Health Systems Adapt to Changing Environment by Expanding Hospice, Home-Based Care

Home-based care, including hospice, is an increasingly attractive space for health systems and hospitals — a trend that accelerated during the pandemic.

Health systems are bringing care to the home by a number of routes. Some have launched their own completely new programs or re-organized an existing suite of services, whereas others have pursued acquisitions or joint ventures.

Initiatives like these allow health systems the opportunity to not only capitalize on growing demand, but also to address a more comprehensive range of their patients’ health needs in the setting that most prefer, according to Angel Vargas, vice president of Care at Home for Kaiser Permanente. Vargas oversees the organization’s Southern California and Hawaii markets.


“The reason why we want [home-based services] to be a distinguisher is because we acknowledge that the hospital can no longer be the future of the health care system,” Vargas told Hospice News at the Aging Media Network CONTINUUM conference in Virginia. “Hospitals should be more of an emergency room and [intensive care unit (ICU)] setting of care, while the home should be the future.”

By 2050, adults 65 and older in the United States will comprise an estimated 88 million, representing 22.1% of the country’s total population, according to a 2015 report by the U.S. Census Bureau. As early as 2011, more than 90% of U.S. seniors indicated that they wished to age in place in their residences, AARP research found.

For most, this extends to end-of-life care. About 70% of American seniors have said they wish to die in their homes, the Kaiser Family Foundation reported.


These shifting demographics suggest that home-based care won’t be relegated to the post-acute end of the health care spectrum, according to Vargas.

California-headquartered Kaiser Permanente Health System provides care to 12.6 million people across eight states and the District of Columbia. The nonprofit’s operating revenue reached $93.1 billion in 2021.

Last year, Kaiser Permanente, Southern California and Hawaii, consolidated its home-based care services into a single division, branded as Care at Home, with Vargas at the helm. The division offers home health care, palliative care and hospice in addition to high-acuity services like hospital-at-home.

“We always had a home health, hospice and palliative care, durable medical equipment and medical transportation portfolio, but it was a little fragmented and decentralized,” Vargas told Hospice News. “So last year we centralized it as a service within the delivery model. Now we’re one unified operation for all care at home — anything in the home is under this portfolio of services”

This integration by Kaiser reflects the ways health systems will need to adapt as they care for the rapidly growing, often chronically ill, Medicare population. These patients are expected to consume health care services and socio-economic supports at disproportionately higher rates than prior generations, placing a heavier burden on the health care system, according to the Census Bureau’s 2015 report.

Angel Vargas, Jan Hamilton-Crawford Mertz Photography
Angel Vargas and Jan Hamilton-Crawford at the 2022 CONTINUUM Conference.

The nation’s fragmented senior care model is not well-positioned to meet the evolving needs of aging adults, and system-wide solutions will likely be necessary to address them, according to Jan Hamilton-Crawford, CEO and president of Trinity Health Senior Communities.

Health care in the United States revolves around a complex reimbursement system that is difficult to navigate, with regulations and rules that can sometimes limit patients’ care options, she added.

“I think it’s still very fragmented, but I do believe it’s coming very, very soon,” Hamilton-Crawford told Hospice News during CONTINUUM. “It’s going to take policy changes at the national level in order for it to happen. That quality, and that continuum of care is there, but we have to go through and jump through the hoops of bureaucracy to make sure that it reaches the patient.”

These labyrinthine reimbursement and regulatory structures complicate providers’ ability to transition patients between settings, and particularly the post-acute, palliative and hospice stages of care, according to Hamilton-Crawford.

Factors like unmet social determinants of health needs also create barriers. For example, patients in hospitals who are eligible for hospice often can’t receive home-based care if they lack secure housing, she explained.

These considerations are spurring some of health systems’ and hospitals’ efforts to build a broader, more integrated suite of services, including home health, palliative care and hospice, according to Hamilton-Crawford.

Hamilton-Crawford pledged to work towards filling gaps in patient care when she took the helm at Trinity Health Senior Communities earlier this year.

The Michigan-based senior living provider is affiliated with the Trinity Health system, one of the nation’s largest faith-based nonprofits with an annual revenue that hovers around $20.2 billion.

Hamilton-Crawford sees a “big opportunity” for health systems and senior living operators to coordinate and arrange more care in residents’ homes, no matter the care setting, she previously told Hospice News sister publication Senior Housing News. This involves making “bold changes” in terms of bridging gaps between services, provider collaborations and transitions of care, she continued.

“Bold changes certainly take their time, and have a lot of challenges with him, weighing several things that we’re doing,” Hamilton-Crawford said. “We have markets where we have hospitals in the market and we may have the full gamut, the entire continuum of care. And then we have some markets where they’re absent with a void of those continuing care assets. We are looking more at assisted and independent living, as well as more PACE programs for Trinity. We are very much aware of the different aspects of senior care, whether it’s housing or an affluent life plan community. It’s serving all of those needs.”

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