Valerie VanBooven's Marketing for Senior Service Providers

Home Health Aides: What They Make, What They Cost

Home Health Aides: What They Make, What They Cost
By Jane

Part two of a three-part series on home health aides, to be published on Tuesdays in The New Old Age.

Last week Marki Flannery, the president of Partners in Care, an affiliate of the Visiting Nurse Service of New York, discussed the advantages of hiring a home health aide from an agency. This week she picks up where she left off, answering questions about the costs of home health aides, the intimate strangers who often make it possible for our parents to remain in their homes, even when they need help or supervision day and night.

Marki Flannery of Partners in Care. (Janet Charles)

Q. What does it cost to hire round-the-clock help, and what is the most economical way to do it?

A. When it comes to needing care 24/7, the first thing you have to do is define exactly what level of care you need. Does your mom need a home health aide to monitor her all day and all night, or do you need a home health aide for your mom only when she is awake?

We will help you figure out what you need by asking how well your mom sleeps at night; how many times she gets up; what her sleeping patterns are. We will also figure out with you if the home environment has a suitable place for the home health aide to sleep, and if the aide who is “living-in” will be able to get some hours of uninterrupted sleep and a couple of hours a day “off-duty.”

If you want a “live-in” home health aide who will be in the home 24 hours a day, but who will have time off to sleep and for personal time, then we suggest two aides to cover the seven days in a week — one who works for four days and another who works the remaining three days.

This shared approach keeps the cost to you as low as possible, because when one aide works more than 40 hours during a seven-day week, we are required by law to pay that aide additional money for each hour worked over 40.

So, here is how the math works:

We charge you for one aide working three days at 14 hours per day, for a total of 42 hours. Forty hours are charged at our hourly rate (currently $18.50 in New York City), and two hours are charged at the overtime rate (currently $23.05) and, we charge you for the other aide working four days at 14 hours per day for a total of 56 hours, with 40 hours being charged at our hourly rate and 16 hours charged at the overtime rate. Thus, a week of round-the-clock help costs $1,894.90.

Of course you could request that one aide work more than four days in a row, but then the costs increase. Or, you could increase the number of aides and have each aide work just 40 hours per week or less, but then you have more aides working for you.

There are times, however, when two aides simply can’t cover the full seven-day week. If your mom truly needs the aide to be awake every hour of the day, we assign two aides to each 24-hour period, one working from 8 a.m. to 8 p.m. and the second working the 8 p.m. to 8 a.m. shift. In this case, to cover the full week, we would assign four aides. Two of them would exceed the 40 hours per week limit, each having to work 48 hours during the week. So, you would have a total of 16 hours charged at the overtime rate. In this scenario, a week of care costs $3,328.80.

These options get you the care you need from a licensed home health care agency at the lowest possible cost and keep the number of home health aides as low as possible. Other options can be worked out but likely will result in increasing the number of aides working for you.

Q. How much money does your average aide make, and what benefits do you offer, compared to the industry at large?

A. We pay our home health aides by the hour, on a graduated scale. That means that the hourly pay rate increases the longer a home health aide works for us. Entry level aides earn $8 per hour, and aides who have worked with us for a few years or more earn up to $13 per hour. According to published information, the national average wage for home health aides is $9.11 per hour. Our average wage is higher.

You may be wondering why we charge you more than the hourly rate we pay our home health aides, and the answer lies in the support we provide to our employees. All of our aides are eligible for individual health benefits, including vision, dental and prescription drug coverage, at no cost to them. We also offer our aides pension benefits, paid vacations and sick time, and we provide uniforms as well.

In addition, all of our aides are offered continuing education and have career advancement opportunities. While we have many home health aides who never want to stop going to people’s homes and helping them live a better life, we also have aides who move up the career ladder to become nurses, supervisors and managers. And of course, there are the usual business expenses, including rent, insurance, recruitment, equipment, staff to oversee the care provided and administrative staff.

All of these things account for our success in keeping home health aides working with us for years. There is a lot of turnover in our industry, and we see it, too. But estimates put the national average at 40 percent to 60 percent, and, year-after-year, we see a turnover rate of less than half the national average. We celebrated our 25th anniversary in 2008 and are very proud of the fact that we have 12 home health aides who have been with us for every one of those years. We have 27 aides who have worked with us for 20 years, another 33 who have 15 years of service, 112 with 10 years and more than 2,100 who have been here at least five years.

Q. Home health aides from licensed agencies must follow certain rules that restricts what they can do. Why is this so?

A. The rules and regulations that govern what a certified home health aide can and can’t do exist primarily to protect the patient and family. People may choose to hire an unlicensed individual and not have to follow the New York State rules and regulations but then, as I have suggested before, the risk factor is likely to increase in any number of ways.

We recently took on the case of a patient whose family had first hired someone recommended to them by a neighbor. This person, not certified and not trained, used the wrong dressing on an open wound, causing considerable harm and pain to the patient. This mistake is far less likely to happen with a certified home health aide. If the patient had been with us from the beginning, the proper treatment would have been prescribed by the doctor and managed by the nurse in cooperation with the patient’s physician, and the aide would have received proper instruction about what needed to be done.

In another case, an adult daughter called us after her mom, who suffered from both Alzheimer’s and congestive heart failure, was admitted to the hospital as a result of an adverse reaction to medications. The daughter had initially hired a person to be with her mom at home and give her the medications she needed. As the mother’s medical condition deteriorated, her medication routine became more complex. Unfortunately, the multiple medications didn’t work well together, and her mom had to be hospitalized. The person hired by the woman’s daughter could not explain to the doctors exactly what meds she had given to the patient and when they were administered. While certified home health aides in New York State can give medications to most patients, they cannot administer medications to patients who are not aware of what they are taking and why, but nurses can. So in this case, we would have provided both an aide and a nurse, ensuring the medications would be properly administered.

We sometimes hear from people that hired a trustworthy person on their own, because he or she can do the food shopping for an elderly parent while a certified home health aide from a licensed agency can’t. Not true. At Partners in Care, we handle grocery shopping for patients all the time, but we do so using a system of checks and balances to ensure that our client’s money is spent on what they want. If the patient wants us to use cash, we put a limit on how much. We also require our aide to keep the receipts and, of course, return the change. We won’t allow our aides to use a patient’s debit or credit card or PIN number. Most often, we use the online credit card purchasing systems available in a market, such as Fresh Direct, and use home delivery.

Another concern we hear goes like this: “I want someone who will pick up my mom after she falls, not leave her on the floor until emergency medical services arrives. And a certified home health aide won’t do that.” Well, this concern is true. A certified home health aide is taught that there is greater risk in lifting or moving an elderly person who has fallen than there is in waiting for the appropriate medical team to arrive. At the same time, a professionally trained aide can usually differentiate a minor fall from a more serious fall that requires professional medical assistance. So, it may not sound like something you want — leaving your fallen mom in her prone position until E.M.S. arrives - but if the certified home health aide has made that determination, there is likely a very serious reason for doing so.

More next week on hiring and managing home health aides, who will be needed in huge numbers as America rapidly ages.

Elders' self-care puts family in tricky spot, experts say- (but I bet your service can help!)

Elders' self-care puts family in tricky spot, experts say
By Matthew Santoni
Pittsburgh Tribune Review
Wednesday, December 31, 2008 

Laura Stewart's heart was in the right place when she and her boyfriend attempted to move her 86-year-old sister from a trash-filled apartment in the Hill District to Stewart's duplex in a Cleveland suburb, her family said.

