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Safe Home Care Coalition

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Bob Roth

on 22 September 2017

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Transcript of Safe Home Care Coalition

Presentation Objectives
differences in agency-hired, trained caregivers (employees) and registry/independent contracted, private caregivers (registry)
Place Along Healthcare Continuum
Image by Tom Mooring
Safe Home Care Coalition: Exposing the Truth
According to the LTCi Sourcebook, published by the American Association for Long-Term Care Insurance, 7.6 million individuals currently receive care at home because of acute illnesses, long-term health conditions, permanent disability or terminal illness. By comparison, there are just over 1.8 million individuals in nursing homes.
Paying for
In-Home Care
long-term care insurance
Home Care Throughout the Years
All Home Care Models are not Created Equal
From the Eyes of a
Medical Social Worker
highlight dangers that can occur without sufficient vetting of home care agencies
describe steps for the process of determining quality and value in home care agencies
identify new practices/protocol for discharge planners and other professional health care providers when referring to in-home personal care
Appropriate Jargon
Payment Models
Regulation and Standardization
Client and Caregiver
In-Home Care Landscape
Faced with a growing number of in-home care agency choices, consumers more and more are turning to companies that offer them the cheapest price for care without understanding the implications of their choice. Many consumers are hiring workers from registries and companies that do not employ or supervise their workers, but merely "place" them in homecare settings.
-Home Care Association of America, 2011
Models of Home Care
Employee Model
Registry/Independent Contractor Model
Private Caregiver Model
Cost to Clients/Patients
Jargon, Language and Semantics
What we refer to as 'care at home' does matter...
client vs. patient
Jargon, Language and Semantics
Non-medical Home Care vs. In-Home Care
personal care
private duty
companion service
custodial services
Paying for
In-Home Care
Veteran's benefits
asset conversion
Medicaid Programs - ALTCS
tax credits and cost of care reductions
savings and pensions
The Healthcare Continuum
About one out of every five U.S. seniors is readmitted to the hospital within 30 days of initially being discharged
A patient's life circumstances (low-income, lack of social support, co-morbid conditions or underlying disability) are all important factors in whether a patient will be readmitted to the hospital
Yet a hospital is rarely the preferred destination for care...
People want to remain at home
The Healthcare Continuum
Post-Acute Solutions to Preventing Readmissions
Implement a robust home health care plan:
Ensure smooth transitional care:
Ensure patients schedule a seven-day follow-up:
research shows home health care (medical social services or home health aides) can be effective
transitional care team or professional who facilitates coordination and continuity of care as they change providers post-discharge
medical studies suggest fewer readmissions among those who followed up with their physicians within 7 days of discharged
Health Care Continuum
86% of Medicare Beneficiaries want to spend their final days at home
there were 46.2M persons 65 years or older in 2014 (14.5% of the U.S. population) by 2060, there will be about 98M
in-home care is an integral part of the spectrum of support for patients...
Caregiver Support Ratio
defined as the number of potential caregivers age 45-64 for each person age 80 and older
in 2010, ratio was more than 7 for each person in the high-risk years of 80-plus
by 2030, the ratio is projected to decline to 4 to 1
by 2050, expected to fall further to less than 3 to 1
of the 50 states, Arizona projected to have lowest caregiver support ratio in country (1.8 to 1 in 2050)
Regulation and
"In Arizona anyone can open and operate a non-medical home care company. The lack of licensure by the state creates an industry that has no standards of service, no over-sight and no criterion of business ethics..."

Regulation and
"The results are a variety of non-medical home care business organizations that deliver their services in a varied manner, exercising a diverse business ethic delivering those services.
As a result of the differences in service delivery and business ethic, the consumer has been, and continues to be vulnerable and the industry's integrity suffers."
Regulation and
no licensing requirements for in-home personal care in AZ
no regulations governing matters such as caregiver credentials or practices for hiring and training caregivers
no regulations regarding care supervision or quality control practices
only national and local associations (HCAOA, AZNHA) which help to set and define industry standards
The Wild West
With no regulations of services, we tend to operate under the assumptions that any agency will do in a pinch
Referral Patterns and Preferences
Client Profile
before developing a profile description, we must understand why these agencies exist in general
who are the clients?
what are their understanding and expectations of a non-medical homecare service?
Client/Consumer Profile
recent changes in physical and/or cognitive level of functioning
dependent for one or more ADL's
often has out of state family (unavailable)
may need help navigating healthcare system
often alone, requires safety and security
wants companionship
instability with health condition(s)
transportation needs
wants to stay home
Client Profile
needs a trustworthy advocate to rely on for an accurate report
needs liaison for medical appointments
wants peace of mind
weighs affordability with service expectations
wants to build rapport with company/caregiver
relies on the assurance that needs are being met
Caregiver Profile
expectations of an in-home personal caregiver?
skilled at job
kind, cordial, friendly, sociable
good communicator/conversationalist
allows the client or family to be in control
Warm Body Fallacy
Employee Model: Rationale
agency or company that employs, trains, bonds and insures and background checks caregivers
agency takes care of legal issues
provides ongoing supervision
deep pool of staff available
Employee Model:
Caregiver Expectations
employment reference check
background check for abuse/neglect finding with DHS
background check for criminal history
license check for any actions
written applications
Employee Model:
Caregiver Expectations Cont'
written competency test
skills test in training facility
proof of TB test
proof of current first aid/CPR
proof of necessary education or licenses
proof of insurance and driving abstract if asked to drive
Registry/Independent Contractor Model
agency/organization that helps locate a caregiver and places them into a client's home on independent contractor basis
do not employ caregivers or take responsibility for their training and supervision
typically lower in cost considering the very little overhead in the way of caregiver training, health benefits, worker's comp etc.
client is liable for the payroll taxes and possible work related injuries of caregiver
Misconceptions of Registry/Independent Contractors
presence of consistent oversight of caregivers
they have comprehensive industry training
there is agency management of payment and taxes
background checks are conducted and adhered to
references are being provided
thorough interview process taking place
a professional caregiver will always be available
they are all bonded and insured
a friend of the patient
the patients neighbor
someone the patients neighbor knows
craigslist/want ads
Home Care Agency Model
Independent Contractor Model
Private Caregiver Model
$20-$25 per hour (hourly minimums vary from 2-4 hours)
$15-$17 per hour
as negotiated between caregiver and client
As patient and client advocates we make decisions about what we think is best for them. Rank services based on what you think would be most important to client and family
Referral Repercussions
Cameron Svendsen
Full transcript