Since 2005, I’ve been the owner and director of an agency providing in-home care to help seniors stay safely and comfortably in their homes. I got into this business because of my personal experience needing to help care for a parent who lived alone, hundreds of miles away from me. She passed away in 2004, and the following year I opened my business in the hopes of helping families facing challenges similar to the ones my family had experienced.
I love what I do, but over the past year or two I’ve become increasingly aware of a media narrative about my business that is both false and detrimental to our nation’s urgent need to find better and more affordable solutions for senior care. This narrative paints a picture of overcharged seniors and families, underpaid and exploited caregivers, and fat cat agency owners in the middle who exploit both sides while offering very little in the way of service.
It’s a compelling story because it touches on some very real problems. One problem is that the vast majority of American seniors want to stay in their homes, but many find it difficult to pay for the support needed to make this possible—despite the fact that seniors can be cared for far more cheaply at home than in a facility. Another real problem is that the amazing people who do the day-to-day, skilled and loving labor of caring for our seniors deserve better pay and support for the important work they do.
I have no quibble with either of these points. I am even sure that there are some unscrupulous agencies who truly are in the business to make money and not to provide service. But that is not true of my agency, and I believe it is not true of most professional agencies, especially those in a highly regulated state like New Jersey.
Please let me explain why a good, well run home care agency is decidedly not a “middleman,” i.e., someone who buys from a seller and sells to a buyer with no value added. Those of us in the home care business are in a unique position to understand the needs of seniors in a way no one else on their health care team can. We know our clients over the long term. We know them in their home environments. We know if they have adequate family support or not. We know what they are not telling their doctors. We can help them.
If you were a fly on the wall in our office for a day, you would see seven full-time and two part-time health care professionals working as a team with one another and with other community care providers to protect the health and safety of our clients. We are often in these clients’ lives for years, and every one of us takes their care personally.
Here are just a few of the ways that a professional agency can contribute to client health in a way that no other health care professional in their lives is in a position to do:
- We perform comprehensive assessments of each client and their environment. We get to know each client’s health history and medications, of course, but also what their home is like (and how safe), what their daily habits and preferences are, who helps them on a regular basis and what their goals are.
- This assessment results in a detailed, individualized plan of care for the home health aide(s) to follow, right down to how best to help the client out of a chair, or what is the safest, most comfortable way to bathe them.
- We always ask, “What are this client’s goals, and how can we make them possible?”
- Our RNs reassess clients every 60 days to look for changes in health status and to be sure the plan of care is still appropriate. We adapt to our clients’ changing needs.
- We instruct our home health aides about dementia and teach them methods for succeeding with challenging clients.
- Because we catch problems early, and because we keep an eye on our clients’ chronic conditions, we reduce unnecessary hospitalizations. This early intervention preserves health and saves the health care system money.
- We listen to our caregivers’ reports about their clients. They tell us when a client’s blood pressure gets out of control, when they see signs of a developing pressure sore, or when their client’s appetite is off. That’s when we spring into action making sure that families and all caregivers of the client are aware, that appropriate instructions are given, and doctors are consulted.
- We refer clients to other services to improve their health, safety or quality of life—podiatrists who make house calls, emergency response systems, resources for free or low-cost medical equipment, Meals on Wheels, and physical or occupational therapists. Often families tell us they had no idea these services were available or accessible to them.
- Teaching is a constant part of what our nurses do. Hospital or rehab instructions given prior to discharge often go in one ear and out the other. Our nurses review these instructions with patients in the home and ask them to “teach back,” so we know they’ve got it.
All of these things and more are part of what our clients receive for the hourly rate they pay for their caregiver. We are hardly acting solely as a “middleman.”
But what about the employees? Wouldn’t they earn more money if they worked directly for the client?
Well, yes, maybe. Especially if they are not paying payroll tax deductions. But there is a great deal they would lose, as well, and a great deal of added risk they would bear.
- Those thorough RN assessments I mentioned above are not only to protect our clients; they protect the safety of our home health aides as well. Clients and families will frequently ask for, or even demand, services or procedures that are unsafe for the aides to perform. Our RNs will not permit the health or safety of the aides to be jeopardized.
- We also stand up for our employees when clients of sound mind are rude or abusive, verbally or otherwise. We troubleshoot problems and help find solutions.
- We provide our aides the support, guidance and encouragement of licensed professionals. They don’t have to worry if they are doing the right thing or not. We are there to ask.
- Our employees have paid sick time, and access to dental/vision insurance, AFLAC, and a 401k plan to which we contribute.
- Medicare, social security and unemployment contributions provide a safety net.
- Employees who are injured on the job are covered by workers’ compensation, both for medical care and lost wages.
- We pay our home health aide for the work they do like clockwork, whether the client or payer source is in arrears or not. The risk is ours, not the home health aide’s.
Our society needs to give serious thought to the aging of our population and the nation’s growing need for support for seniors. We need creative solutions for meeting these needs, for helping families pay for care, and for supporting our front-line care workers.
Professional home care agencies will surely continue to play a critical role in our care network. The journalists, politicians and pundits who shape our discussions around senior care should take care to understand what we do and represent our work accurately.