ability to certify home health permanently.

Myers is aligned with many other home health insiders who believe the next logical step is for the Centers for Medicare & Medicaid Services (CMS) to allow for telehealth visits to be reimbursable under Medicare.

COVID-19 and the complications that come with it are not going away any time soon. That means that governmental agencies, patients and the workforce that provides them care should prepare for a future that takes that into account.

“I think you’re going to find that those curriculums will add a certain amount of required hours for home-based care,” Sophia Thomas, the president of the American Association of Nurse Practitioners (AANP), told HHCN. “[That way], they can see what the facets of providing health care in that arena is like. I think [will definitely happen] for RNs, and perhaps for NPs as well.”

Allowing nurses to do more

Additionally, as Full Practice Authority (FPA) becomes more commonplace for nurses across the U.S., it will allow NPs to open up their own clinics and conduct home health care with fewer obstacles.

FPA gives NPs the autonomy to evaluate patients, diagnose, order and interpret diagnostic tests and initiate and manage treatments. Before COVID-19, 22 states, the District of Columbia, Indian Health Services and the VA Health System granted FPA.

Without FPA, NPs are bound by burdensome fees and required to receive written agreements from a physician in order to open up a practice.

Since the beginning of COVID-19’s spread, five additional states have granted FPAfor the duration of the crisis, according to AANP.

“I can tell you that in states that have full practice authority, NPs are opening up clinics and they’re meeting the access to care needs for patients and they’re doing home-based visits,” Thomas said.

States without FPAy have a stronger barrier to entry for NPs looking to provide home-based care.

“Five states have issued full practice authority waivers that last for the duration of the emergency, but after that, the states — including my own state of Louisiana — will be going back to the way it was before,” Thomas said. “A temporary waiver doesn’t make a nurse practitioner very comfortable while going to open up her own practice, when she knows that as soon as the emergency declaration is over, we’re going to have to go back to the way things were.”

But the temporary could, and perhaps should, become permanent. The home health and home care industries must be ready when it does.

“This is a time for home-based services to truly shine,” Myers said. “We can step up and try to find out the problems that need to be solved, and then help solve them.”

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