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Episode 21

The state of home care in the UK with Jane Townson, CEO of HomeCare Association

Jeff Howell: Welcome to home health, 360 a podcast presented by AlayaCare. I’m your host, Jeff Howell. And this is the show about learning from the best in home healthcare from around the globe.

Jeff Howell: Hi everyone. And welcome to another edition of home health, 360, where we speak with leaders in home care and home health from across the globe. Today, we are reaching out across the pond to speak with an award-winning CEO. We have Jane Townson, the CEO of the UK home care association, which has been rebranded to be just home care association. You can find them at They are the trusted voice in bringing people together and shaping and advancing home care in the UK. Jane, I also noticed that you have a PhD in plant physiology, so I guess I’m gonna have to welcome, uh, Dr. Townson to the show.

Jane Townson: Oh, nice to be here, Jeff. Thank you for inviting me.

Jeff Howell: So Jane, with a membership of about 2300 agencies across the UK, you work on priorities like quality innovation, best practices, financial sustainability, and regulation. Uh, what would you say is the organization’s, uh, priorities and what are you spending the most time on these days?

Jane Townson: Well, you, you mentioned some of them, our, our members have got five priority areas, but the top two for sure are workforce and financial sustainability. And then the third one is public awareness and public understanding so that people know that home care is an option for them. And they, they don’t necessarily have to go straight to a care home. And then as you mentioned, regulation of home care, but not, uh, just the care and, and also other aspects of regulations such as employment and, um, innovation best practice, good quality, a lot of interest in digital solutions for home care and how we can use data and data science to predict and implement preventative strategies for, um, maintaining people’s health and wellbeing.

Jeff Howell: I’m definitely gonna wanna ask you about that a little bit later. Uh, how big is your team,

Jane Townson: Uh, team in the home care association? We’re quite small. We’ve got 20, just under 24 people.

Jeff Howell: And then, uh, what do conferences look like these days? How often are you guys getting together? Do you one big annual conference? Do you have local chapters?

Jane Townson: Well, um, obviously the pandemic had changed normal practice and we very recently on the 16th of March held our first in person conference for three years. And it was really well attended. We had, um, a big waiting list because people were so excited to be able to come out and see each other again. Um, but we also, uh, offer a range of online events and, uh, in person events to smaller ones. So we, we today, for example, we broadcast a webinar about, uh, the care quality commission that regulates home care in the UK in the, in England, I should say, and, um, explained to our members how their inspection regime is changing. So, uh, and one of our legal partners gave that talk. And then we may have round table events where we get groups of CEOs together for dinner, where we chew over what’s happening. Um, we have special interest groups.

Jane Townson: So we, we do events on topics like, um, technology solutions or integration with health. You know, basically whatever anybody wants to talk about we workforce is another one. We, we are doing one, we’ve got one coming up soon on wellbeing of care workers and what employers can do to promote that. Um, we’ve got another one coming up on media awareness and how to manage reputation and proactively communicate to avoid bad press when things go wrong, because things often do go wrong in care, you know, or, you know, for example, you may have to close a service or right. Um, somebody may complain about you on social media. What do you do about, about that? So we, we try to offer lots of practical training courses and opportunities for learning for our members. Um, so they’re the events and we also have separately training workshops on different topics. So dementia care end of life care, medicines management, how to grow your business, how to plan and organize home care, you know, just lots of different things that people who, who deliver home care need and want to know.

Jeff Howell: So I’m sure there’s a lot of folks listening that are not really familiar with the UK healthcare system. I’m gonna do my best to impress you here. Uh, so all English residents are automatically entitled to free public health care through national health service ands. And that covers hospitals, physicians and mental health. Is that all correct? Did I get that right?

Jane Townson: Yes. So we all pay for that through general taxation.

Jeff Howell: Got it. Okay. So I’m in Canada and that we have a similar sort of, um, free, uh, home care, uh, sorry, health system now home care falls under social care, correct. That’s

Jane Townson: Right.

Jeff Howell: Okay. And so can you provide us some insight on how home care really falls into the healthcare continuum? I’m really, um, curious about if it falls under social care, do, is it divided into, uh, income levels or, um, by age, like it is in the United States? Like how, how does it work?

