Safe at Home
A look at the state of the local home health care industry.
Few people are fortunate enough to age without some degree of physical or mental impairment. In response, the home health care industry has expanded to include medical professionals such as registered nurses as well as companions who make sure older people aren’t home alone every day. Most importantly, the right home care can help the elderly avoid hospitalization by managing chronic conditions and supervising post-operative healing.
The term “home health” can encompass a wide variety of services, says Warren Hebert, CEO of the HomeCare Association of Louisiana. It’s difficult to say whether Louisiana has enough providers to meet its population’s needs, he says; some parts of the state are well supplied while others are lacking.
“The whole business is growing because of demographics,” he says. The challenge will be to have enough providers in many categories, including therapists, social workers and nurses’ aides.”
Social workers Betty B. Tedesco and Dianne C. McGraw saw this need in 1991 and founded a business to provide case management to help families manage elder care. In 2001, they added home care to their services and changed their company’s name to Home Care Solutions.
“All clients receive an in-home visit from a care manager,” McGraw says. Then a plan of care is drawn up, and the company supplies caregivers who can provide for just about any need a client has, including transportation, cooking and help with grooming needs. Out-of-town clients use the company’s care management division to schedule doctor’s visits and accompany older relatives to medical appointments.
Care managers oversee the caregiving, and make periodic visits to see how clients are doing and whether their needs have changed. The goal is to keep elders as independent as possible by helping them remain active.
“We really don’t use the word ‘sitter,’ ” Tedesco says. Caregivers can help people entertain, garden or do volunteer work. Long Term Care Insurance can help to pay for services provided by Home Care Solutions, but the bulk of their business is private pay.
Employees are specially trained to work with adults who have Alzheimer’s disease or dementia, McGraw says. The company employs between 100 and 130 people.
Sometimes families have a tough time agreeing on how much help an elderly member needs, Tedesco points out. It isn’t until an older person ends up in the hospital that a spouse or children realizes it’s time to bring in help to “stop the slide down,” she says.
Home Care Solutions does not provide medical treatment; a patient who needs wound care, for example, may need the services of a visiting nurse. But the caregivers can remind people to take their medications and make sure meals are nourishing, appetizing and served on time.
Loren Berot, owner of Right At Home Metro New Orleans, got into the home care business for a very personal reason: She had an elderly father who couldn’t be left alone overnight. When her mother wanted to take a short trip, Berot realized the family needed a trusted caregiver to call on. She bought the franchise for the Orleans and Jefferson Parish territories in March of 2014.
Berot says the best part of her job to date has been making home visits. “I really enjoy going out to see how clients are doing,” she says. “I love to hear (their) stories. That to me is part of the fun.”
Right at Home doesn’t have an hourly minimum, and some clients simply need a one-hour visit every morning to help them get up, dress and eat breakfast. Others need round-the-clock assistance. Many are people who need some help while they recover from surgery. Medicare can cover a given number of hours of occupational or physical therapy, Berot says, but it doesn’t pay for companionship, housekeeping or other nonmedical services.
Because clients tend to form bonds with their caregivers, Berot tries to send the same people out to a given client as often as possible. Like other agency owners, Berot says finding enough good employees is an ongoing challenge. “There is quite a bit of turnover in these jobs,” she says. All of her employees undergo background checks, driving tests and drug testing. She pays the necessary taxes and worker’s compensation insurance, so clients don’t have to worry about the legal requirements.
It isn’t unusual for older people to deny they need help. Once they realize how much more they can do with just a little assistance, though, they change their minds, Berot says. They enjoy the companionship, and they look forward to having caregivers come. Having a third party such as Right at Home discuss the situation with them can make home health care easier to accept. Sometimes, “someone who is not a family member does better with your loved one,” she says.
Passing it down
In New Orleans in 1925, nurses seeking private duty work registered with the New Orleans District Nurses Registry. As time went on, hospitals developed their own nursing pools, so a nurse bought and privatized that business in 1980, which was then bought by Rose Mary Breaux and her husband, Raymond in 1988. In 1993, they added Nurses Registry Home Health to their portfolio. Their daughter, Jeanne Caldwell, came aboard in 1994 to “help out for a few years to help get the home health side off the ground.”
Rose Mary Breaux died in 2006. Raymond Breaux, Jeanne Caldwell and her daughter, Molly Caldwell, now run the businesses.
Jeanne Caldwell says her mother considered nursing a vocation and was very proud of her R.N. and B.S. N. degrees. “My mom treated the whole patient: body, mind and spirit,” she says. Nurses Registry is a private-pay business that can supply nurses, aides and custodial caregivers, while the home health division is a Medicare-certified agency that supplies home health services.
The need for in-home medical care of all types is growing, Jeanne Caldwell says, thanks to the development of technology that allows people to undergo such treatments as IV therapy and infusion at home. Sometimes people can recuperate from surgery better at home, amid their familiar surroundings, if they can have daily visits by a nurse or nurse’s aide.
Attitudes towards aging have changed, and people are as interested in quality of life as they are length, Caldwell says. She considers it part of her job to work with each client’s family to make caregiving easier for family members, and to promote healthy lifestyles for her clients. She points to her own father, who at 87 still plays tennis and remains active in the business.
Who pays for what?
Often family members are confused about what home health care is Medicare-covered and what must be paid by the patient or family. The majority of care offered by Guardian Home Health Care of Louisiana is covered by Medicare and/or Medicaid, says Beverly Odom, who has owned the business since 1997. To qualify for covered care, a patient has to have a face-to-face visit with a physician who orders the medical care needed. “Our nurses have to be relevant” to the patient’s medical problem, she says, to perform such services as wound care, disease management and short-term care after a hospitalization.
Typically, these patients are 65 or older, Odom says, but occasionally a younger person qualifies because of a disability.
Odom prides herself on the longevity of her staff. For example, her director of nursing has been with the company since 1997. She has employed as many as 99 people and as few as 48. “The burden of training is on us,” she says. “It has its challenges.”
In the years after Hurricane Katrina, Odom saw a lack of places where the terminally ill could receive palliative care, so she opened My Hospice (the name Guardian Hospice was already taken.) To qualify, a patient must have a doctor’s diagnosis of six months or less to live. The hospice strives to make its patients as comfortable as possible.
“There is a need for in-patient hospice, too,” she adds, because some families choose to keep their dying family member at home. Her company offers support and training for them as well.
“Dying is not painful,” Odom says. “Disease is.”
Ready for help?
The Mayo Clinic’s website includes checklists to help you decide whether aging or ill family members need home health care.
The following are a few points to consider:
• Do they wear the same clothes every day or dress inappropriately (summer clothing in cold weather, etc.)?
• Are the bottoms of their pots and skillets scorched? (This may indicate an inability to remember leaving food on the stove.)
• Have they experienced rapid weight loss, due to an inability to shop or cook?
• Have they gained weight suddenly? (They may be retaining fluid.)
• Are they happy? Or do they seem lonely, confused or frightened?
• Does their home seem safe? Can they handle the steps, for example, or read the fine print on medicine bottles and cleaning supplies?