Tuesday, April 7, 2009

Who Profits Now in the Attendant Home Health Care Industry?

An overlooked area of health care is that supporting the aging population facing normal gerontological deteriorative processes. This is not so much preventative medicine, but supportive care. My wife and I have now directly participated witnessing the deteriorative aging process in 4 immediate relatives, both mothers, and two uncles all in their late 80s and early 90s. We experienced extended hospitalizations with the accompanying disorientation, the vegetative state fostered by most 'convalescent/nursing homes', the extreme cost of in-home 24 hour attendant care, and the hurdles of dealing with administrative paperwork, legalities/liabilities of health care workers transporting selves to acquire groceries and medications, etc. I was shocked to learn of the excessive margins (owners' profits) in the operation of home health care, and home attendant care businesses, where the ratio of owner operating costs to care worker salary 3:1, the care worker earning less than 30% of the charges, and in some cases, many making even less than this. The need for these services to the aged is great now and growing rapidly with a huge amount of exploitation of both the client/patients and the health care workers.

Care is being provided by individual workers with good intent, but with (poor/if no training) in the areas of meal preparation, first aide, basic medical symptom recognition and appropriate action, and psychosocial interactive techniques. Most of the workers are first generation Filipino, or other Pacific Islanders here in California. The wages they receive are substandard and sometimes exploitive, with often no job security.

Some form of subsidized training, needs to be a part of the healthcare mix, as these individuals are living at the subsistence level already. As many of these individuals may work 24/7, some accommodation needs to be provided for training that allows the care worker to attend training without losing their current job assignments. Better yet, a subsidized training program prior to working seems more reasonable with a living wage/stipend provided during the training period, followed with a license/certification. This could be a state or Federal program. In addition, as many of these individual care workers COULD be self contractors, the state could ease the process of running a soul proprietor contracting business by providing the counseling resources to locate liability insurance and complete the necessary forms and procedures to establish the ‘business’, as well as have a central site to advertise services as well as assess those services, much like AngiesList.

Individual care worker contractors would reduce the overhead to nearly “0”, while improving the salary compensation of the worker and reducing the cost to the patient/client. The overhead would be minimized by the municipality, state, or federal agency overseeing this contracting/licensing/certification/training/advertising. Accountability of care workers could fall on 2 sources, family members, or in the event of no available family, a municipal/state/federal caseworker, much like those used for foster care. Family members would also require training on what to observe/assess and how to assist through training once again provided through municipal/state/federal resources. How about if all of this became a part of the K-12 public education curriculum, right from the start? What a novel idea, teaching real life skills in school!

For the instances that large scale business provide for these services, some form of oversight and monitoring of the businesses that provide these workers is needed, as they should surely be NOT FOR PROFIT businesses. If profits are hidden in owner salaries and administration, as I suspect is currently the case, then there needs to be some way of creating a transparency here so that excesses are not being taken.

The need is huge and a profit based industry will not support the need of individual elderly who need these services, and who are mostly on minimal incomes themselves.

What IS Working and What Is NEEDED?

With 90% of the workforce still employed, take a look at the parts of the economy that ARE working. We have electricity flowing to our homes, waste and sewage are removed, water is available, the grocery stores have shelves filled with food, gasoline is there when we need it, the communication grid still allows me to use the internet/phone/tv cable, UPS trucks still are dropping off packages, pharmaceuticals are there if we have the money for their purchase, the courts/lawyers seem to be available and functioning, cash still comes out of our ATMs for those that have cash or credit, doctors/dentists/optometrists and hospitals still seem to be in business, schools are open but are getting more overcrowded though getting by with fewer supplies and support, planes still streak across the sky, and the freeways and roadways are still bumper to bumper at commute time. What does this tell us about what is necessary in the economy? To what extent are these components in danger? How can we insure the continued availability of these structures to support our society. If not the focus of those who are setting policy, what is THEIR FOCUS? As people become unemployed, to what jobs in the economy are they to be re-directed? How do we open up the job market to the employable? How do we provide living wages for those who will work? How do provide for the potential improvement of jobs for the ‘under-employed’? Are we each individually going to have to move-over a bit to make room and maybe SHARE part of our employment job market?