Jane Townson: So adult social care as a whole is quite complicated. Um, because collectively we support all different types of people who’ve got needs, you know, so that could be children or that, you know, children, um, people under 65 people over 65, people with who were born with physical or learning difficulties, mm-hmm , um, older people who have perhaps developed frailty or dementia or have some other long term condition and social care is means tested. So the state does fund some people. And the rules for that are just in the process of being changed because we’ve had, um, in back in September, an announcement about reform of funding of social care. But what we’ve had up to now is if people have assets of the below 14,000 pounds, they will, and they have eligible what are considered to be eligible needs. Then they would have their care completely paid for between 14,000 pounds and 23,250 pounds.

Jane Townson: They may have to pay something towards their care, but not all of it. And then if people have assets above that, then they have to pay for all of it themselves until they run out of money. Mm. Now the, the change that’s coming is that the bottom threshold is moving from 14,000 to 20,000 and the upper threshold is moving from 23,250 to a hundred thousand. So in theory, more people would be eligible for more funding from the state, but in reality, there’s, there isn’t really enough money available to make much of a difference. So what will probably happen in practice is that the eligibility criteria will, uh, go up and then the other very significant factor is that they are introducing a cap on care costs. So the new system will be, uh, when you reach an expenditure of 86,000 pounds in total, um, for, for eligible needs your care costs then, okay, you won’t have to pay anymore yourself. And the state will take over.

Jeff Howell: This is for the group of people that have to start with funding their own care because they have enough assets. Is that right?

Jane Townson: Well, everybody actually, so everybody, um, will have a care cap clock that starts ticking, but obviously some people have got assets that mean that they will have to pay to begin with and other people will have no assets to begin with and don’t have to pay. Um, so it it’s quite complicated and we’re all trying to figure out how it’s going to work in practice. So this hasn’t been implemented yet. This is it’s just been, um, you know, it was, it was announced in September, but the theory is that people will not be exposed to catastrophic care costs. So some people end up, you know, having to use all of their life savings and sell their houses and everything to pay for care. No, um, it will just be, you know, once you’ve spent eight up to 86,000, you won’t have to spend any more of your own money.

Jeff Howell: So let’s say I’m well off. And I’m in the, in the, the, the rich category of I have to pay for my own care. However, that will be capped at 86,000 and then any care costs after that will be, will come from social care.

Jane Townson: Yes, that’s the theory.

Jeff Howell: Okay. It’s interesting. I’ve never heard of it being based on assets. Um, so for example, in the United States, Medicare is for 65 and above and Medicaid is for if you’re at the poverty line, uh, and that’s income based, it’s not asset based. So if you own property, um, is there a challenge with people that, uh, have assets that are not that liquid and, and they’re, they’re having to sell property or cash in on some ill?

Jane Townson: Yeah, that’s really, what’s driven yeah. Much of this because there’s been quite a strong sense within society that it’s not fair that you have, some people have to sell their houses to pay for care. Yeah. But as a, as a society, everybody wants perfect care and perfect healthcare, but they don’t want to pay anymore taxation and they don’t want an insurance scheme either. So it’s quite challenging to make it work. And, you know, the end result of this has been a progressive decline in the number of people receiving care at a time when the demographics are going in the opposite direction. And also yes, an increase in, uh, I mean, in home care, in, in the UK, about 70% of the hours of funded by the state and about, okay, 30% people pay for them for themselves. But, um, it’s difficult to get very, very accurate data because nobody actually collects those data. So we are just sort of estimating it from the amount of provision in the market and, and so on.

Jeff Howell: Interesting. So that was gonna be my next question. Um, I that’s 70, 30. Okay. And then, um, I actually read an article recently that about 40% of care agencies are actually still powered by paper. So that would be a pretty, uh, strong leading indicator as to, uh, why this data is not being, uh, collected. What are your, do you think 40% is an accurate number? Well,

Jane Townson: No. What I mean is it’s not, it’s not being collected by the government. Um, so they don’t have any real idea, you know, what’s going on in the marketplace, which has been problematic for them when trying to develop policy and to cost policy. So how, how many self funders might there be there? I mean, with, with care homes, it’s easier because we know how many care homes there are. We know how many care home beds there are, and we know how many of them are full . Um, that the, the bit that people aren’t that, you know, the government hasn’t got such a clear picture on is how much every care home is charging for the care. But in home care, it’s much harder to know who’s out there purchasing care because, um, you haven’t got anything physical, like a bed that you can see in a building called a care home.

