Senior Care Academy - A Helperly Podcast

Care Beyond Walls: Transforming Senior Healthcare with Matt Hansen

• Helperly, Caleb Richardson • Season 3 • Episode 8

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What happens when a doctor of physical therapy who swore he'd never work with older adults discovers his true calling in senior care? Matt Hansen, Executive Director of the Home Care and Hospice Association of Utah, takes us on his remarkable journey from pediatric specialist to passionate advocate for quality home-based care.

Matt reveals how his perspective dramatically shifted when he recognized the profound similarities between life's bookends—young children and seniors often share the clearest understanding of what truly matters in life. Through candid storytelling, he challenges some of our most deeply held assumptions about caring for aging loved ones, particularly the belief that families should handle everything themselves.

The conversation tackles head-on the uncomfortable reality that well-intentioned family caregiving often fundamentally changes relationships. When adult children become caregivers, they frequently stop being daughters or sons in the same way. Professional support can preserve these precious family dynamics while ensuring comprehensive care.

Perhaps most provocatively, Matt questions the inheritance mindset that prevents seniors from utilizing their life savings for quality care. "The money my parents saved is there to take care of them," he emphasizes. "The greatest inheritance they've given me isn't financial—it's values, work ethic, and love."

Looking toward the future, Matt shares his optimism about emerging technologies that promise to transform home care. From non-wearable sensors that monitor vital signs through mattresses to AI systems that streamline documentation, these innovations may help address the serious staffing and reimbursement challenges facing the industry.

For anyone considering home care for a loved one—or as a career path—this episode offers invaluable perspective. As Matt beautifully states, entering someone's home to provide care isn't just a job; it's stepping onto "sacred ground" where you might be their only advocate for maintaining independence and dignity.

• Moving from pediatrics to geriatrics after initially being reluctant to work with older adults
• The misconception that families can handle senior care alone without professional support
• How family relationships change when relatives become caregivers instead of maintaining their primary roles
• Challenging the mindset that saved money should be preserved as inheritance rather than used for quality care
• The funding challenges facing home care with Medicare Advantage plans paying significantly less than traditional Medicare
• Technology innovations making aging in place safer, including non-invasive monitoring systems and AI-assisted documentation
• Utah's surprising statistic of over 450,000 family caregivers, many who don't identify as caregivers
• The sacred responsibility of working in someone's home and serving as their advocate

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Speaker 1:

Joining us today is Matt Hanson, the Executive Director of the Home Care and Hospice Association of Utah. Matt is a passionate advocate for senior care and he works tirelessly to support home care and hospice providers while navigating the ever-changing landscape of health care policies and funding. With years of experience in the industry, he has firsthand knowledge of the challenges that caregivers face, the evolving needs of seniors and the impact that legislation has, like potential Medicaid cuts on care services. So we're really excited to have Matt on today to kind of pick your brain and get some insights from you. So thanks for coming.

Speaker 2:

You're welcome. Thank you, Caleb. I'm excited to be here today.

Speaker 1:

Thanks. So first, kind of jumping into it, can you share maybe a story that shaped your passion or what got you into senior care? I think that it's few and far between the eight-year-old kids that are like when I get older, I want to be an executive director of the Home.

Speaker 2:

Health and Hospice Quite different. Honestly, my clinical background is as a DPT or a doctor of physical therapy and, somewhat ironically, my career actually started in pediatrics. So my father was a gerontologist and a professor in the University of Utah, and he also did consulting for a number of early skilled nursing facilities in Utah and surrounding states, and so I had the opportunity to accompany him on a few of his visits, and for a child, the experience was actually somewhat traumatic, to be honest the noises, the smells, seeing older adults confined to wheelchairs or beds, you know, with remnants of the morning's meal on their t-shirt and I thought it was a symptom of the demographic and not necessarily of the setting, which still had a lot to learn back in the 1980s. So, you know, based on my initial impressions, I actually swore that I would never work with older adults, and so I went the opposite extreme. I went into pediatrics, which also certainly has a lot of noises and smells of their own right, but I didn't realize at the time.

