Matt Hansen is the Executive Director of the Homecare and Hospice Association of Utah (HHAU). Previously, he worked as an independent strategic consultant with a health care industry focus.
Hansen recently spoke on the implications of moving care into the home at our 2022 Utah State of Reform Health Policy Conference in Salt Lake City.
In this Q&A, Hansen discusses how the pandemic impacted his work and what HHAU is working on to improve home and hospice care.
State of Reform: What are you spending your mental energy on right now?
Matt Hansen: “We represent a majority of the homecare and hospice agencies in Utah, and I would say a majority of our attention right now is going to two things: the staffing crisis and finding more resources for family caregivers. We really see family caregivers as untapped resources as far as providing care in the home that needs additional resources.”
SOR: Can you tell me a little bit about those two issues?
MH: “Staffing has been an issue in health care for a long time, and we’ve seen the freight train coming from a long distance away. But with the public health emergency and COVID-19, it really accelerated the collision course. We’ve been in a position now where we’ve seen a lot of caregivers—as well as professional health care workers—leave the industry. There are individuals leaving because of burnout or because they’re able to make just as much somewhere else without as much mental stress and mental pressure.
That’s always hard to see because these professionals obviously entered the industry for a reason. They have the passion and they have the heart, but then either the circumstances themselves or [their potential maltreatment] cause them to not stick around.
I’d say that the staffing issue is even worse right now with our nurses. That’s because we’re competing with a lot of other industries that simply can pay them better. Reimbursement rates just aren’t such that we can keep them around. If they can make just as much work in fast food at $18 or $20 starting, many of them are leaving for those industries.”
SOR: How was hospice and homecare affected by the pandemic in terms of your workforce and morale?
MH: “2020 was very difficult, more than anything because of access to the care beneficiaries and to the patients themselves. A lot of people just didn’t feel comfortable having anyone come into their home, and we weren’t getting a lot of referrals. The first concern from providers was if they were going to be able to have enough business to keep themselves afloat. After we got past that initial stage, a lot of precautions were put in place like PPE, masking, gloves, etc. The public also began to understand a little bit more when the vaccine became available. Business was impacted significantly in 2020. But in 2021, we started seeing more provider relief funds and different things became available to help providers.”
SOR: What is HHAU doing to try to strengthen the hospice and homecare workforce right now?
MH: “One of the silver linings of the pandemic has been that we’ve been able to work across industries. We’ve formed collaborative work groups between skilled nursing, assisted living, homecare and hospice, and even other industries. These workgroups are looking at what we can do to try to recruit people into health care, and what we need to do to promote change. We can encourage employers to set limits, express appreciation to our workers, and increase staffing.
We’ve been reaching out to higher education institutions to become a part of their curriculum and send liaison groups to go speak to students in classes. We are also working upriver by working with high school groups. We’re also working to advocate for family caregivers getting paid and setting up more mechanisms for them to be paid to take care of their loved ones at home.”
SOR: What legislation did you support or oppose in this last session? What are you hoping to see in the legislature next session?
MH: “We only ran one bill ourselves and we ended up pulling it out as part of the negotiation process. We’re trying to standardize a review process for Medicaid rates. We experienced our first increase for homecare in 12 years in 2019 and we’re extremely grateful for that, but a lot has happened since 2019. However, we understand that there are only so many funds that can go around. We’re working with Medicaid accountable care organizations (ACOs), the Department of Health, and other providers to come up with a process where someone can request a review every so often.”
SOR: How do the priorities in the state budget represent hospice and homecare needs? How are the struggles you’re facing—like those in workforce shortages—being supported financially?
MH: “The One Utah Health Collaborative that the governor has initiated is included in his budget priorities for this next year. I think that really serves everybody because it’s inviting everybody to the table and really looking at how we can make health care more affordable, more equitable, [and] more innovative. We’re excited about that opportunity to be able to express some of our ideas. It’s not just about homecare. We believe that people should be able to have a choice where they receive care, but if home is less expensive than other settings or institutional care, we need to make sure we can make that happen.”
SOR: What does the future look like for you and your organization?
MH: “We’re very optimistic about the future of homecare and hospice. There’s been a shift in sentiment. I think through the pandemic, people have seen that a lot more can be done at home than has been done historically. This includes primary care, some hospital at home initiatives, [and] skilled nursing at home, and it’s more cost effective.
In many cases, there’s always going to be a place for institutional care. Some people just need it and we need to support it. However, I think giving people the choice is important and I think we’re going to see some legislation both nationally as well as statewide [to support home and hospice care].”
This interview was edited for clarity and length.