But police and legal experts said Stewart had plenty of law-abiding alternatives to binding Evelyn Poynter's wrists in duct tape, forcing her into a car wearing only her nightgown and a blanket, and driving her around for eight hours Sunday.

"I have some sympathy for these people if they were trying to do the right thing, but obviously, kidnapping was the wrong way to do it," said Larry Frolik, a professor at the University of Pittsburgh School of Law and chair of the Pennsylvania Bar Association Elder Law section.

Stewart, 72, and Earl Cross, 76, were charged with kidnapping, conspiracy, assault, false imprisonment and unlawful restraint, said Pittsburgh police Lt. Kevin Kraus. Darnell Randall, 48, of the Hill District was arrested in Pittsburgh on charges of helping Stewart and Cross bind Poynter and force her into a Cadillac Escalade.

A police affidavit filed to support the charges against Randall notes the "deplorable" condition of Poynter's apartment and says there were "extreme amounts of garbage and clutter throughout."

But if Poynter's family believed she was not taking care of herself, they could have contacted the Allegheny County Area Agency on Aging's protective services division, which deals with elderly victims of abuse, neglect and self-neglect, Frolik said. A doctor's evaluation can determine if someone is physically and mentally capable of taking care of him or herself, and if not, an Orphan's Court judge can appoint a guardian to make important decisions for the person.

"If the woman was competent, she has the right to live however she wants to. This is sometimes difficult for families to accept," said Martha Mannix, another Pitt professor who runs the university's Elder Law clinic.

A third option would be getting the person to sign over either full or partial power of attorney, Frolik said. Documents to do so can be downloaded from the Internet, or an attorney could be hired to do it in a few hours, he said.

Leslie Stewart, 39, Laura's daughter and Poynter's niece, said she did not know if her family considered having Poynter evaluated or checked by the Agency on Aging, but it was clear that Poynter was finding it physically difficult to take care of herself.

"She couldn't do it physically, and I don't think anybody knew where her mind was," Leslie Stewart said. "My aunt doesn't let anybody into her apartment, so hiring someone to help her was out of the question."

Randall, a handyman renovating the Clarissa Street apartment building that Laura Stewart owns and Poynter calls home, was scheduled for a preliminary hearing Jan. 8 and was still in the Allegheny County Jail on $10,000 bail. Stewart and Cross were held without bail in Shaker Heights, Ohio, and were awaiting transportation back to Pittsburgh by Allegheny County Sheriff's deputies.

Matthew Santoni can be reached at msantoni@tribweb.com or 412-380-5625.

Articles like these are great opportunities to market your elder care services....

Cookbook Medicine Won't Do For Elderly

Personal Health

By Jane Brody 
The Martha Stewart Center for Living at Mount Sinai Medical Center in New York is like no medical clinic I’ve ever seen. It is brightly lighted and quiet — there is no television blasting. It has wide corridors and plenty of comfortable chairs with sturdy arms, and yet few people wait more than 10 minutes to see a doctor or nurse practitioner.

The center, which opened in 2007, was designed especially for primary care of older adults, many of whom have complex chronic medical problems like diabetes, heart disease and hypertension as well as debilitating conditions like arthritis and osteoporosis.

 

Just as a child is not a small adult and requires specialized care, adults over the age of, say, 65, are not just old adults and should not be treated like patients half their age.

The population of aging Americans is expected to mushroom in the years ahead. Geriatricians, the experts in elder care, are already in short supply, and their numbers will continue to shrink. But knowing the kind of care that these specialists provide may help older people and those who look after them learn to seek it out wherever they go.

“Cookbook medicine may be appropriate for younger people but is not always appropriate for older people,” Dr. Mark Lachs, a geriatrician at Weill-Cornell Medical Center in New York, said in an interview. He sees two dangers in how older adults are treated: overtreatment and undertreatment.

“If a high-functioning 80- or 90-year-old develops angina, aggressive treatment would be appropriate,” Dr. Lachs said. “Care should not be withheld solely on the basis of age.”

On the other hand, overtesting and overtreating older patients can result in debilitating side effects. Before deciding on tests and treatment, he said, “the doctor must take into account the whole picture of the patient, the patient’s family and life situation.”

Screening for Lifestyle

Dr. R. Sean Morrison is one of the geriatricians at Mount Sinai. “The overall goal is to help older adults achieve the best quality of life possible, given the limits of medical technology and knowledge,” he said.

When I asked how he would approach a new patient of 85, Dr. Morrison said he would start with a series of questions: “Tell me about yourself. What do you like to do? What are the things you would like to do that you cannot do anymore? What is your medical history? What medications do you currently take? What brings you here today?”

The geriatric exam itself would depend on the patient’s answers. “If the patient is a healthy 75-year-old who plays golf and tennis and has no functional limitations,” Dr. Morrison said, “the focus would be on preventive screening and advance care planning.

“But if the patient has functional limitations, the focus would be to restore and improve what can be restored and improved, such as reducing the risk of falls, addressing any acute medical conditions, and streamlining medications for chronic health problems so that the right drugs are taken for the right conditions.”

“You want a doctor who asks more than just about your medical conditions,” he added. The doctor should ask about the effect of medical conditions on quality of life, and then should explore what improvements are possible. “The focus of care should be on quality of life,” he said. “Too often, doctors lose sight of this goal when the focus is on treating specific diseases.”

The doctor should address a patient’s most serious health threats, of course, but also the patient’s most serious concerns. Is the patient troubled by problems like fatigue, pain or shortness of breath, or having problems with medications?

For example, he said, if a patient has serious arthritis and hypertension and cannot go to places without a readily accessible bathroom on the first floor because she takes a diuretic for high blood pressure, perhaps the blood pressure medication should be changed. The patient may prefer a different drug that carries a slightly greater risk of stroke if it means a better quality of life.

The Exam

“When going to a new doctor, an older patient should receive a comprehensive assessment, not just a physical exam,” Dr. Chad Boult, a geriatrician at the Johns Hopkins School of Public Health, said in an interview. “The patient should be asked, What is important to you about your health now? What is your life like — your exercise habits, diet, use of alcohol and tobacco? Is your environment safe and convenient?”

There are three areas that should be explored during a geriatric exam that are often missed if the doctor focuses on a specific illness, Dr. Morrison said:

¶Dementia. He asks the patient: “Are you having trouble with your memory? Is it O.K. if I check with a family member about this?” He said there were often treatable causes for memory problems, like thyroid disease, medication side effects or depression.

¶Risk of falls. Checking balance, gait and strength is easy, he said. “I would meet you in the waiting room, watch how you stand up from a chair and walk to the exam room. I’d throw a pen on the floor and ask you to pick it up. I’d ask you to sit in a chair and stand up three times as quickly as you can. Can you get up and down without using the arms of the chair? If the patient uses a cane, how is it used and is it the right height?”

¶Incontinence. “There’s a tremendous social stigma associated with incontinence even when there are medical reasons for it,” Dr. Morrison said. It is as common as hypertension and diabetes among the elderly, but patients rarely discuss it with their doctors unless asked about it, he said.

Dr. Boult said that patients’ feet were often overlooked, leading to problems that can become life-limiting. Many older people cannot reach their feet to clean them and cut their toenails, and they develop painful sores.