Speaker 2:

It wasn't that that bothered me about those experiences, and so later in life, as a physical therapist, I had a staffing agency in Washington State that I ran. It was my company and I was doing a lot of home health. As part of that Some of our contracts I'd realized that the bookends of life were very similar, so I fell in love with working with older adults. Many people understand the true meaning of life, I think, early in life and later in life right what's most important to them. It's in the in-between years that we seem to get lost in the rat race. So that's where I've just really gained a new respect and love for working with this population as well.

Speaker 1:

Yeah, I think that's a good point. Like I have a toddler and then I work at the senior care space, so like what's important to him and what's important to people at the end of life, like you said, is it's there's a lot of commonalities, except just more understanding at the end of life versus just doing what feels natural when you're a three-year-old. So what led you then to ultimately take on the role of the executive director of HHAU and what? I guess what's that journey been like from pediatrics to like initially getting into senior care and to being one of the I mean in Utah the biggest legislative advocate for home care?

Speaker 2:

services? Yeah, absolutely so. My mother is a breast cancer survivor and at the time of her diagnosis we had two young children and decided that we wanted to raise them around grandparents as long as we could. So we moved back to Utah. I quickly realized, however, that it wasn't the right environment for my staffing agency. The market was too saturated, Reimbursement rates were depressed, so I came back into corporate America. I worked eight years in healthcare management, but being on call 24-7, you know, for example, I was running and helping with hospice within our mountain, and if there was what we refer to as a death call or someone was passing, you know having to go out any time of night filling aid shifts.

Speaker 2:

That type of work was eating me up and I felt that I was losing kind of my passion for health care. So I'm a get-it-done person. I'll do what it takes so that a client isn't inconvenienced, but my family was paying the price. At the same time, I was very involved in our state home care association really the predecessor of the Home Care and Hospice Association of Utah. It was the Utah Home Care Association and I served as board president. And then in 2019, right in the middle of a merger with our state hospice association, our shared executive director unexpectedly resigned due to their spouse being reallocated. We kind of had an out-of-country assignment and the steering committee went into a panic and asked if I could help, and so my last project with Intermountain Healthcare had just come to an end and I was very intrigued by the challenge. So I gave them a year, knowing that it was a labor of love and couldn't compensate me what I was used to. But I fell in love with the work and have been here since. So I also have a business background with an MBA, and our board has been very supportive of the consulting work that I do, as long as there isn't any conflict of interest.

Speaker 2:

Yeah, it's a different world. Yeah, so just the advocacy. I mean I really miss um. Yeah, well, I'd say, first of all, the mission of the association itself is really to protect people's rights and access to care by supporting and promoting home-based home health, hospice and personal care industries. Right, so we do a lot of education, we do a lot of advocacy, partnership, public outreach, and it's really, you know, I fell in love with it. I miss the one-on-one I do as a physical therapist. I'm not doing a lot of one-on-one other than all your family and friends and everybody else who's saying, hey, I got this pain in my back, can you take a look? Right, so, and I have a little patient that I still see on Friday evenings that's my date night. My wife says you got to keep seeing her, but she has cerebral palsy and I've been seeing her for over a decade now. I've been seeing her for over a decade now. But really being on a stage where you make more of a difference in health care, I mean we need a lot of change in health care, right, and I just saw it as an opportunity to really have a bigger impact and to really advocate not only for those that receive the care, but also for all those workers who are out there and are frustrated, you know, because they see the same thing and they see the things that need improvement but may just not be in a position where they're able to do that. So I fell in love with that kind of advocacy and the education aspects of association life. Yeah, wow, it's interesting.

Speaker 2:

And we have what the world kind of presents as competing entities for the caregivers, in that we have a lot of advocacy groups. Right, we have some groups that are trying to push for unionization, they're pushing for caregiver rights et cetera. And then we have owners and operators who, you know the way that it's presented is that they're in opposition to each other. But I really don't feel that that's the case. I mean, I think owners, operators, would love to see a lot of professional caregivers get paid much more than they are, if they are able to afford it. Yeah, and people just don't realize how thin the margins really are and as we get more cuts to Medicaid or are not funded properly or in skilled care and the cuts to home care et cetera, it just really pinches and it makes it very difficult. It just really pinches and it makes it very difficult, and so I think, unfortunately, as the caregiver, a lot of the times it ends up paying the price right where the conditions may not be as great as they'd love them to be, or in some states where they do have, you know, labor is organized and they have these great, you know minimum wage you hear $25 minimum wage and things like that but then there's home care organizations going out of business or they're having to pass that expense on the private duty side onto the client, so they're charging $50, $60 an hour instead of $30 to $40 an hour, which is still a huge increase in Utah, from where we were five years ago. So it's becoming increasingly less accessible.

