I need your help, please

dabunchJuly 11, 2014

I'm thinking of starting a Homecare business. In the beginning a NON-medical. In the future I may incorporate some medical. I DESPISE dealing with insurances, hence the non-medical. DH is a physician, semi-retired. I too, have a medical background, but am not a nurse...eventually a semi-medical training book may be in the picture, but I have to start with direct care, first.

I am not happy with what I see out there with other homecare businesses. I want to be different and CARE. I would like to see a specialty para-nursing, homecare type people available for assisting the clients. There seems to be a GAP in training and knowledge between CNA, HHA, and companions. None of them seem to be all-around type caregivers. To me, if you are hired to work, you need to perform and KNOW what you're doing.

I mostly lurk and have posted mostly in the decorating forum.

I have read some of the insightful posts, and you posters are a wonderful bunch, full of knowledge and information. I would like to pick YOUR brain as to what is really needed for elder care. Post surgical care would be included....and other. I think I have a lot of the needs covered, but I'm sure that there are plenty more...

I'm also very afraid of the liability, and the quality of employees that may be applying for this type of work. I have short term goals and long term goals as I put my business plan on paper.

I genuinely want to help people. I am uber responsible and have very high standards. Who knows? Maybe I'll get disenchanted and quit before I even start it ;)
Any tips, information, or warnings are appreciated. TIA

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If you want to get into the care business without insurance you had better stop now. Business/liability insurance is a must in the care business.

A homecare business without medical care is housekeeping. You should work for a company to see if you can direct others. Caring is nice but you must be able to divorce yourself from caring too much.

    Bookmark   July 11, 2014 at 8:39PM
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I have had soe interesting experiences that might appeal to you. After my 95 yr old mother passed away, I volunteered as a senior peer counselor with a local non-profit. For almost 7 years, I visited seniors with issues they wanted to talk about. A couple of years ago, I transitioned to being a member of an advisory council for our local county agency on aging. I still see a 90 yr old woman who is blind and who lost her care-giver son 4 years ago. I take care of her banking, pay her bills (she also legally blind and lives independently), keep her Rxs in order once a week (filling her pill box and even her insulin syringes). We have someone else to take her to Dr appts (I did for a while) and do her shopping.

So now I have the best of both worlds, a place in the community council plus a personal stake in the life of a person I have come to love.

There are plenty of opportunities for you. Think about working with (or even starting! a non-profit. The Older Americans' Act of 1965 created funding for health care insurance counseling as well as nursing home ombudsmen. Federal funds also go to nutrition programs and other programs.

There is a lot of opportunity within your local community without going into business, and yes, needing liability insurance. Good luck, and bless you for offering to help.

Here is a link that might be useful: Federal Older Americans Act info

    Bookmark   July 11, 2014 at 10:04PM
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CA Kate

I think you need to look at your resource pool first thing. We finally have 3 caretakers that are any good. If all one needs is someone to sit with a person and make 'meals' then there are many who like to sit.... take that literally.

My DH is far past that and all his caretakers have to be able to bathe, turn, empty folly bags... without getting it on the carpet, feed him thru a PEG tube, aspirate, AND stay awake and attentive. The really good agency we use has 4 - yes four - people who are qualified to care for him. We are using three of those.

Many have 3 kids at home, maybe a live- in man, a day job, going to school, and, think they can come here and get paid to sleep.

I was told, before we had caretaker #1, to lock up anything I didn't want stolen or looked thru or used. I did that and am glad of it. The people are all (supposedly) screened, checked-out and bonded. Yes.... well..... prove who stole the stainless. No, I'm not going to put cameras all over the house!

It doesn't sound as if you have any experience working for an agency of this kind. I'd suggest you do so before embarking on such a new venture.

    Bookmark   July 11, 2014 at 11:14PM
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Thank you all for your guidance.

Maifleur- I do know that I will need a workers comp ins, some type of liability ins and to bond my employees. That goes without saying. I do not want to deal with reimbursements by health insurances, such as Medicare or Medicaid. The rules are just too stressful. I used to argue with insurances when I set up medical practices years ago. The liability for medical care is totally different than what I'm thinking of doing. At this point, other than Bus/Liability/WC ins, I do not want to deal or help anyone maneuver health insurances. THAT is a different field.

My motto would be more of assisting with living independently, and getting through tough times like a family member would do. That may require some grey areas of medical help like assisting with pills, getting around, grocery shopping, overseeing someone following orders for a test prep.