Jane Townson: You know, people are in their own homes and okay. There’s no way of knowing what they’re doing, you know? So , so, um, that that’s been, yeah, quite a challenge. I should also mention as well, that about 25% of the state funded home care is purchased by the NHS. So people that have, uh, more complex healthcare needs that can be supported at home may have their care funded by the health service. And that that’s obviously fully funded mm-hmm . So that’s only really for people that have be, have got defined health needs. But the thing that is really illogical about this whole system is that the definition of a health need is not very consistent. So if you’ve got cancer, let’s say, and you are dying at home, you may well qualify for what’s called continuing healthcare funding, which is funded by the NHS.

Jane Townson: And so that will mean that regardless of your means, all of your home care is paid for, but if you’ve got dementia, which is a disease as well, that is very debilitating and, and, you know, results in all kinds of symptoms that are very difficult, doesn’t count as a healthcare need. So it’s not funded by the NHS. There are quite a lot of injustices in the system and people under 65. So people that may have been born with a disability of some kind, either physical or, or learning, um, quite often the funding for them is more generous. So the amount spent per person on average is probably about two, two times higher than the amount spent on an older person. And that’s another inequality in our system.

Jeff Howell: I’m curious about how fragmented the industry might be. Um, so I noticed you have 2300 members and, um, I’m, I’m assuming you might have maybe half of all agencies. Um, what are your thoughts on how the number of agencies cause the population I think is 60 million, right?

Jane Townson: Yes. Well, I think it’s very, very similar to the world over that. Um, in our country, there are actually 10,000 agencies registered with the regulator to deliver community based support, but quite a number of them. Okay. Um, are dormant. So they’re not actually delivering any care . Um, and, and then some of them are not what we would call regular domiciliary care. So they may be more supported living for people with disabilities. Let’s say, so some of our members do that, but there are other associations that also focus on that area. So we think there are probably six and a half thousand agencies doing, uh, regular domiciliary care. But, um, we, so we’ve probably got about a third of the market, but, um, all but one of the larger me, uh, larger providers are in our membership and the larger providers between them have about half of the workforce.

Jeff Howell: Okay. Got it.

Jane Townson: So the numbers of agencies itself is a little bit deceptive because a 85% of them have fewer than 50 employees. So there’s an awful lot of very small providers.

Jeff Howell: Yeah. We, we see that in other places as well. And it’s not surprising that your membership would skew towards the, uh, the upper half of, uh, size in the industry. For sure. And, and, um, the folks that aren’t part of a home care association tend to be smaller.

Jane Townson: Yeah. I mean more than half of our members are SMEs. So we have a lot of the small ones in our membership. Mm-hmm but, um, what I’m saying is that even though there are fewer larger ones, more of the workforce, proportionately is in them.

Jeff Howell: that makes sense. What do you think are the biggest obstacles that agencies face in the UK today?

Jane Townson: So in our membership, we have very small to very large providers, predominantly state funded to predominantly private pay providers. And every combination in between we have generalists and specialists. So by specialists, I’d be talking about live-in care or housing with care or complex care with nursing and then startups to mature businesses and all of those different variations. And there are more besides, um, mean different needs and different pain points at different times on their business journey. So the most common issues that everybody faces are financial, sustainability and workforce, and those two things are intimately entwined.

Jeff Howell: Sure. Yeah. There’s no shortage of clients. ,

Jane Townson: There’s no shortage of clients that no, it’s the workforce. That is the, the limiting factor. And, you know, the part of the reason why that’s a limiting factor is because there isn’t enough money in the system to recognize and reward them properly. So the, you know, the pay terms and conditions of employment are not great. That isn’t the only reason some of it is also related to how home care is commissioned and purchased. So the councils, the local authorities that purchase most of the home care, um, on behalf of the state have had their budgets cut dramatically. Over the last 10 years, they try to drive the fee rates that they pay for home care down to rock bottom, and they also ration the care. So they will purchase home care by the minute in some places , and they will only pay for contact time with clients, um, and not specifically the travel time and, and other waiting time in between. So that means that the hourly rate that they pay for the client contact time has to be enough to cover all of the working time, because to be compliant with the national legal minimum wage that has, that includes all working time, not, not just the client contact time.