Speaker 2:

I'm a 48-year-old and I no longer have the hops that I used to on the basketball court. I can't dunk the ball any longer like I used to and I miss that. However, my game's adapted to become a better outside shooter. I'm not as quick as my feet, but I can post up. I have greater upper body strength, so someday my body won't even be able to run up and down the court and I may have to play half court or just play a game of horse with the grandkids.

Speaker 2:

Um, but I'll keep doing what I love and even if I have to look, even if they have to lower the basket for me, where I find a new physical activity that I can enjoy, uh, and is more appropriate for my abilities and for me. That's quality of life is people doing what they want to do, being where they want to be, being with who they want to be with, even if it looks different, right, and even if we have to adapt and I see it as our role in home care. That's part of what we're there to help people do is help them feel fulfilled and find ways to adapt to still find joy in life.

Speaker 1:

Yeah, that's a really great comparison.

Speaker 2:

Hey home for me, because I'm not that. I mean I'm 26, but I was compared to when I was like 16.

Speaker 1:

I am an older adult, you kill hours, but even still I'm like man compared to working out four hours a day in high school, like I even have some limited stuff. So I like that, I like that. And then there is I have a question on what misconceptions you feel like there might be about home care and hospice, because I think that it is as many agencies that there are providing the service. I feel like it's still so common to hear like mom just fell or something. What should we do? Like it's crazy to me that there's so many people that still don't know that home care is really a viable option and maybe there's some misconceptions.

Speaker 2:

Yeah, I mean home care specifically. I think there are misconceptions about each of the industries for different reasons, right, home health, hospice, home care, home care specifically. I think one of the greatest misconceptions is that we can do it on our own right.

Speaker 1:

Yeah, have mom move into the basement, exactly.

Speaker 2:

Whether it's because of frugality or whether it's because of, hey, it's our responsibility, which is understood, but a lot of the times, I think people don't tap into additional support that's there, whether it's paid caregivers, whether it's neighbors, whether it's your church congregation, and by doing that we might be making it work, but we also might be leaving a lot of different aspects of that loved one's life that are unfulfilled.

Speaker 2:

Right, and we can do better for them, but we can do better for them together. We can do better for them, but we can do better for them together. Additionally, a lot of people do have not everybody has those resources, but a lot of people have saved their entire lives, right, and they've worked hard, et cetera. I think that money should be used to help them to be happy, to be safe, to be well, to be where they want to be, where I think some families get into. Oh, we can't spend that. That's our inheritance, right, we can't spend that. We need to hold on to that. And again, I'm not saying that's the case with everybody, but I certainly have seen it.

Speaker 1:

You know the money that my parents have saved that's there to take care of them.

Speaker 2:

right, I may not get a penny, but the greatest inheritance that they've given me is not the financial one, because I don't anticipate With six kids in the family. I don't anticipate. With six kids in the family. I don't anticipate I'm going to inherit much of anything. Anyway, I want them to be here and be comfortable as long as possible. Grace inheritance They've given me as a work ethic intelligence, love for family, love for God Right.

Speaker 1:

Yeah, I love that, yeah, I think that, yeah, that a lot of people take the inheritance, even if it is like sizable, with their grandkids, you know, like in our kids, like I think people don't take that into consideration enough, um, when looking into getting support. Um, yeah, and the other thing that I've said a lot is when people try to take it all on themselves the daughter, you know, mom, can move in the basement or whatever it's like they stop. The saddest thing and it happens without people noticing it or calling it out is they stop being daughter and start being caregiver or aid life's memories and take her shopping and have fun and leave all the stuff.

Speaker 2:

That changes that relationship dynamic to a profession yeah, the dynamic changes, and sometimes the person who's receiving the care starts to feel like they're a burden and they live with a lot of guilt. And that's a sad thing too.