Other Considerations

Dr. Morrison said that before recommending screening tests like mammograms for breast cancer and PSA tests for prostate cancer, the question to ask is, “What are we going to do with the test results? If we’re not going to act on them, screening should be stopped.” If a patient has chronic conditions that limit life expectancy, he said, there is no point in screening for most cancers.

On the other hand, he said, two medical procedures can greatly improve the quality of life for older adults: joint replacement and cataract surgery. Too often, patients think such surgeries aren’t worth the bother because they won’t be around much longer. He described a woman who at 82 was having trouble walking but chose not to have a knee replacement. Now 102, the patient told him, “I should have listened to you years ago.”

Like this woman at 82, many older people are quite healthy, Dr. Boult said.

But about one-quarter of the older population has multiple chronic conditions and spends 80 percent of Medicare dollars, he added. “These patients need coordinated care, a system of regular monitoring, and regular access to a primary care doctor who can detect problems early before they require expensive, dramatic treatments.”
http://www.nytimes.com/2008/12/30/health/30brod.html?_r=1&ref=science&pagewanted

Home Health Aides: What They Make, What They Cost

Home Health Aides: What They Make, What They Cost
By Jane

Part two of a three-part series on home health aides, to be published on Tuesdays in The New Old Age.

Last week Marki Flannery, the president of Partners in Care, an affiliate of the Visiting Nurse Service of New York, discussed the advantages of hiring a home health aide from an agency. This week she picks up where she left off, answering questions about the costs of home health aides, the intimate strangers who often make it possible for our parents to remain in their homes, even when they need help or supervision day and night.

Marki Flannery of Partners in Care. (Janet Charles)

Q. What does it cost to hire round-the-clock help, and what is the most economical way to do it?

A. When it comes to needing care 24/7, the first thing you have to do is define exactly what level of care you need. Does your mom need a home health aide to monitor her all day and all night, or do you need a home health aide for your mom only when she is awake?

We will help you figure out what you need by asking how well your mom sleeps at night; how many times she gets up; what her sleeping patterns are. We will also figure out with you if the home environment has a suitable place for the home health aide to sleep, and if the aide who is “living-in” will be able to get some hours of uninterrupted sleep and a couple of hours a day “off-duty.”

If you want a “live-in” home health aide who will be in the home 24 hours a day, but who will have time off to sleep and for personal time, then we suggest two aides to cover the seven days in a week — one who works for four days and another who works the remaining three days.

This shared approach keeps the cost to you as low as possible, because when one aide works more than 40 hours during a seven-day week, we are required by law to pay that aide additional money for each hour worked over 40.

So, here is how the math works:

We charge you for one aide working three days at 14 hours per day, for a total of 42 hours. Forty hours are charged at our hourly rate (currently $18.50 in New York City), and two hours are charged at the overtime rate (currently $23.05) and, we charge you for the other aide working four days at 14 hours per day for a total of 56 hours, with 40 hours being charged at our hourly rate and 16 hours charged at the overtime rate. Thus, a week of round-the-clock help costs $1,894.90.

Of course you could request that one aide work more than four days in a row, but then the costs increase. Or, you could increase the number of aides and have each aide work just 40 hours per week or less, but then you have more aides working for you.

There are times, however, when two aides simply can’t cover the full seven-day week. If your mom truly needs the aide to be awake every hour of the day, we assign two aides to each 24-hour period, one working from 8 a.m. to 8 p.m. and the second working the 8 p.m. to 8 a.m. shift. In this case, to cover the full week, we would assign four aides. Two of them would exceed the 40 hours per week limit, each having to work 48 hours during the week. So, you would have a total of 16 hours charged at the overtime rate. In this scenario, a week of care costs $3,328.80.

These options get you the care you need from a licensed home health care agency at the lowest possible cost and keep the number of home health aides as low as possible. Other options can be worked out but likely will result in increasing the number of aides working for you.

Q. How much money does your average aide make, and what benefits do you offer, compared to the industry at large?

A. We pay our home health aides by the hour, on a graduated scale. That means that the hourly pay rate increases the longer a home health aide works for us. Entry level aides earn $8 per hour, and aides who have worked with us for a few years or more earn up to $13 per hour. According to published information, the national average wage for home health aides is $9.11 per hour. Our average wage is higher.

You may be wondering why we charge you more than the hourly rate we pay our home health aides, and the answer lies in the support we provide to our employees. All of our aides are eligible for individual health benefits, including vision, dental and prescription drug coverage, at no cost to them. We also offer our aides pension benefits, paid vacations and sick time, and we provide uniforms as well.

In addition, all of our aides are offered continuing education and have career advancement opportunities. While we have many home health aides who never want to stop going to people’s homes and helping them live a better life, we also have aides who move up the career ladder to become nurses, supervisors and managers. And of course, there are the usual business expenses, including rent, insurance, recruitment, equipment, staff to oversee the care provided and administrative staff.

All of these things account for our success in keeping home health aides working with us for years. There is a lot of turnover in our industry, and we see it, too. But estimates put the national average at 40 percent to 60 percent, and, year-after-year, we see a turnover rate of less than half the national average. We celebrated our 25th anniversary in 2008 and are very proud of the fact that we have 12 home health aides who have been with us for every one of those years. We have 27 aides who have worked with us for 20 years, another 33 who have 15 years of service, 112 with 10 years and more than 2,100 who have been here at least five years.

Q. Home health aides from licensed agencies must follow certain rules that restricts what they can do. Why is this so?

A. The rules and regulations that govern what a certified home health aide can and can’t do exist primarily to protect the patient and family. People may choose to hire an unlicensed individual and not have to follow the New York State rules and regulations but then, as I have suggested before, the risk factor is likely to increase in any number of ways.

We recently took on the case of a patient whose family had first hired someone recommended to them by a neighbor. This person, not certified and not trained, used the wrong dressing on an open wound, causing considerable harm and pain to the patient. This mistake is far less likely to happen with a certified home health aide. If the patient had been with us from the beginning, the proper treatment would have been prescribed by the doctor and managed by the nurse in cooperation with the patient’s physician, and the aide would have received proper instruction about what needed to be done.

In another case, an adult daughter called us after her mom, who suffered from both Alzheimer’s and congestive heart failure, was admitted to the hospital as a result of an adverse reaction to medications. The daughter had initially hired a person to be with her mom at home and give her the medications she needed. As the mother’s medical condition deteriorated, her medication routine became more complex. Unfortunately, the multiple medications didn’t work well together, and her mom had to be hospitalized. The person hired by the woman’s daughter could not explain to the doctors exactly what meds she had given to the patient and when they were administered. While certified home health aides in New York State can give medications to most patients, they cannot administer medications to patients who are not aware of what they are taking and why, but nurses can. So in this case, we would have provided both an aide and a nurse, ensuring the medications would be properly administered.

We sometimes hear from people that hired a trustworthy person on their own, because he or she can do the food shopping for an elderly parent while a certified home health aide from a licensed agency can’t. Not true. At Partners in Care, we handle grocery shopping for patients all the time, but we do so using a system of checks and balances to ensure that our client’s money is spent on what they want. If the patient wants us to use cash, we put a limit on how much. We also require our aide to keep the receipts and, of course, return the change. We won’t allow our aides to use a patient’s debit or credit card or PIN number. Most often, we use the online credit card purchasing systems available in a market, such as Fresh Direct, and use home delivery.