Jeff Howell: And are there a number of, um, so I know in north America, there’s a lot of companies that do a four hour minimum, uh, shift length, but I think in the UK, you, you do have some cases where it’s a, sometimes it’s a 15 minute visit, right?

Jane Townson: Yeah. I mean, um, in England, the proportion of 15 minute visits is quite low, probably around 6%, but in Northern Ireland, in some parts of Northern Ireland, literally half of the home care visits are commissioned at 15 minutes, which is really bad because I, yeah, I mean, sometimes there is a case for short visits because you may just be popping in to check that somebody’s taken their medicines or something, but to make every visit 15 minutes, especially with the type of people that we are now supporting, who generally have pretty complex needs. It’s, there’s, there’s really not enough time. Some of the, uh, agencies that focus on the private pay market have a policy of, of, of not doing visits shorter than an hour or only doing visits an hour or more.

Jeff Howell: Yeah. It’s hard to run a financially sustainable business if you have so many 15 minute visits and you’re spending more time driving than you’re you’re, uh, charging for care. For sure. What about, um, you had talked about the changes that the, the, um, is, is it CGC? Did I get that right? The,

Jane Townson: The care quality commission, CQC

Jeff Howell: Care quality commission CQC, right. What are the kinds of new changes that they have, uh, implemented? I’m assuming it’s a lot of COVID related things like making sure it’s a safe working environment. Um, has there been anything that’s been COVID related?

Jane Townson: Oh, yes. There’s been a lot of changes to working practices because of COVID 19, but separate from that, the care quality commission has been reviewing its strategy and they want to focus much more on the experiences and views of people receiving services. They also want to do what they call smart regulation. And I think that’s a combination of things, but using more data, um, to help assess risk and taking a more risk based approach. So previously they would do a comprehensive inspection of every registered service at least every three years. And they’d give ratings so outstanding, good requires improvement or inadequate. If you unfortunately receive an inadequate rating, they would come back and reinspect much quicker if, and similarly with requires improvements. But if you got good or outstanding, then they wouldn’t come back for 30 months unless something happened in between, you know, unless somebody made a complaint or there was a safeguarding concern or, you know, something, but now at the moment, what they’re doing is very much focusing on, uh, services where they perceive there to be a risk and that they, their perception of risk may arise because of complaints from people receiving services, or, uh, the local authority might have raised concerns with them, or there have been accidents or care workers not turning up for visits when they should or whatever, you know, so there being a lot more focused.

Jane Townson: But the downside of that is that the care providers that let let’s say were rated good and want to give evidence that they have improved further to achieve outstanding their care quality commission is just basically not giving them any priority. Um, so they’re focusing on the areas of concern rather than taking a view off the whole market.

Jeff Howell: This, uh, risk based approach are, is there as we move into, uh, a bit more of a value based healthcare world, uh, has there been progress made on, um, funding models that actually, uh, make care agencies accountable to, uh, achieving better outcomes?

Jane Townson: Well, you, they already are through the, um, through the care quality commission system of regulation. So if you don’t achieve the minimum standards, you get struck off the register and then you’re not allowed to operate anymore. So that’s, you know, one extreme. Yeah. Uh, and you may be prosecuted in the worst cases, um, at the other end of the, um, spectrum in order to achieve an outstanding rating, you have to demonstrate improved outcomes. But, um, most if I tell you that the average, well, roughly speaking, the average percentage of agencies that have achieved an outstanding rating in the country is about 4%. But, uh, some of the providers that focus on the private pay market have achieved 4 44, 0% outstanding ratings. So when you have, uh, higher income from, you know, better charge rates, and when people pay for their own care, they are the commissioners.

Jane Townson: You know, they call the shots, they dictate what they want when they want, how they want it. When people have care, that’s funded by the state, then what happens is that social workers, conduct assessments of those people and then write down what that person needs or can have. And then they send that to the care agency. So it’s much harder for the care agency to adapt and modify and be responsive to that person’s needs because they’ve been dictated to mm-hmm. like, you know, you will go and see Mrs. Jones, you will get her out of bed. You will give her breakfast, you’ll give her a shower. What, what Mrs. Jones actually wants that day doesn’t necessarily feature, which many of us think is not a good thing. Um, there have been a number of attempts to move towards more outcome focused approaches to commissioning, but it’s quite difficult to make it work in an environment where the money is so tight, because if you are purchasing home care by the minute or by the hour , um, why would you, what’s the incentive to look at outcomes?