Speaker 1:

It is super sad. So, on that note, what would you say? So obviously there's a lot of apprehension that we face in home care, home health and hospice, but what are some other challenges that we face apart from funding in this space? Yeah, apart from funding. Man, I could go on and on about the funding, right?

Speaker 2:

I'd say probably education. I mean helping people and helping the public to really know what's available to them and what resources are available to make it work and to make it happen. That's definitely a challenge. I'd say competing, and it does tap into some part into reimbursement. It's not just reimbursement. There are competing interests, right, and so the lobbying power and all of that. You have headwinds. Sometimes we get a lot of rhetoric out of Washington DC and I think that a lot of people understand. They voice support Republicans and Democrats for care at home. However, the rules and regulations that are passed often tell a different story. Right, we need champions, not rhetoric, and that's a challenge for us, right, because people in theory are like oh yeah, it's awesome, everybody's had an experience, everybody knows somebody who's been on hospice or on healthcare.

Speaker 1:

There's some loved ones somewhere Exactly.

Speaker 2:

So they see the value. It's just that, you know, I think advocacy follows the dollar or the dollar follows advocacy right, you can flip that as well, and that's part of the problem. We're not as big as some of the other industries, we don't have as loud a voice, and and so a lot of the rules and regulations that get passed aren't, you know, in in line with with what we're hearing from our elected officials.

Speaker 1:

Yeah, I think you nailed it with education where, if people knew it's funny. So we run a personal care agency and it's funny how many times people want stuff way outside of the scope of what we're able to do. It's more falls into home health, hospice or like physical therapy and we're like we are not licensed to do that. But yeah, people just don't know what there is and it's crazy because the vast majority of West Americans want to age in place.

Speaker 2:

Aging in place longer with the right support can literally add years to life and like it's so important but it's not yeah, or understanding that if they meet a certain criteria, those things that they would like you to do as a personal care agency could be covered 100% right by their Medicare.

Speaker 1:

Exactly yeah.

Speaker 2:

But not knowing what the criteria is and how to tap into that.

Speaker 1:

Yeah, so what you mentioned funding and some Washington DC. There's a lot of news articles and stuff that come out and it's like rah rah, and especially we saw it a lot last year with the presidential campaign. It was a topic that was talked about a lot. But what good do?

Speaker 2:

you see in the windshield coming our way and what bad potential do you see coming our way in the industry? Yeah, I think bad really is tied to reimbursement. Right, I mean we have again medpac is is recommended more uh cuts for home health and pausing any adjustment for for hospice and next year again a seven percent cut for home health is what they're recommending again, despite all the big cuts that they've had in the past years.

Speaker 1:

And they just don't get it because yeah sorry, just eating up everything. That's crazy.

Speaker 2:

Yeah, it is, and part of the problem is that they're still saying that. You know, I've heard numbers anywhere the home health margin is anywhere between 18 and 24%, right. However, you have to take into consideration that they're just looking at traditional Medicare and more than 50% of reimbursement is now tied to MedAdvantage, and MedAdvantage reimburses way less. So really, when you look at it, I mean, you know most agencies are probably dealing with a margin somewhere between five and 7%, you know, not 17, 20%. So, yeah, reimbursement, I mean, is the bad as far as the good. I think there's a lot of things that can be done to reverse some of the bad that's been done in the past. For hospice, we're looking at an extension of the telehealth flexibilities that were introduced during the COVID-19 pandemic, and so we're hoping that those will get extended at least through the end of 2027 and eventually become permanent. For home care, eliminating the 80-20 provision from the access rule, which would mandate that 80% of Medicaid reimbursement funds to providers actually be used for caregiver wages, which seems like a good thing.

Speaker 1:

But again, when you're looking, at how tight the margins are, it could sink the industry. So yeah, Like you said, on the offset it looks really good, but then it's hard because then on the admin support that caregivers require and the softwares that are needed for paying them and, like all of these things, the additional cost to a state as well.

Speaker 2:

Right, I mean it's kind of crazy there are a lot of good things in the access rule, but the 80-20 provision is the bad thing, right, so? And also just technology. I mean I, I see a bright future. I really do. I'm I'm more optimistic about the future of care in the home than I ever have been, honestly.