Another concern we hear goes like this: “I want someone who will pick up my mom after she falls, not leave her on the floor until emergency medical services arrives. And a certified home health aide won’t do that.” Well, this concern is true. A certified home health aide is taught that there is greater risk in lifting or moving an elderly person who has fallen than there is in waiting for the appropriate medical team to arrive. At the same time, a professionally trained aide can usually differentiate a minor fall from a more serious fall that requires professional medical assistance. So, it may not sound like something you want — leaving your fallen mom in her prone position until E.M.S. arrives - but if the certified home health aide has made that determination, there is likely a very serious reason for doing so.

More next week on hiring and managing home health aides, who will be needed in huge numbers as America rapidly ages.

New York Times: Home Health Aides: Why Hire From an Agency?

Here is an interesting article from the New York Times. What’s even more interesting is reading it from the actual site itself and looking at the posts that people wrote after the article went live. I would encourage all senior service providers to read those posts, and get to know your target market.  Understand what they are saying about home care services, understand their fear, and then craft a marketing message that eliminates that fear. Don’t contribute to some of the problems and perceptions that people have about elder care services. Valerie

Here’s the actual link:

http://newoldage.blogs.nytimes.com/2008/12/23/home-health-aides-why-hire-from-an-agency/?hp

 

December 23, 2008, 10:45 am
 
Home Health Aides: Why Hire From an Agency?
By Jane Gross
This is the first of a three-part series on home health aides, to be run on consecutive Tuesdays at The New Old Age.

Living out their lives at home, rather than in an assisted living center or a nursing home, is the overwhelming preference of the elderly and their adult children. Remaining at home often means hiring, paying for and supervising aides to help with shopping, cooking, bathing, dressing, eating, toileting and medication management.

This can cost upwards of $150,000 a year for someone who needs 24/7 assistance that is custodial, rather than medical, and thus not covered by Medicare, the universal health care system. Medicare pays for doctors, hospitalizations, surgery, diagnostic tests and medication for those 65-and-over — but not for what is commonly known as long-term care.

Only the impoverished elderly, in some states, are protected from this huge expense by Medicaid, a means-tested program that increasingly is looking for ways to pay for care at home. Medicaid has traditionally paid for care only in skilled nursing facilities, but patients’ preferences and the greater cost of institutional care are driving the trend toward home care coverage.

Marki Flannery of Partners in Care, part of the Visiting Nurse Service of New York. (Janet Charles)
The Visiting Nurse Service of New York is the nation’s largest not-for-profit provider of home health care. Some of the costs are covered by Medicare and Medicaid, and some by patients and families themselves, either directly out-of-pocket or with long-term care insurance policies, which themselves can be very expensive. These private-pay patients and families are clients of Partners in Care, an affiliate of the Visiting Nurse Service of New York that is run by Marki Flannery.

I asked Ms. Flannery to explain to our readers the value of hiring home health aides through a licensed agency, like Partners in Care, rather than in the so-called “gray market,’’ an over-the-back-fence approach that is far less expensive because there is no middleman, so to speak, but that lacks the protections and supervision provided by an agency.

Ms. Flannery also shares with us her advice on choosing an agency, determining the most economical set-up under the agency framework, what agency aides are paid and what you will pay for them. She will also address why agency adies are restricted in ways that gray market aides aren’t, how to insure a good working relationship and what the future holds for her industry as more and more people live longer and longer.

Today, she will talk about the reasons for using an agency and how to choose one. Her answers to other questions will follow, in posts on Tuesdays over the next two weeks.

Q. Why should someone hire a home health aide from an agency instead of hiring a person recommended by a friend?

A. There is a list of things people consider when they are faced with the need to hire a home health aide to help take care of someone. The list isn’t always in the same priority order, but the items on it are pretty much the same.

For most of us, that list includes:

Cost: What will I have to pay for each hour of care?
Flexibility in the job description.
Loyalty of the employee to me.
Consistency, meaning the same person comes to the home day after day.
Security: Can the person be trusted to do the right thing?
Expertise: Does the person really know how to provide the care he or she is being hired to give to my elderly parent, or my husband or wife?
It is possible that, through your personal network or through an ad you place in your local newspaper, you might find a person to work for you who is the solution to your needs. Many people — even people who work in the health care industry — go that route. Notice I say that you might find a person to work for you, but you aren’t going to find a certified home health aide. You probably aren’t going to find a person who has actually received formal training to do the job you need him or her to do.

And that right there is the difference between hiring a stranger recommended to you by a neighbor and hiring a home health aide who is part of an organization whose business is to properly train home health aides and send them to you when and where you need them, every day. Even more so, we are talking about an organization that is in the business of providing care to you for the long term, as your needs increase and the medical situation gets worse, which is often the case.

It’s sort of like getting an electrical problem fixed in your home. You can hire an unlicensed electrician to do the rewiring. The lights may work, but if you have all the lights on, plus the toaster, and the hair dryer, are you at risk for a blackout? Or worse, an electrical fire? Maybe. Maybe not. But would you take that chance on yourself and your family?

Let’s talk about the list and the things you should consider.

If the only thing you are concerned about is how much you are going to pay per hour, you certainly might be able to negotiate a better deal by hiring someone who used to be a nanny to now provide care to your 85-year-old mother. Hourly rates for this kind of babysitter vary across the country — in New York City, the going rate is about $12 per hour. Hiring a certified home health aide from Partners in Care is going to cost $18.50 an hour in New York City. So is an additional $6.50 an hour worth it to you?

Well, to answer that question, you have to answer some other questions that address the rest of the items on that list:

Will the home health aide be caring for someone with a diagnosed medical condition?
If my mom hates the person I hire, can I quickly find a replacement — or even a replacement for the replacement?
If this person calls in sick or plans a vacation, am I able to work from home to provide care?
Can I trust this person to do the food shopping for my dad and only buy what he needs and not extras?
Am I worried that my mom might fall and break her hip — again — and then need to be hospitalized, or do I have an aide who is trained to prevent falls?
What is the chance that my situation becomes one of those awful newspaper stories of “elder abuse” or financial fraud?
If my dad’s condition worsens and more medical attention is needed, can I get a registered nurse to come to the home? To talk directly to his doctor? To arrange a plan of care?
And finally: Do I need help understanding the health care system in this country and who pays for what?
I am the president of a licensed home health care agency and have been in this business for more than 25 years. So, there is no doubt in my mind that the best answer to each of these questions comes when you hire professionals. Time and time again, we’ve seen people start with the babysitter approach and wind up with a catastrophe that costs more and causes harm to loved ones. But we know the informal workforce will always be there — even more now as jobs are harder to find and to keep.

The equation for you is about risk and return. A licensed home health care agency won’t beat the cost on an hourly basis, but if all you are considering is dollars and cents then the risk factor in your equation has just increased. However, considering all the other items on the list will increase your return.

Licensed agencies can find substitutes or replacements for you so you never have to miss a day of work or skip an evening out with friends.

Licensed agencies are in the business of satisfying you, the customer. They don’t want to lose you, so they will work very hard to accommodate your needs.