Jane Townson: You know, cause you’re only being paid, you’re being paid for time and task, not for what happens to the person. So we need to have a complete shift in thinking and also in a way of measuring outcomes too. And you know, this is an area that I’m very interested in, particularly in how those kind of outcome measures can be incorporated with health outcome measures and used to really determine whether what we are doing is working, you know, whether place a is doing it better than place B what interventions we could employ to extend healthy life expectancy and sort of shift that demand curve because we’re struggling internationally to meet needs currently of our older and disabled people. But, you know, in 30 years time, the numbers of us are going to have doubled. So if we’re not managing now, what’s it going to be like in 30 years time? So we need to do something different.

Jeff Howell: Yep. For sure. Um, so it sounds like the, the risk based approach really is the care quality commission is making sure that agencies are delivering high quality care, but you’re still really living in a fee for service, um, world where the funding goes to the high quality agencies. But the actual, when we break it down to a client by client basis, um, we’re still in a, a fee for service world and not sort of measuring, uh, outcomes and, uh, trying to deliver the best care and even figuring out what to measure. It’s still in the, uh, really in the infancy.

Jane Townson: Well, in the state funded part of the market, that’s true in the private pay part of the market. More innovation has been able to flourish. And so we have some members who have been using digital tools for a long time. And when you have digital tools that enables you to get to gather data, that then helps you to see what’s happening. So for example, if you notice that a higher proportion of the normal of your clients are having falls, then you can start to investigate. Why is that? Or, you know, if a number of quite a high number of your, the people that you’re supporting are ending up in hospital with urine tract infections, because they weren’t treated soon enough, then it, it enables you to think, well, what could we do to change that? So in that example, um, uh, some providers have, have, you know, trained their care staff to do more observations, um, and measurements, you know, maybe just temperature, um, and also urine dip tests, not to diagnose anything, but when they phone the GP, the general practitioner and say, Betty, isn’t, doesn’t seem herself today.

Jane Townson: Um, you know, I’m worried that she might have a UTI in the past, the GP would say, well, let’s just leave it a couple of days and see how Betty is. Whereas if you can phone the GP and say, Betty’s not herself, I’ve done taken her temperature, I’ve, um, done a UIC test. This is what I found. Uh, they’re much more likely to prescribe antibiotics straight away. And when that happened, the number of emergency admissions to hospital for that reason reduced by 63%, which is very substantial. So, you know, it by, by just taking some fairly simple measurements and observations, it enables you to take action. So, you know, why, why would we not want to do that? And, and, you know, I think there’s a lot of, well, there’s a, there’s quite a bit of, um, evidence that there are a number of activities of daily living that once they start declining are quite good predictors of whether people are going to need more healthcare.

Jane Townson: So, uh, there, there was a study in France, it was, they followed about 300 people over 75 and they had home care workers going into their homes. And there were about 27 different observations they took, and they didn’t know anything about the person’s health condition as such, but they were looking at, um, things like, can this person move around their house? Can they make their own meal? Um, have they been in contact with their friends and family? Are their legs swollen? Do they look fever? Are they a bit feverish? Um, you know, all, all kinds of different things that you might observe and sort of recorded them all. And then this cohort of people were trapped for almost a year. And then I think about 30% of them altogether ended up in the emergency department. I’m not sure what you call that in Canada, uh, accident emergency.

Jane Townson: We call it here, uh, you know, so they had emergency admissions to hospital and then they were able to use sort of data science to model the data and create algorithms. And, um, the algorithm, they were able to come up with some predictive algorithms, uh, you know, that they were able to use the observations that have been collected by the home care workers and, uh, to predict with 70% accuracy, uh, admission to the emergency department two weeks in advance of when it happened. Um, and of the 27 observations, there were about nine that, that had a particularly powerful influence on the predictability. And, you know, so they were things like mobility, like, uh, you know, being able to make, get their own foods, being connected to their families or communities sort of mood in general. Um, and whether they had, you know, any kind of symptom that might indicate, you know, be having a bit of a temperature or something like that.

