Monday, August 24, 2009

Are Home Health Care Agencies the Next Business "Bubble?"

Ads for Home Health Care agencies are all over the Classifieds sections of local newspapers these days. Not only are these businesses wanting you to hire their caregivers to assist you our your loved one at home, they want YOU to work for them! Suddenly, the market for Certified Nurses' Aides (CNAs) is huge, and training sessions are springing up everywhere to prepare those who wish to enter the workforce in this capacity.

This is good news, right? With so many people out of work, hasn't the boom in this market has come at a great time? The answer is both "Yes" and "No." CNAs can make between $7 and $10 or more an hour, working in nursing homes, assisted living facilities, and private homes. But not everyone is suited for this work. And therein lies one of the "rubs." Working as a nurses' aide is not glamorous, by a long shot. It is hard work, with lots of heavy lifting and sometimes unpleasant duties. While there are situations where CNAs care for delightful patients who are a daily joy, CNAs often clean some big bottoms and deal with every bodily fluid imaginable. Patients who are suffering from dementia may be violent, or at best, unpleasant and unruly. Facilities are notoriously understaffed, so a CNA may be in charge of the care of well over a dozen patients during a shift.

There are those who become CNAs because they truly enjoy the work... and/or, like my niece, they are working toward a nursing degree, and this job is great experience and helps pay the bills. For countless others, this is "just a job." The difference between "just a job" flipping burgers at McDonald's or stocking shelves at Wal-Mart and being a CNA is that CNAs are caring for someone's parents or grandparents. And let's be honest, we all want our loved ones cared for as well as possible. Should we come to a point where we need extra in-home care for Grandma or Poppa... or worse, they require nursing home care... we expect high-quality treatment. So we want CNAs who are working with our loved ones because they WANT to be there and enjoy caring for them... not those who needed a job and this one paid best. And we don't want this care managed by a company that is impersonal and cares more about the "bottom line" than the quality of services rendered.

While there ARE legitimate, well-run, caring businesses opening to provide caregiving services, particularly home health care, this business trend also shows signs of becoming the next "bubble." Our population is aging rapidly, and as baby boomers begin to get their AARP cards and enter the world of senior discounts, Medicare, and retirement villages, all sorts of markets are developing to meet their needs. And high on the list in the years ahead will be services and care that can allow seniors to continue to live in safety and good health within their own homes.

This trend has not escaped the notice of entrepreneurs who see an opportunity to start a new business venture and, hopefully, make a nice chunk of change. So we see Bob leave the real estate company where he was an agent to start a Home Health Care agency. He gets all of the requisite permits and hires a dozen or so CNAs to represent him and actually do the work while he manages the office. Sounds simple enough, right? Maybe... but this situation is ripe with opportunity for misstep.

A person with a good business "sense" and organizational skills may very well be able to surround himself/herself with qualified people who will "make the company look good." But suppose Bob doesn't have a Registered Nurse on staff or the consultation services of other qualified medical personnel. Who will check on the CNAs in the field to ensure that their work is appropriate, caring, and meets standards and guidelines for quality care? Will Bob have the knowledge and skills necessary to comply with all insurance regulations, bill clients fairly, and troubleshoot problems? Will Bob be genuinely concerned with providing quality care for his clients at a fair rate? Or will he charge $25 an hour, pay his aides minimum wage, and pocket the difference? Will the aides who work for Bob be experienced, caring, professional assistants? Or will they view their work as an hourly wage position that requires showing up, doing the least that has to be done, and collecting a paycheck to feed their family?

Do not misunderstand me. I am a huge proponent of home health care. Without this service, my 97-year-old grandmother would have been placed in a nursing home more than a decade ago, and I am quite sure she would not be alive today. Quality home health care is invaluable, and my grandmother has wonderful, caring, professional CNAs who see to her needs several days per week. Her aides work for an agency managed through our county health department, and Medicare pays for their services. Sadly, the aides do not get as much of the hourly rate paid by Medicare as I feel appropriate, but that is another debate completely. My grandmother's care also includes frequent visits by registered nurses who assess her health in-depth, administer necessary injections (B-12, flu, etc.), and notify her doctor when anything seems amiss with her physical well-being.

A private-care franchised Home Health Care company recently opened for business in my community, and all reports indicate that qualified, caring CNAs on staff are providing excellent care to local residents. The fee is $15 an hour. I have no idea how much of that is paid to the caregiver and how much the business pockets, but at such a low hourly rate, neither can be getting rich. But I am happy to hear that those in our community who need this service now have another option.

So what are we to do? When we find ourselves needing home health care... either personally or for a loved one... where do we turn? Here are some questions to ask potential Home Health Care provider companies as a starting point...

  1. How long has the company been in business?
  2. What is the owner/manager's background for operating such a business? Does this person have personal experience with Home Health Care?

  3. Is this person a Certified Nurses' Aide and/or a Registered Nurse? Does the owner/manager have other medical background?
  4. How large is the staff? What are the qualifications of the staff? Is everyone certified? Does the staff include nurses and other medical personnel? Is everyone properly certified and licensed?

  5. What are the rates for services? Are staff members adequately compensated? Is experience and good job performance rewarded?

  6. Are references available? Can current clients be contacted for feedback?

  7. What is the mission statement of the company? Is the goal of the business to service its clients with utmost quality and care, or did this simply seem like a good new business arena to enter?

The Home Health Care business is just one of many that will "ride the bubble" of meeting the needs of an aging population. Others will surely follow... and this is a good thing. But we must be diligent in ensuring that our goods and services are worthy of our hard-earned dollars... and that our needs, and those of our loved ones, are met with care and professionalism. Home Health Care may indeed be a "business bubble," but it appears to be a service that is here to stay. How well these services are delivered will be mandated in large part by the recipients. Over time, we can hope that the cream will rise to the crop, and those wishing to merely make a quick buck will fall by the wayside.


Mark said...

Excellent post. Great lunch-time read. These are very important things to consider, but, although I know that my parents will be truly old some day, I shudder when I imagine entrusting their livelihood to potentially shady businesspeople. Perhaps, as you suggest, the competition during the rising of the "bubble" will help weed out the nefarious.

Debbie Robus said...

Good point, Mark! Actually, I was more concerned about a glut of the nefarious than competition getting rid of them. The scary thing is that there is more than enough work to go around... and too many agencies, like Medicare, pay exorbitant fees, much of which is pocketed by an agency owner and not the actual caregivers.

We as family members and guardians are going to have to be on our toes to ensure that "proper credit" - and compensation - is given where due... and that our loved ones receive the best care for the dollar. Always love your comments... thanks for reading and sharing your thoughts!

eschmidt said...

Great post, you make some valid points! Another factor that comes into play is the housing market; many people, including the elderly, are being forced to stay in their homes because they can't sell their homes. If a senior needs care and they are stuck in their homes, homecare is a viable option, if not a necessity. The key is to put a great deal of effort into researching care providers; there are a lot of great agencies out there!