Licensed agencies offer you the same home health aide day-after-day, provided that is what you want. Licensed agencies work to make the match between you and the home health aide as perfect as possible — so the needs of the patient are understood, the right language is spoken, the right foods can be cooked and the right respect for customs and preferences is shown.

Licensed agencies assign a registered nurse to each patient, and that nurse supervises the aide, monitors the patient’s condition and medications, confers with the physician and is an information resource for you.

But perhaps most importantly, licensed home health care agencies provide you with highly trained expert aides who know how to do their job well before they enter your home. They don’t learn at your expense. Our aides, for example, have been thoroughly interviewed and screened, have had reference checks, and have spent more than 114 hours learning the skills to provide quality care to the people you love. One hundred and fourteen hours of training is a lot of training. And our home health aides have “refresher” training each year.

Q. What factors should we consider when choosing among the different home health care companies?

A. If you have decided to hire a licensed home health care agency to provide a certified home health aide to help you care for your elderly parent, your next logical question is which home health care agency should you hire? Likely, you will ask yourself questions such as: do they all offer the same services; do they all charge the same prices; does one have a better reputation than another?

Part of the answer lies in understanding that there are for-profit home health care agencies and not-for-profit agencies. The biggest difference between those two types of organizations is how they make business decisions. For-profit companies often select the kind of cases that will make them the most money and turn away other cases. Or, they don’t employ certified home health aides at all. Their people are not trained to do the same things for you as are certified aides. A not-for-profit agency doesn’t turn away cases. At Partners in Care, we take short-term cases and long-term complex cases, and we staff them properly to match your needs.

It is also important to learn about the full set of resources that a home health care agency can offer you because health care situations can change overnight. Partners in Care is part of the Visiting Nurse Service of New York, the country’s largest not-for-profit certified home health care organization.

So, if your elderly mom’s condition worsens and care is needed that will be covered by Medicare, we coordinate that care so your mom gets the medical attention she needs and Medicare covers the cost. Or, if your mom needed care that was initially covered by Medicare but now her condition has improved and Medicare will no longer pay, you can transition your mom to care you pay for privately while keeping the same home health aide.

Next week, Ms. Flannery tells us what home health aides earn and what they cost.

Elders' self-care puts family in tricky spot, experts say- (but I bet your service can help!)

Elders' self-care puts family in tricky spot, experts say
By Matthew Santoni
Pittsburgh Tribune Review
Wednesday, December 31, 2008 

Laura Stewart's heart was in the right place when she and her boyfriend attempted to move her 86-year-old sister from a trash-filled apartment in the Hill District to Stewart's duplex in a Cleveland suburb, her family said.

But police and legal experts said Stewart had plenty of law-abiding alternatives to binding Evelyn Poynter's wrists in duct tape, forcing her into a car wearing only her nightgown and a blanket, and driving her around for eight hours Sunday.

"I have some sympathy for these people if they were trying to do the right thing, but obviously, kidnapping was the wrong way to do it," said Larry Frolik, a professor at the University of Pittsburgh School of Law and chair of the Pennsylvania Bar Association Elder Law section.

Stewart, 72, and Earl Cross, 76, were charged with kidnapping, conspiracy, assault, false imprisonment and unlawful restraint, said Pittsburgh police Lt. Kevin Kraus. Darnell Randall, 48, of the Hill District was arrested in Pittsburgh on charges of helping Stewart and Cross bind Poynter and force her into a Cadillac Escalade.

A police affidavit filed to support the charges against Randall notes the "deplorable" condition of Poynter's apartment and says there were "extreme amounts of garbage and clutter throughout."

But if Poynter's family believed she was not taking care of herself, they could have contacted the Allegheny County Area Agency on Aging's protective services division, which deals with elderly victims of abuse, neglect and self-neglect, Frolik said. A doctor's evaluation can determine if someone is physically and mentally capable of taking care of him or herself, and if not, an Orphan's Court judge can appoint a guardian to make important decisions for the person.

"If the woman was competent, she has the right to live however she wants to. This is sometimes difficult for families to accept," said Martha Mannix, another Pitt professor who runs the university's Elder Law clinic.

A third option would be getting the person to sign over either full or partial power of attorney, Frolik said. Documents to do so can be downloaded from the Internet, or an attorney could be hired to do it in a few hours, he said.

Leslie Stewart, 39, Laura's daughter and Poynter's niece, said she did not know if her family considered having Poynter evaluated or checked by the Agency on Aging, but it was clear that Poynter was finding it physically difficult to take care of herself.

"She couldn't do it physically, and I don't think anybody knew where her mind was," Leslie Stewart said. "My aunt doesn't let anybody into her apartment, so hiring someone to help her was out of the question."

Randall, a handyman renovating the Clarissa Street apartment building that Laura Stewart owns and Poynter calls home, was scheduled for a preliminary hearing Jan. 8 and was still in the Allegheny County Jail on $10,000 bail. Stewart and Cross were held without bail in Shaker Heights, Ohio, and were awaiting transportation back to Pittsburgh by Allegheny County Sheriff's deputies.

Matthew Santoni can be reached at msantoni@tribweb.com or 412-380-5625.

Articles like these are great opportunities to market your elder care services....

Cookbook Medicine Won't Do For Elderly

Personal Health

By Jane Brody 
The Martha Stewart Center for Living at Mount Sinai Medical Center in New York is like no medical clinic I’ve ever seen. It is brightly lighted and quiet — there is no television blasting. It has wide corridors and plenty of comfortable chairs with sturdy arms, and yet few people wait more than 10 minutes to see a doctor or nurse practitioner.

The center, which opened in 2007, was designed especially for primary care of older adults, many of whom have complex chronic medical problems like diabetes, heart disease and hypertension as well as debilitating conditions like arthritis and osteoporosis.

 

Just as a child is not a small adult and requires specialized care, adults over the age of, say, 65, are not just old adults and should not be treated like patients half their age.

The population of aging Americans is expected to mushroom in the years ahead. Geriatricians, the experts in elder care, are already in short supply, and their numbers will continue to shrink. But knowing the kind of care that these specialists provide may help older people and those who look after them learn to seek it out wherever they go.

“Cookbook medicine may be appropriate for younger people but is not always appropriate for older people,” Dr. Mark Lachs, a geriatrician at Weill-Cornell Medical Center in New York, said in an interview. He sees two dangers in how older adults are treated: overtreatment and undertreatment.

“If a high-functioning 80- or 90-year-old develops angina, aggressive treatment would be appropriate,” Dr. Lachs said. “Care should not be withheld solely on the basis of age.”

On the other hand, overtesting and overtreating older patients can result in debilitating side effects. Before deciding on tests and treatment, he said, “the doctor must take into account the whole picture of the patient, the patient’s family and life situation.”

Screening for Lifestyle

Dr. R. Sean Morrison is one of the geriatricians at Mount Sinai. “The overall goal is to help older adults achieve the best quality of life possible, given the limits of medical technology and knowledge,” he said.

When I asked how he would approach a new patient of 85, Dr. Morrison said he would start with a series of questions: “Tell me about yourself. What do you like to do? What are the things you would like to do that you cannot do anymore? What is your medical history? What medications do you currently take? What brings you here today?”

The geriatric exam itself would depend on the patient’s answers. “If the patient is a healthy 75-year-old who plays golf and tennis and has no functional limitations,” Dr. Morrison said, “the focus would be on preventive screening and advance care planning.