Jane Townson: But I, I just think it’s very interesting because they didn’t, you know, the, the home care workers didn’t really know anything about the medical history of people, but when you combine those kind of observations, you start to get a lot of information that can be useful. And I think that would be, um, if we could do that at scale, it would start to change the demand curve, because it would mean that you could start to put interventions in earlier that may prevent those people ending up in hospital, which of course is the most expensive setting. And once people end up in hospital, right, quite often, unfortunately they can deteriorate further. They may be stuck in a hospital bed and, and lose muscle strength. They may develop a hospital, a quite infection. Um, and then of course the bed they get can get sort of stuck in the bed because it’s, it’s hard to get them home again, because there may, may not be enough home care. And then that means that new admissions to the hospital are more difficult. So, you know, other people that might be having to say heart attack or something, you know, can’t necessarily get into hospital fast enough. So it, it has a, a huge effect on the whole system. So the more that we can support people to live well at home, the better we’re all going to be

Jeff Howell: Totally agree. And, uh, the older I get, the more I look back at the movie, the minority report where Tom cruise was predicting crimes before they happened. And it really, for healthcare, it’s all about trying to not report on what happened, but be able to predict what’s going to happen. And, uh, like you say, um, hospices and hospitals, anything that’s a building is actually pretty expensive, so we can keep people in the home then, uh, like you said earlier, there’s not enough money to go around. So we definitely need to make sure that, um, we’re delivering care to people in the setting that they want, which is their home. And coincidentally enough, it’s a lot less expensive to do that as well. Um, so we’re almost at our time here, Jane, but, uh, I’ll let you, uh, I’ll get you outta here on this. Give us a reason to be optimistic about the future of care in the home.

Jane Townson: Well, as you say, um, a majority of people want to stay at home and we’ve actually seen, um, a substantial increasing demand here at least 10 or 15% more hours of home care delivered in the last year. The workforce in home care has continued to increase. So it’s now in the UK, there are more jobs in home care than there are in care homes. There is entrepreneurial flare and abundance. There are loads of very smart people coming up with really cool ideas for how one could do things better for gizmos and gadgets that we can all use at home to help us, um, stay well for longer. The health service here in this country is also recognizing that, uh, the social determinants of health, I mean, you know, that’s been known in the literature for, for years, but they’re actually focusing more on, you know, um, offering those kind of services and, and engaging with us to work in multidisciplinary teams on the ground, which I think is really exciting.

Jane Townson: So I think that’s, that’s where we need to get to. So, you know, we, we are working, we already do in home care sort of work very closely with GPS and community pharmacists and district nurses and, um, housing providers and equipment providers. But having that a bit more organized and a bit stronger leadership I think would be really beneficial. So we are having quite a big reform of, of our healthcare system here as well, which I didn’t mention sort of moving towards what are called integrated care systems, um, and joint commissioning between health and social care. So we’ve got a lot of issues to fix. Okay. But I do think the right people are beginning to talk to each other and, and the technology solution as well, help the data will help. So I, I think there are plenty of reasons to be cheerful.

Jeff Howell: Yeah, well, there’s some big challenges to overcome, but, uh, it’s also a really exciting time with, uh, the innovation that’s happening. And, um, we certainly ha are at least these silver tsunami is something that we see coming. And, uh, you know, it’s just very predictable and we’re right at the front edge of it. And so, but at least it’s gonna be something that happens sort of slowly over time. And, um, if we have the right people working on solving these problems, then, uh, it’s a place we need to get to. Well, thanks for having, uh, coming on Jane, I’m going to, uh, drop your website again. It’s homecare So you can go there to learn a little bit more about, uh, the home care association. See the great work that, uh, Dr. Townson and her team are up to. And I wanna thank you again for coming on today.

Jane Townson: Great pleasure. Thank you.

Jeff Howell: Home health 360 is presented by AlayaCare. First off, I want to thank our amazing guests and listeners to get more episodes. You can go to health 360 that’s spelled home health 360, or search home health 360 on any of your favorite podcasting platforms. The easiest way to stay up to date on our new shows is to subscribe on apple podcasts, Spotify, or wherever you get your podcasts. We also have a newsletter you can sign up for on Eli health, 360 to get alerts for new shows and more valuable content from AllCare right into your inbox. Thanks for listening. And we’ll see you next time.

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Episode Description

Jane Townson, CEO of HomeCare Association in the UK, chats to us about the differences in home care from across the pond where she dives into the differences in home health system funding in the UK, common issues agencies face and what’s being done to overcome them. With years of experience under her belt, Jane shares insights on trends into the future of home health care and what direction the industry should take to be successful.

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