When it comes right down to it, it’s hard to believe the senior home care industry hasn’t grown even more than it has.
Begun in 1880s, home care constitutes a growing industry of more than 33,000 providers serving an estimated 12 million clients. In 2009, the annual expenditures for home health care topped $72 billion, according to National Association for Home Care & Hospice based in Washington, D.C.
“There are 78 million baby boomers that will becoming the majority – 11,000 a day [turning 65] for the next 19 years. That will change every facet of society,” association President Val Halamandaris said. “America is going to go so far as to be a geritocracy.”
He urged boomers to “reinvent” their approach to caring for others, perhaps consider sacrificing for the good of the country. There simply is not enough money to sustain the health-care system as it now is constituted, Halamandaris said.
Numbers tell the story. Add the 78 million baby boomers to the 48 million Americans now on Medicare and the 12 million others with disabilities, Halamandaris estimated that 170 million Americans – about half of the current population – likely will need some type of home-based care in the near future. And those people overwhelmingly prefer to remain living at home.
Eric Little, senior vice president of franchise development for Right at Home, a home care and assistance company based in Omaha, Neb., posted more than $200 million in systemwide sales last year. More than third of its franchisees grossed more than $1 million in 2011.
Right at Home has locations in more than 240 locations in 40 states, as well as Canada, the United Kingdom, Brazil and – for the past year – in China. Little said the company anticipates adding two to three more countries a year going forward.
“We have room for 300 to 350 locations in the U.S., but we’ve been turning away people on a franchisee basis,” Little said. He said it is important to the company that it honor its commitment to adequately train, equip, market and mentor new franchisees. According to the company’s website, the initial investment required is between $64,900 and $111,600.
Formed in 1995, Right at Home provides care for people who don’t need an institutional setting but still need some assistance to live at home. Ruth Rovner, 90, of Carpentersville, hired a Right at Home caregiver five years ago at the suggestion of her daughter. The retired school teacher suffers from macular degeneration and a loss of central vision. Her caregiver, who works three and a half hours three to four times a week, helps with bathing and drives Rovner to the nearby senior center.
“It doesn’t help me see any better but it makes a difference so I can get out,” Rovner said. “She takes me a shopping and helps me pick out a few things that I need. She serves as my eyes three to four hours a day.”
Dorothy Janisch, 81, of Algonquin, has had her home caregiver about a year – four hours a day, three days a week.
“She helps take me to the grocery store and doctor. She helps with bathing and with light housework. She does the washing and cooks supper,” Janisch said. “I have a balance problem sometimes. I thought about assisted living, but I really wasn’t crazy about it. … She helps me enough where I can stay in my home.”
Little describes the baby boomers as “fiercely independent” with an “overwhelming desire to stay in their homes.”
“They’ve already had to give up driving privileges. That is their last frontier. That is the last sign of independence,” Little said. “But as time goes on the need for care increases. They may be mentally fine, but physically they might not be able to function by themselves and remain independent.”
Jeanette Palmer, 53, of Elgin, has run a private-pay Right at Home franchise in Algonquin and a satellite office in Mt. Prospect since 2003. Recently, she expanded her territory to into Cook County – running from West Dundee north to Richmond, East Dundee to Chicago. She has four office staff and 45, mostly part-time caregivers in the field. The majority are certified nursing assistants and her agency is licensed through the Illinois Department of Public Health.
The vetting process includes background checks and fingerprinting, she said, unlike many placement agencies that hire unsupervised, potentially untrained independent contractors.
Palmer said they are part of a vast, underground network of freelance caregivers who charge far less than the average, basic $20 hourly charge she charges clients. The more services, the higher the fee.
“Seniors grew up during the Depression, so $20 an hour is a lot of money for them,” Palmer said. “But you have to be careful. There are all of the legitimate companies, but intermixed are some other agencies that were not licensed. It’s kind of tricky.”
Halamandaris said the National Association for Home Care & Hospice has been working to develop nationwide licensing standards, and a method by which consumers can weigh in on particular companies.