“But if the patient has functional limitations, the focus would be to restore and improve what can be restored and improved, such as reducing the risk of falls, addressing any acute medical conditions, and streamlining medications for chronic health problems so that the right drugs are taken for the right conditions.”

“You want a doctor who asks more than just about your medical conditions,” he added. The doctor should ask about the effect of medical conditions on quality of life, and then should explore what improvements are possible. “The focus of care should be on quality of life,” he said. “Too often, doctors lose sight of this goal when the focus is on treating specific diseases.”

The doctor should address a patient’s most serious health threats, of course, but also the patient’s most serious concerns. Is the patient troubled by problems like fatigue, pain or shortness of breath, or having problems with medications?

For example, he said, if a patient has serious arthritis and hypertension and cannot go to places without a readily accessible bathroom on the first floor because she takes a diuretic for high blood pressure, perhaps the blood pressure medication should be changed. The patient may prefer a different drug that carries a slightly greater risk of stroke if it means a better quality of life.

The Exam

“When going to a new doctor, an older patient should receive a comprehensive assessment, not just a physical exam,” Dr. Chad Boult, a geriatrician at the Johns Hopkins School of Public Health, said in an interview. “The patient should be asked, What is important to you about your health now? What is your life like — your exercise habits, diet, use of alcohol and tobacco? Is your environment safe and convenient?”

There are three areas that should be explored during a geriatric exam that are often missed if the doctor focuses on a specific illness, Dr. Morrison said:

¶Dementia. He asks the patient: “Are you having trouble with your memory? Is it O.K. if I check with a family member about this?” He said there were often treatable causes for memory problems, like thyroid disease, medication side effects or depression.

¶Risk of falls. Checking balance, gait and strength is easy, he said. “I would meet you in the waiting room, watch how you stand up from a chair and walk to the exam room. I’d throw a pen on the floor and ask you to pick it up. I’d ask you to sit in a chair and stand up three times as quickly as you can. Can you get up and down without using the arms of the chair? If the patient uses a cane, how is it used and is it the right height?”

¶Incontinence. “There’s a tremendous social stigma associated with incontinence even when there are medical reasons for it,” Dr. Morrison said. It is as common as hypertension and diabetes among the elderly, but patients rarely discuss it with their doctors unless asked about it, he said.

Dr. Boult said that patients’ feet were often overlooked, leading to problems that can become life-limiting. Many older people cannot reach their feet to clean them and cut their toenails, and they develop painful sores.

Other Considerations

Dr. Morrison said that before recommending screening tests like mammograms for breast cancer and PSA tests for prostate cancer, the question to ask is, “What are we going to do with the test results? If we’re not going to act on them, screening should be stopped.” If a patient has chronic conditions that limit life expectancy, he said, there is no point in screening for most cancers.

On the other hand, he said, two medical procedures can greatly improve the quality of life for older adults: joint replacement and cataract surgery. Too often, patients think such surgeries aren’t worth the bother because they won’t be around much longer. He described a woman who at 82 was having trouble walking but chose not to have a knee replacement. Now 102, the patient told him, “I should have listened to you years ago.”

Like this woman at 82, many older people are quite healthy, Dr. Boult said.

But about one-quarter of the older population has multiple chronic conditions and spends 80 percent of Medicare dollars, he added. “These patients need coordinated care, a system of regular monitoring, and regular access to a primary care doctor who can detect problems early before they require expensive, dramatic treatments.”
http://www.nytimes.com/2008/12/30/health/30brod.html?_r=1&ref=science&pagewanted

New York Times: Home Health Aides: Why Hire From an Agency?

Here is an interesting article from the New York Times. What’s even more interesting is reading it from the actual site itself and looking at the posts that people wrote after the article went live. I would encourage all senior service providers to read those posts, and get to know your target market.  Understand what they are saying about home care services, understand their fear, and then craft a marketing message that eliminates that fear. Don’t contribute to some of the problems and perceptions that people have about elder care services. Valerie

Here’s the actual link:

http://newoldage.blogs.nytimes.com/2008/12/23/home-health-aides-why-hire-from-an-agency/?hp

 

December 23, 2008, 10:45 am
 
Home Health Aides: Why Hire From an Agency?
By Jane Gross
This is the first of a three-part series on home health aides, to be run on consecutive Tuesdays at The New Old Age.

Living out their lives at home, rather than in an assisted living center or a nursing home, is the overwhelming preference of the elderly and their adult children. Remaining at home often means hiring, paying for and supervising aides to help with shopping, cooking, bathing, dressing, eating, toileting and medication management.

This can cost upwards of $150,000 a year for someone who needs 24/7 assistance that is custodial, rather than medical, and thus not covered by Medicare, the universal health care system. Medicare pays for doctors, hospitalizations, surgery, diagnostic tests and medication for those 65-and-over — but not for what is commonly known as long-term care.

Only the impoverished elderly, in some states, are protected from this huge expense by Medicaid, a means-tested program that increasingly is looking for ways to pay for care at home. Medicaid has traditionally paid for care only in skilled nursing facilities, but patients’ preferences and the greater cost of institutional care are driving the trend toward home care coverage.

Marki Flannery of Partners in Care, part of the Visiting Nurse Service of New York. (Janet Charles)
The Visiting Nurse Service of New York is the nation’s largest not-for-profit provider of home health care. Some of the costs are covered by Medicare and Medicaid, and some by patients and families themselves, either directly out-of-pocket or with long-term care insurance policies, which themselves can be very expensive. These private-pay patients and families are clients of Partners in Care, an affiliate of the Visiting Nurse Service of New York that is run by Marki Flannery.

I asked Ms. Flannery to explain to our readers the value of hiring home health aides through a licensed agency, like Partners in Care, rather than in the so-called “gray market,’’ an over-the-back-fence approach that is far less expensive because there is no middleman, so to speak, but that lacks the protections and supervision provided by an agency.

Ms. Flannery also shares with us her advice on choosing an agency, determining the most economical set-up under the agency framework, what agency aides are paid and what you will pay for them. She will also address why agency adies are restricted in ways that gray market aides aren’t, how to insure a good working relationship and what the future holds for her industry as more and more people live longer and longer.

Today, she will talk about the reasons for using an agency and how to choose one. Her answers to other questions will follow, in posts on Tuesdays over the next two weeks.

Q. Why should someone hire a home health aide from an agency instead of hiring a person recommended by a friend?

A. There is a list of things people consider when they are faced with the need to hire a home health aide to help take care of someone. The list isn’t always in the same priority order, but the items on it are pretty much the same.

For most of us, that list includes:

Cost: What will I have to pay for each hour of care?
Flexibility in the job description.
Loyalty of the employee to me.
Consistency, meaning the same person comes to the home day after day.
Security: Can the person be trusted to do the right thing?
Expertise: Does the person really know how to provide the care he or she is being hired to give to my elderly parent, or my husband or wife?
It is possible that, through your personal network or through an ad you place in your local newspaper, you might find a person to work for you who is the solution to your needs. Many people — even people who work in the health care industry — go that route. Notice I say that you might find a person to work for you, but you aren’t going to find a certified home health aide. You probably aren’t going to find a person who has actually received formal training to do the job you need him or her to do.

