Exploring the Impact of the CARES Act on Home Health and Hospice

With the signing of the Coronavirus Aid, Relief, and Economic Security (CARES) Act last month, 100 billion dollars were earmarked for the U.S. healthcare industry. It sounds like a lot of money…but given the challenges of COVID-19 and all the healthcare entities sharing those funds, much more will undoubtedly be needed. Forcura’s relationship with home health and hospice agencies has offered us a unique look into their business operations, including their ongoing efforts to improve care outcomes and ROI. But how are they faring now, when faced with this unprecedented health crisis?  What benefits are they receiving from the CARES Act? And how will post-acute care be changed once the pandemic eases?    

Weathering the Storm

Like the rest of the healthcare industry, COVID-19 has broadsided the home health and hospice sectors, presenting them with situations that may compromise their employees, their patients and their businesses. According to William A. Dombi, Esq., president of the National Association for Home Care & Hospice (NAHC), they’re seeing a mixed bag of disruptions.

“In some cases, patients are refusing to be admitted into home care, or not allowing home health workers into their residences, fearing possible infection.  Plus, new home care patients have declined because all elective surgeries are on hold. On the other hand, home health providers are being asked to visit patients who have been exposed to or need treatment for the virus, complicating their care regime and increasing their personal risk. Hospice agencies find that their teams are being barred from long-term care and assisted living facilities – where so many cases have occurred -- as part of the effort to slow the spread.”

Financial, Regulatory and Technology Relief

The CARES Act includes an array of benefits directed at home health and hospice, such as:

  • Expanded access to telehealth and other connected capabilities,
  • Technology-enabled collaborative learning,
  • Improved care planning and training,
  • Better transitions between acute care and home-based services.

The first disbursement of CARES Act funding is already beginning to help home health agencies cope with the unforeseen expense of COVID-19, says Joanne E. Cunningham, M.H.Sc., executive director of the Partnership for Quality Home Healthcare.

“With grants to home health providers, the CARES Act is enabling them to obtain PPEs (personal protection equipment), train staff on their use and other new protocols, screen patients and employees for COVID-19, and expand telehealth. Home health agencies don’t shut down their businesses, even when some of their partner physician practices are closed or have limited hours, presenting an additional challenge to the continuity of patient care and their bottom line.”

Both Joanne and Bill praise one major change initiated by the CARES Act: physician assistants (PAs), nurse practitioners (NPs) and other non-physician practitioners are now able to medically certify home health for Medicare patients, as well as establish and manage a care plan. It was a long time coming, with legislative and advocacy efforts underway since 2007!

“A quarter of a million NPs, PAs and clinical nurse specialists are the primary care practitioners for homebound patients,” notes Bill. “We hope this certification capability will find its way to hospice, too. It should foster stronger relationships between community-based primary care practitioners, home health nurses and hospice care.”

“This pushes everyone to practice at the highest capacity of their scope,” Joanne adds. “Home health workers are doing the maximum they can do under their licenses to address these extraordinary circumstances.”

Home health and hospice are realizing significant value from their expanded access to telehealth services, to maintain care continuity and create staff efficiencies. They see how important it is to be in contact, whether visually or via simple phone calls with patients and their families. Bill expects the use of this technology to continue to grow post-pandemic.

“Provided there are payers, I anticipate more use of 24/7 remote monitoring, need-specific telehealth, and even wound care and therapy services. COVID-19 has created a wide-angle view of telehealth and related services within home health and hospice, beyond what already exists.”

Joanne also points to the benefits of technology that enables home health and hospice agencies to quickly and easily assess their operations.

“Being able to monitor outcomes and cash flow in this environment is critical. Agencies with platforms offering them regular guidance about their business are able to evaluate and creatively manage this perfect storm.”

A “Game Changer” for the “Ultimate Problem Solvers”

While much is uncertain about the future, Bill and Joanne agree that post-acute care will survive and shine.  Joanne acknowledges that home health as a sector is “well equipped” to solve their way through COVID-19 and move forward.  She says the lessons learned will frame how they prepare and work in the future.

“Today we’re building the plane as we fly it. Because of that, home care will see some definite changes in health policy. For example, personal protective equipment (PPE) has not been a standard of practice in home health, but certainly may be going forward, as is the case potentially for  remote screening and clinical assistance by phone. It will also be interesting to see how many young people choose to go into public health after this.”

Bill cites examples of the “resilience and creativity” of home care and hospice: they’re accessing PPE from nail salons and tattoo parlors, and using empty plastic soda bottles for face masks. He also believes acute care providers are developing a better understanding of, and greater respect for, the extensive and medically complex services that home health has been administering for years.

“This workforce will be held in much higher regard, thanks to the attention they’re receiving from the national media during the pandemic. Many stories have focused on the workers, the difficult jobs they’re doing, the risks they're taking going into homes, and also the value that they're providing. I just hope everyone will remember a year from now how important home health and hospice employees were to keeping this world going!”

As a partner to home health and hospice, Forcura could not be prouder to see how swiftly our industry has risen to the challenges posed by this pandemic. We are honored to collaborate with our clients to bring their remote workforce online, and are passionately committed to enhancing our solution continuously so that we too operate at the “top” of our license, today and always.

Annie 10-Retouched


As Chief Strategy Officer, Annie Erstling is responsible for driving growth at Forcura. She oversees the company's strategic planning, product innovation, marketing and strategic partnerships. She has experience launching new brands, products and companies across the healthcare and technology sectors.

Connect with Annie on LinkedIn.

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