Speaker 1:

Wow, yeah, what, what things, um, what's your vision of the future for home care and hospice? What's what's exciting to you?

Speaker 2:

Um, you know I am, as I mentioned, I'm really excited about, I'd say, despite all the headwinds, I'm excited about the technology, so we're going to have a lot more tools to be able to help us right?

Speaker 2:

I'm very bullish on new and emerging technology that supports remote patient monitoring, for example, and AI is going to continue to make assessments and documentation a lot more efficient and accurate in the near future.

Speaker 2:

I think it's going to be easier to keep people at home safely because of the technologies that are emerging. As we adopt them and work hand-in-hand with some of these things, we're actually going to build a true continuum of care, which is really what we need to help people stay out of the hospital. We're already seeing people at home with an average acuity level that's a lot higher than it used to be, because they're being discharged from the hospital earlier. They're often bypassing skilled nursing and rehab altogether, so I see that trend continuing. I also think we'll continue to see more hospital at home or, if the program goes away, an expansion of home health services to cover many of the simpler procedures that would have fallen under hospital at home. So, yeah, I think we're going to see a lot more just kind of services provided at home, and we're going to have the technology to support us.

Speaker 1:

Yeah, when you think of the technology that is coming out. I don't know if you thought about this. I really enjoy toying around with AI. Do you see any AI disruptions or anything that whether it's an idea that you have or a product that you've seen that's exciting to you?

Speaker 2:

Yeah, absolutely. As far as AI goes, I mean right now most of what we're seeing is documentation, right. I mean we're seeing it in the back office end with scheduling, we're seeing it with just kind of efficiencies. We're seeing it on the finance side of things and I think it's good there With documentation and assessments. It still has room.

Speaker 2:

I've seen some awesome demos, but then when you hear from people that are actually using it, you're like yeah you know, we see some of the same types of issues that we see with ChatGPT, when we're just using something, you know, with these hallucinations, and we're just trying to like wait, that's whoa, that's wrong, right. Or how it's scoring on the home health side of things, the OASIS assessment right, and so I think people need to be cautious still, but it's getting better. That's the whole point of AI, right. It's learning itself. It's teaching itself. So as time goes on and the technology gets better, it's going to help people to be so much more efficient.

Speaker 2:

From other technology, I mentioned remote patient monitoring, and there are some groups out there that are being a lot more proactive in remote patient monitoring. So they're not waiting for someone to fall right or they're not. You know, it's a lot less dependent on somebody having to, you know, actually use the technology themselves, like go in and weigh themselves, etc. Where a lot of this can be done. It's non-evasive, non-wearable, and a lot of stuff's being done automatically from sensors that are underneath a bed mattress that can actually take your oxygen saturation, your heart rate throughout the night at rest right through the mattress, right With incredible accuracy and all kinds of things like that I've seen.

Speaker 2:

You know there's fall detection technology that's out there that they don't have to put on the life alert where they're wearing it. It's just a small little monitor that can be very inexpensive, that's put up. I've seen it as low as $5 per unit per month. It's put up in the home and it uses radar technology. Another technology I've seen was infrared. So it's privacy, right. It doesn't show the person If they're walking around, they're skibbies, you're not going to see it, right. It just shows the outline of the person and if that person goes down, it gives you all this information. That then alerts the monitoring system and says we may just have a fall and they can respond instantly. So smart homes, right. Smart home technology.

Speaker 1:

Yeah.

Speaker 2:

So yeah, I'm really excited about that type of stuff.

Speaker 1:

Me too, I'm excited to see the adoption over the next decade, I think, especially as more and more baby boomers get into the age of needing home care and home health and hospice, I think that we'll see more and more technology that's supporting it. So that way, the caregivers I don't know. I hope that the reimbursements will go up, but at bare minimum. Hopefully the strain physically and emotionally on caregivers might go down with all these technologies supporting, like I said, on back end, back office stuff, admin stuff that just drains people.

Speaker 2:

Yeah, and supporting family caregivers right. I mean, we have over 450,000 family caregivers in Utah alone and there's a lot.