And that right there is the difference between hiring a stranger recommended to you by a neighbor and hiring a home health aide who is part of an organization whose business is to properly train home health aides and send them to you when and where you need them, every day. Even more so, we are talking about an organization that is in the business of providing care to you for the long term, as your needs increase and the medical situation gets worse, which is often the case.

It’s sort of like getting an electrical problem fixed in your home. You can hire an unlicensed electrician to do the rewiring. The lights may work, but if you have all the lights on, plus the toaster, and the hair dryer, are you at risk for a blackout? Or worse, an electrical fire? Maybe. Maybe not. But would you take that chance on yourself and your family?

Let’s talk about the list and the things you should consider.

If the only thing you are concerned about is how much you are going to pay per hour, you certainly might be able to negotiate a better deal by hiring someone who used to be a nanny to now provide care to your 85-year-old mother. Hourly rates for this kind of babysitter vary across the country — in New York City, the going rate is about $12 per hour. Hiring a certified home health aide from Partners in Care is going to cost $18.50 an hour in New York City. So is an additional $6.50 an hour worth it to you?

Well, to answer that question, you have to answer some other questions that address the rest of the items on that list:

Will the home health aide be caring for someone with a diagnosed medical condition?
If my mom hates the person I hire, can I quickly find a replacement — or even a replacement for the replacement?
If this person calls in sick or plans a vacation, am I able to work from home to provide care?
Can I trust this person to do the food shopping for my dad and only buy what he needs and not extras?
Am I worried that my mom might fall and break her hip — again — and then need to be hospitalized, or do I have an aide who is trained to prevent falls?
What is the chance that my situation becomes one of those awful newspaper stories of “elder abuse” or financial fraud?
If my dad’s condition worsens and more medical attention is needed, can I get a registered nurse to come to the home? To talk directly to his doctor? To arrange a plan of care?
And finally: Do I need help understanding the health care system in this country and who pays for what?
I am the president of a licensed home health care agency and have been in this business for more than 25 years. So, there is no doubt in my mind that the best answer to each of these questions comes when you hire professionals. Time and time again, we’ve seen people start with the babysitter approach and wind up with a catastrophe that costs more and causes harm to loved ones. But we know the informal workforce will always be there — even more now as jobs are harder to find and to keep.

The equation for you is about risk and return. A licensed home health care agency won’t beat the cost on an hourly basis, but if all you are considering is dollars and cents then the risk factor in your equation has just increased. However, considering all the other items on the list will increase your return.

Licensed agencies can find substitutes or replacements for you so you never have to miss a day of work or skip an evening out with friends.

Licensed agencies are in the business of satisfying you, the customer. They don’t want to lose you, so they will work very hard to accommodate your needs.

Licensed agencies offer you the same home health aide day-after-day, provided that is what you want. Licensed agencies work to make the match between you and the home health aide as perfect as possible — so the needs of the patient are understood, the right language is spoken, the right foods can be cooked and the right respect for customs and preferences is shown.

Licensed agencies assign a registered nurse to each patient, and that nurse supervises the aide, monitors the patient’s condition and medications, confers with the physician and is an information resource for you.

But perhaps most importantly, licensed home health care agencies provide you with highly trained expert aides who know how to do their job well before they enter your home. They don’t learn at your expense. Our aides, for example, have been thoroughly interviewed and screened, have had reference checks, and have spent more than 114 hours learning the skills to provide quality care to the people you love. One hundred and fourteen hours of training is a lot of training. And our home health aides have “refresher” training each year.

Q. What factors should we consider when choosing among the different home health care companies?

A. If you have decided to hire a licensed home health care agency to provide a certified home health aide to help you care for your elderly parent, your next logical question is which home health care agency should you hire? Likely, you will ask yourself questions such as: do they all offer the same services; do they all charge the same prices; does one have a better reputation than another?

Part of the answer lies in understanding that there are for-profit home health care agencies and not-for-profit agencies. The biggest difference between those two types of organizations is how they make business decisions. For-profit companies often select the kind of cases that will make them the most money and turn away other cases. Or, they don’t employ certified home health aides at all. Their people are not trained to do the same things for you as are certified aides. A not-for-profit agency doesn’t turn away cases. At Partners in Care, we take short-term cases and long-term complex cases, and we staff them properly to match your needs.

It is also important to learn about the full set of resources that a home health care agency can offer you because health care situations can change overnight. Partners in Care is part of the Visiting Nurse Service of New York, the country’s largest not-for-profit certified home health care organization.

So, if your elderly mom’s condition worsens and care is needed that will be covered by Medicare, we coordinate that care so your mom gets the medical attention she needs and Medicare covers the cost. Or, if your mom needed care that was initially covered by Medicare but now her condition has improved and Medicare will no longer pay, you can transition your mom to care you pay for privately while keeping the same home health aide.

Next week, Ms. Flannery tells us what home health aides earn and what they cost.

Home Health Aides: What They Make, What They Cost

Home Health Aides: What They Make, What They Cost
By Jane

Part two of a three-part series on home health aides, to be published on Tuesdays in The New Old Age.

Last week Marki Flannery, the president of Partners in Care, an affiliate of the Visiting Nurse Service of New York, discussed the advantages of hiring a home health aide from an agency. This week she picks up where she left off, answering questions about the costs of home health aides, the intimate strangers who often make it possible for our parents to remain in their homes, even when they need help or supervision day and night.

Marki Flannery of Partners in Care. (Janet Charles)

Q. What does it cost to hire round-the-clock help, and what is the most economical way to do it?

A. When it comes to needing care 24/7, the first thing you have to do is define exactly what level of care you need. Does your mom need a home health aide to monitor her all day and all night, or do you need a home health aide for your mom only when she is awake?

We will help you figure out what you need by asking how well your mom sleeps at night; how many times she gets up; what her sleeping patterns are. We will also figure out with you if the home environment has a suitable place for the home health aide to sleep, and if the aide who is “living-in” will be able to get some hours of uninterrupted sleep and a couple of hours a day “off-duty.”

If you want a “live-in” home health aide who will be in the home 24 hours a day, but who will have time off to sleep and for personal time, then we suggest two aides to cover the seven days in a week — one who works for four days and another who works the remaining three days.

This shared approach keeps the cost to you as low as possible, because when one aide works more than 40 hours during a seven-day week, we are required by law to pay that aide additional money for each hour worked over 40.

So, here is how the math works:

We charge you for one aide working three days at 14 hours per day, for a total of 42 hours. Forty hours are charged at our hourly rate (currently $18.50 in New York City), and two hours are charged at the overtime rate (currently $23.05) and, we charge you for the other aide working four days at 14 hours per day for a total of 56 hours, with 40 hours being charged at our hourly rate and 16 hours charged at the overtime rate. Thus, a week of round-the-clock help costs $1,894.90.

Of course you could request that one aide work more than four days in a row, but then the costs increase. Or, you could increase the number of aides and have each aide work just 40 hours per week or less, but then you have more aides working for you.

There are times, however, when two aides simply can’t cover the full seven-day week. If your mom truly needs the aide to be awake every hour of the day, we assign two aides to each 24-hour period, one working from 8 a.m. to 8 p.m. and the second working the 8 p.m. to 8 a.m. shift. In this case, to cover the full week, we would assign four aides. Two of them would exceed the 40 hours per week limit, each having to work 48 hours during the week. So, you would have a total of 16 hours charged at the overtime rate. In this scenario, a week of care costs $3,328.80.

