For Your Protection

Should In-Home (Non-Medical) Health Care
Be Licensed?
 “Baby Boomers” are now turning 65 and are beginning to see and understand the magnitude of the need for organized caregiving at the far end of their life. This age range in population is growing three times faster than family members available to care for them, primarily spouses and adult children aged 45 to 64. 

Family caregivers, as they age, are at increasing risk of needing support themselves.   Stress, depression, isolation, and burnout from 24/7 caregiving leave adverse health impacts on our overburdened family caregivers.  Some family member in our mobile society are geographically too far away to be helpful to their parents and experience stress trying to convince their parents to move closer to them or get paid home care help.  Additionally family caregivers in today’s fragile economy cannot afford to leave the workforce and must instead struggle to manage the competing demands of eldercare and work responsibilities.   Thus, they are less likely to continue to provide their unpaid care to their loved ones.

According to a recent Caregiving cost study by MetLife, an estimated 16 million workers are trying to balance full-time employment with caregiving for a family member.  As workers need to take off and lose productivity in the workforce because of their responsibilities to their aging loved ones, they cost their employers upwards of $34 billion annually.

Non-Medical Home health care and personal assistance workers are core to the caregiving infrastructure that we are challenged to develop. It is less expensive than nursing home or assisted living facilities and advocates of home care say it’s much more compassionate. It is certainly necessary to ease the family caregiver’s experience.

Today’s Non-Medical Homecare IndustryThere are about 45,000 non-medical homecare agencies in the United States.   More and more members of AAHSA (the American Association of Homes and Services for the Aging) are implementing non-medical homecare services as a first step into incorporating home and community-based services into their operations.  Continuing Care Retirement Communities, independent living and congregate housing providers can use homecare as a means to help residents age in place, as well as increase outreach into their communities.

 Who Are the Non-Medical Homecare Workers? They are individuals who provide basic hands-on caregiving services to millions of elders and persons with disabilities, home care and personal assistance.  They struggle with basic conditions of employment.  Although the intrinsic rewards are high, these in-home workers typically receive low wages and few benefits.  They work under demanding physical and emotional conditions.  Their rates of injury are high, and in general, their formal training requirements are quite limited.

Over half of this workforce works part-time, some by choice but a significant amount of caregivers would prefer to work more hours.  Unfortunately for those workers, their jobs are structured as part-time employment, often with erratic or unpredictable hours.

As a result of their low wages, part-time hours, and lack of benefits, according to “Bloomberg Businessweek” Magazine, approximately 50 percent of home care and personal assistance aides live in households that rely on one or more public benefits such as food stamps or Medicaid.  That is, over 1 million American workers, providing crucial services to families across the nation are consigned to near-poverty because of the structure of their employment.

This causes a high turnover rate that in turn undermines the workforce stability and continuity of care.  The agencies that hire these homecare workers often experience gaps in staffing and/or worker shortages.  They compensate by employing some aides to work overtime.  Those aides then suffer from stress and burnout, compromising the quality of care they deliver.

The Value of Home Care Providers  

Home care workers are an asset and are imbedded in the lives of their clients and the families of their clients.  They are an asset to our society because:

·        They work every day in millions and millions of  homes around the country.
·        Eight of every ten hours of paid services for the elderly are delivered by a direct-care worker, not by a doctor or a nurse.

·        Care providers are very well suited for observing and reporting changes in their clients’ conditions and for catching problems early.   They interface with family caregivers and support positive health-related behaviors.

The Largest Problem Seniors Face with In-Home Care
A report by the Senate Special Committee on Aging notes that “addressing elder abuse in home-based care settings is becoming a growing concern.”  Much of the concern centers on how thoroughly technical colleges and companies train and screen workers before sending them into people’s houses.   Seniors deserve the right to feel safe and well satisfied with their in-home care.

What Are Some Solutions?
Medical and Non-medical Home Care companies still aren’t regulated in all states.  A little more than a dozen require licenses for companies that provide non-medical services.  South Carolina legislation passed a bill to license in-home, non-medical health care in May of 2011.  They then turned over the task of regulating such licensing to DHEC.  The writers at DEHEC wrote regulations and submitted them to their directors.  The directors failed to accept the regulations in February 2013 because they were too strict.  The task was given back to the DEHEC writers.  Sources at DEHEC have stated that it would take a minimum of two years to revise the license regulations because it is not a DEHEC priority.  Thus the licensing procedure is not in place as yet.  Today the industry faces a hodgepodge of inconsistent rules that advocates say puts vulnerable people at risk of financial exploitation or physical abuse.  We need to light a fire under DEHEC to revise in-home, non-medical health care immediately so seniors can feel safe with the workers who come into their home to give care when they are unable to care for themselves. 

Second, our country’s approach to direct-care worker training needs to be modernized.  We need consistent standards for all in-home workers.  The hours of their training needs to increase…it needs to be enhanced using competency-based curricula that support the delivery of person-centered care. 

Third, we need federal and state regulations to raise the minimum wage for direct-care workers.  Long Term Health Insurance needs to be enhanced so that more seniors can afford the care they need and the type they desire.

Finally, there is a need to design and promote new models of care.  For instance workers can gain deeper clinical skill and knowledge if they move across settings and work in interdisciplinary teams with doctors, nurses, social workers, etc.  Through training and health education, aides can improve the health experience and outcomes of their clients while addressing the needs and concerns of family caregivers.

How Can We Help The Process of Licensing in South Carolina?
We can first discuss what is important for our senior home care.  This would include:
·        Proper education for our certified nurse assistants.
·        Long-term health insurance that covers the needs of seniors who prefer to live at home
·        Thorough background checks on anyone walking into a senior home
·        Drug testing of licensure applicants
·        Responsibilities and duties of nurse assistants and their role in care teams, interfacing with family caregivers and their support for positive health-related behaviors. 

Next, we can speed the process of licensing non-medical home care by becoming a unified voice that urges DEHEC to act sooner rather than later.
Finally, we can become a good role model for other states to follow.
In a struggling economy we need to move unemployed individuals into economic opportunities of strong job growth potential.  In-home care jobs are plentiful and among the fastest growing.  In addition workers do not require higher education.  Better quality direct-care jobs will bring more stable employment and more cash directly into communities most in need.  This will spur a virtuous cycle of consumer spending and economic growth.  This will give our seniors the best of care while aging with dignity at home.  Let us dedicate ourselves to making America a better place to grow old.