Speaker 1:

I didn't know that that's a lot. Yeah, it's a lot.

Speaker 2:

It's a lot nationwide as well. I mean, it's incredible, and oftentimes they don't even identify themselves as family caregivers, right, they don't know that they're a part of, potentially, of a community and that there are resources available to them, and I think we need to work with families a lot more closely.

Speaker 1:

Yeah, I would. I would love um something out there. Like I like to joke how there's not really a guide on how to be a parent. Um, you just have a kid and all of a sudden you're figuring it out, and then there's not really a guide on the opposite end of life, of how do you take care of your aging parents, and so there should be a better guide and community there, because we're learning so much We've learned so much over the last 20 years of how it all works and what to expect, and so everybody's going. Most people are going to experience having an aging loved one, and so giving them the support that they need would just be huge. So what? This is kind of the final question.

Speaker 1:

That 25 minutes went super fast. It was fun talking about talking to somebody like yourself. That's like leading the charge trying to help home care and hospice and, and like I said, on the legislative side, where you said there's a lot of, there's a lot of us out here. There's a lot of caregivers and nurses and CNAs and people trying to do this that just don't have a voice. So cumulatively, through HHAU, we're able to try to have a voice. But what legacy or long-term impact. Do you hope to leave personally on Utah home care and hospice?

Speaker 2:

Well, I probably wouldn't use the word legacy to describe the impact that I hope to make on home care and hospice, but I think we've already done some great work, some really great work that a lot of people aren't even aware of, and I want to be a part of doing a lot more. Once my work in the industry is done, if I can walk away knowing that I've helped to inspire others so that the work can go on and that the care I will receive right or will be receiving as an older adult is better than the existing quality of care when I started my career, I'll consider that a win. We need to make big changes in healthcare, as I mentioned, and I want to be a part of that solution.

Speaker 1:

People- who know me and worked with me know that I'm a problem solver and ideas guy and I have a lot of ideas. Yeah Well, that's awesome. You're well on your way to leaving that impact we won't call it legacy, that impact on this space. You had a big impact on me and just in this 30 minute conversation. So, um, yeah, I'm excited to see what keeps on unfolding for the industry and and especially in Utah. So appreciate you coming on. Is there any other closing thoughts? I guess the last piece is what advice do you have for somebody breaking into or just starting in the um home, care home, health and hospice space?

Speaker 2:

Yeah, I, mean that's a great question too. So I'll be brief, but I'd make sure that you feel confident in your skills and working in an environment where you aren't surrounded by coworkers. When people don't do well in home care, it's usually because of that. They jump in. They hear about good pay et cetera. Right, changing work environment, everything like that so many pluses about working in home care.

Speaker 2:

It's an amazing practice setting this sometimes gets a bad reputation as being the wild west, so I prefer to describe it as kind of the front lines right of health care, a lot like emergency medicine. You can see people are just about any diagnosis, and so, lastly, I'd say you're likely you'll likely work in mansions, immaculate homes, but you'll also work in homes where you're afraid to sit down because of hoarding bug infestations, pet feces, all kinds of stuff. I have all kinds of stories. You have to remember that even in those situations, though, you're likely that person's best advocate and possibly their only hope to being able to remain in their home and out of the hospital. It's a blessing to be in people's homes. You know it's sacred ground to me. It's a blessing to be there, and I'd say remember, you know, if you're starting your journey along, you know, in home care. Remember that, and remember that you're that person's best advocate and maybe the only person that is advocating for them.

Speaker 1:

Yeah, I could not agree more. Like, I love that we're. You might be the only person that's trying to help them maintain independence, the only person they see that week. Like we're, we're have we have a huge impact. And so, you know, giving the respect to yourself, knowing that that's your impact, that you're having, I think is an important thing. Getting into the space of like, yeah, it's a, it's a grind some days, but it's totally worth it and invaluable. So great answer. Yeah, Matt, I appreciate you coming on and sharing 30 minutes of your time today and your insights, and we might have a future one. There's just there's a lot to unpack in the home care and hospice space.

Speaker 2:

Happy to be a resource. Thanks, Caleb. Thanks for what you do.

Speaker 1:

Thanks, yeah, thanks.