These options get you the care you need from a licensed home health care agency at the lowest possible cost and keep the number of home health aides as low as possible. Other options can be worked out but likely will result in increasing the number of aides working for you.

Q. How much money does your average aide make, and what benefits do you offer, compared to the industry at large?

A. We pay our home health aides by the hour, on a graduated scale. That means that the hourly pay rate increases the longer a home health aide works for us. Entry level aides earn $8 per hour, and aides who have worked with us for a few years or more earn up to $13 per hour. According to published information, the national average wage for home health aides is $9.11 per hour. Our average wage is higher.

You may be wondering why we charge you more than the hourly rate we pay our home health aides, and the answer lies in the support we provide to our employees. All of our aides are eligible for individual health benefits, including vision, dental and prescription drug coverage, at no cost to them. We also offer our aides pension benefits, paid vacations and sick time, and we provide uniforms as well.

In addition, all of our aides are offered continuing education and have career advancement opportunities. While we have many home health aides who never want to stop going to people’s homes and helping them live a better life, we also have aides who move up the career ladder to become nurses, supervisors and managers. And of course, there are the usual business expenses, including rent, insurance, recruitment, equipment, staff to oversee the care provided and administrative staff.

All of these things account for our success in keeping home health aides working with us for years. There is a lot of turnover in our industry, and we see it, too. But estimates put the national average at 40 percent to 60 percent, and, year-after-year, we see a turnover rate of less than half the national average. We celebrated our 25th anniversary in 2008 and are very proud of the fact that we have 12 home health aides who have been with us for every one of those years. We have 27 aides who have worked with us for 20 years, another 33 who have 15 years of service, 112 with 10 years and more than 2,100 who have been here at least five years.

Q. Home health aides from licensed agencies must follow certain rules that restricts what they can do. Why is this so?

A. The rules and regulations that govern what a certified home health aide can and can’t do exist primarily to protect the patient and family. People may choose to hire an unlicensed individual and not have to follow the New York State rules and regulations but then, as I have suggested before, the risk factor is likely to increase in any number of ways.

We recently took on the case of a patient whose family had first hired someone recommended to them by a neighbor. This person, not certified and not trained, used the wrong dressing on an open wound, causing considerable harm and pain to the patient. This mistake is far less likely to happen with a certified home health aide. If the patient had been with us from the beginning, the proper treatment would have been prescribed by the doctor and managed by the nurse in cooperation with the patient’s physician, and the aide would have received proper instruction about what needed to be done.

In another case, an adult daughter called us after her mom, who suffered from both Alzheimer’s and congestive heart failure, was admitted to the hospital as a result of an adverse reaction to medications. The daughter had initially hired a person to be with her mom at home and give her the medications she needed. As the mother’s medical condition deteriorated, her medication routine became more complex. Unfortunately, the multiple medications didn’t work well together, and her mom had to be hospitalized. The person hired by the woman’s daughter could not explain to the doctors exactly what meds she had given to the patient and when they were administered. While certified home health aides in New York State can give medications to most patients, they cannot administer medications to patients who are not aware of what they are taking and why, but nurses can. So in this case, we would have provided both an aide and a nurse, ensuring the medications would be properly administered.

We sometimes hear from people that hired a trustworthy person on their own, because he or she can do the food shopping for an elderly parent while a certified home health aide from a licensed agency can’t. Not true. At Partners in Care, we handle grocery shopping for patients all the time, but we do so using a system of checks and balances to ensure that our client’s money is spent on what they want. If the patient wants us to use cash, we put a limit on how much. We also require our aide to keep the receipts and, of course, return the change. We won’t allow our aides to use a patient’s debit or credit card or PIN number. Most often, we use the online credit card purchasing systems available in a market, such as Fresh Direct, and use home delivery.

Another concern we hear goes like this: “I want someone who will pick up my mom after she falls, not leave her on the floor until emergency medical services arrives. And a certified home health aide won’t do that.” Well, this concern is true. A certified home health aide is taught that there is greater risk in lifting or moving an elderly person who has fallen than there is in waiting for the appropriate medical team to arrive. At the same time, a professionally trained aide can usually differentiate a minor fall from a more serious fall that requires professional medical assistance. So, it may not sound like something you want — leaving your fallen mom in her prone position until E.M.S. arrives - but if the certified home health aide has made that determination, there is likely a very serious reason for doing so.

More next week on hiring and managing home health aides, who will be needed in huge numbers as America rapidly ages.

Elders ' self-care puts family in tricky spot, experts say- (but I bet your service can help!)

Elders' self-care puts family in tricky spot, experts say
By Matthew Santoni
Pittsburgh Tribune Review
Wednesday, December 31, 2008 

Laura Stewart's heart was in the right place when she and her boyfriend attempted to move her 86-year-old sister from a trash-filled apartment in the Hill District to Stewart's duplex in a Cleveland suburb, her family said.

But police and legal experts said Stewart had plenty of law-abiding alternatives to binding Evelyn Poynter's wrists in duct tape, forcing her into a car wearing only her nightgown and a blanket, and driving her around for eight hours Sunday.

"I have some sympathy for these people if they were trying to do the right thing, but obviously, kidnapping was the wrong way to do it," said Larry Frolik, a professor at the University of Pittsburgh School of Law and chair of the Pennsylvania Bar Association Elder Law section.

Stewart, 72, and Earl Cross, 76, were charged with kidnapping, conspiracy, assault, false imprisonment and unlawful restraint, said Pittsburgh police Lt. Kevin Kraus. Darnell Randall, 48, of the Hill District was arrested in Pittsburgh on charges of helping Stewart and Cross bind Poynter and force her into a Cadillac Escalade.

A police affidavit filed to support the charges against Randall notes the "deplorable" condition of Poynter's apartment and says there were "extreme amounts of garbage and clutter throughout."

But if Poynter's family believed she was not taking care of herself, they could have contacted the Allegheny County Area Agency on Aging's protective services division, which deals with elderly victims of abuse, neglect and self-neglect, Frolik said. A doctor's evaluation can determine if someone is physically and mentally capable of taking care of him or herself, and if not, an Orphan's Court judge can appoint a guardian to make important decisions for the person.

"If the woman was competent, she has the right to live however she wants to. This is sometimes difficult for families to accept," said Martha Mannix, another Pitt professor who runs the university's Elder Law clinic.

A third option would be getting the person to sign over either full or partial power of attorney, Frolik said. Documents to do so can be downloaded from the Internet, or an attorney could be hired to do it in a few hours, he said.

Leslie Stewart, 39, Laura's daughter and Poynter's niece, said she did not know if her family considered having Poynter evaluated or checked by the Agency on Aging, but it was clear that Poynter was finding it physically difficult to take care of herself.

"She couldn't do it physically, and I don't think anybody knew where her mind was," Leslie Stewart said. "My aunt doesn't let anybody into her apartment, so hiring someone to help her was out of the question."

Randall, a handyman renovating the Clarissa Street apartment building that Laura Stewart owns and Poynter calls home, was scheduled for a preliminary hearing Jan. 8 and was still in the Allegheny County Jail on $10,000 bail. Stewart and Cross were held without bail in Shaker Heights, Ohio, and were awaiting transportation back to Pittsburgh by Allegheny County Sheriff's deputies.

Matthew Santoni can be reached at msantoni@tribweb.com or 412-380-5625.