“Sunshine is a wonderful antiseptic. The public needs to know what they are dealing with,” he said. “My view is you license everybody who comes into the home. I don’t care who they are. There is an obligation to take care of vulnerable people. That is the responsibility of state government.”
Illinois compares favorably to many states, Halamandaris said, but all too often home care services “exist in a vacuum.” He urged federal and state leaders to eliminated many of the convoluted rules that prevent home health care from qualifying for Medicare reimbursement.
“It keeps you independent, it’s less costly and you can maintain your lifestyles as much as possible,” said Carol Louise, executive director of Family Alliance Inc. in Woodstock. “Many of my clients have home care twice a week and come to Family Alliance three times a week.”
Palmer, who owned a company that sold electronic parts to manufacturers such as Motorola, was frustrated in her efforts to find home care for her mother. Back in the 1980s, she said, home health care was like the “Wild West.” Palmer credited the National Private Duty Association for its work in establishing caregiver standards and a licensing process for corporate providers.
The investigative process she undertook while researching care options for her mother, and the opportunity to make a real difference in a person’s life, drew her toward the industry. Families are scattered around the country like never before. Hiring a qualified home caregiver gives their children peace of mind – even as her business has become more complicated. Not only do the needs of the 100 clients she serves change, so do the rules she must operate under.
“It’s like different businesses under one umbrella,” she said. “Staying in compliance with the law is like a spinning plate all by itself.”
Palmer described the federal Affordable Care Act as a “giant black hole” that could force her to trim the number of full-time jobs or raise her rates should she reach 50 full-time employees.
“In order to provide insurance, I’ll have to add $7 an hour to the cost of the care I have currently and that will make it much more difficult to compete,” she said. “I’m already dealing with a huge underground.”
Starting next fall the Department of Health and Human Services will begin penalizing hospitals if their Medicare readmission rates are higher than expected. One in five Medicare patients who leave a hospital will be readmitted within 30 days.
“Health-care reform is on everybody’s mind right now, but there are a lot of unknowns,” Little said. “What we do know is that whatever they decide it is going to affect all of us. We are keeping very close tabs on it. … Our founder worked as a hospital administrator before this. He saw (those) coming to their hospitals being sent home and there was no real care at home. … Fast forward to today and the same problem still exists.”
Little said many frugal seniors, who return home from the hospital with a new bag of medications figure they’ll finish off the old pills first. The problem is the new medication is different than what they were taking. Often, they wind up back in the hospital.
Halamandaris said since 5 percent of the public is responsible for half of all health-care costs, creative approaches and new alliances could prove crucial moving forward.
“We’re starting to look at the health-care community as partners rather than as competitors. We’re starting to break down the silos that exist between hospitals and doctors and home health,” Halamandaris said. “Our salvation is in our working together.”
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Looking for a home care or hospice agency?
Finding the right provider does not have to be difficult. The Home Care/Hospice Agency Locator contains the most comprehensive database of more than 20,000 home care and hospice agencies. Use this resource to find all the agencies in any particular area of the country. Visit www.nahcagencylocator.com.
Questions to ask when hiring a caregiver:
• Do your parents want to stay in their current home as long as possible? Or are they considering “downsizing” or moving to a senior living community? Discuss what they would prefer if they were to experience a decline in health and need greater assistance with the activities of daily living. Home care? Assisted living?
• Many people erroneously believe that Medicare pays for a nursing home or home health care services. But in reality, long-term care is not covered by Medicare, and paying for it can quickly deplete financial resources. Investigate whether your parents are good candidates for long-term care insurance. And if they already have a policy, is it from a reputable company?
• Do they offer alternate arrangements should the caregiver become ill?
• Do they federal and state taxes, Social Security (FICA) and unemployment insurance, so that our family is not legally responsible?
• Are the caregivers legally able to work in the United States? Does the company perform criminal background checks and state abuse registry checks? Does it check caregivers’ references from prior work history?
• If the caregiver or a loved one is injured while in a private home, who is responsible? Are they bonded and insured?