When it starts getting into NURSING, as in complications to a wound, catheter, infection, that is too much responsibility to charge $20-$25/hr. Visiting nurses charge $220/hr around here. Not many can afford a nurse, and insurances are not that quick to approve care, unless absolutely necessary, and only a limited amount of visits. I would like to work in conjunction with a homehealth agency. Many people need 4-8hours of assistance daily, or post surgery assistance in between nurse visits. THAT is the level of responsibility I am willing to take.

Westelle- the people that you are utilizing for the feeding tube are they from a home healthcare agency, i.e. nurses, or CNAs, reimbursed by Medicare? My biggest problem will be not crossing over into the real medical area. I am concerned about the help. A few years ago, and in a different state, my MIL went through 7 people, before she got a decent one. Yes, things were missing, too. Then when she was nearing the end of her life and needed more help, the woman quit. Unbelievable.

Shushipup- Thank you for that info. Something to think about.
I realize that opening up my own business is a huge undertaking, and that is why I am doing a lot of research before I commit. Working for another agency may be problem, because IF they are smart enough, they have a non-compete clause in their employment contract ;)

Keep your ideas, tips, and warnings coming. Thanks.

    Bookmark   July 12, 2014 at 10:06AM
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My experience is as a volunteer with non-profits and governmental offices, not for-profit companies that would ask for a non-compete clause.

    Bookmark   July 12, 2014 at 1:20PM
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CA Kate

The people who care for DH are CNAs provided by a for-profit agency. I pay the agency, they take care of all the taxes, insurances, etc. for their employees.

Hospice provides nursing care twice a week and I know they bill Medicare.

When we got our first Aide DH didn't need too much help, only watching so he didn't fall. As time has gone on he has gradually needed more and more help. He is now totally disabled. At what point would you have cut-off the care you are thinking of giving? Our first Caregiver is still with us and has grown into the job and will be here 2 years in Sept.; the night shift caregiver started a year ago; the third woman covers the other two on their days off.

I guess I'm not sure what kind of a care agency you're proposing.

    Bookmark   July 12, 2014 at 6:09PM
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I think you want to have people that come in that treat patient like beloved family member! Well, they are nearly non- existent. As you read this forum you know that those of us that have stepped up to the plate often have siblings & they are usually staying a long distance from the situation. So you are lucky to get 1 person in family to take care of mom, dad or grandparents, etc. Some people are nurturing & many are not. How do you find the nurturing ones. You will mostly get those that need a job, any job. You mentioned post surgery, you would almost have to have a CNA if there is drainage. They would be needing help to get to shower & be given the shower, meds are the norm after surgery, what shape is spouse in, would they be any help. What about person living alone, you're talking full time help which gets very expensive & that is really a problem. Unless you live in wealthy area most folks can't afford 4x$16 or $20= $64 to $80 a day times 5 days up to $400 a week just for 4 hrs which is least they will come. That's $1600 = a month for just a few hours. That is why so many of us do it & even with 5 days 4 hrs a day I had to shop take them to dr appt, clean house, laundry etc. It was lot of work. They might make bed or do few dishes but they managed to get out of a lot of work except the few good ones we had but seems they had to go back to school & I think sometimes got moved by agency to another client as I heard it mentioned ,we don't want caregiver to be too attached.(with older folks that can result in them giving caregiver everything but kitchen sink) It's not a business I would want to run. The Philippine agency with CNA's was best because we have a large influx of folks from there & they are good caregivers & more caring than most of others so supply of qualified people would be necessary- might check employment office & ask how many come in asking for that kind of work. Good Luck!

    Bookmark   July 12, 2014 at 9:43PM
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Westelle- Let me first say how sorry I am for what your DH and you are going through. Life can be cruel.

Shusipup-You gave me some food for thought...I did human resources for a human services non-profit. I was disappointed how the top echelon were only interested in having a good job with great benefits themselves, but they really didn't care about the mentally handicapped. Oh yes, they would "use" the volunteers. I don't know enough about non-profits, otherwise. Would the funding be there? You cannot count on grants all the time. We are not wealthy, so I cannot work for free. Do you get paid for the position of being on the advisory council? What do you do?

SunnyCa- You have given me ANOTHER idea.

As I read all of your posts, "my wheels are turning"....

Maybe the way to go is Training, development, and human resources, and seeing if the state would help out with some of the cost. I doubt it, though. The state is broke, and only has money for mothers with children.... This way we (DH is retiring next year) can reach out to even family members who cannot afford the care but can learn how to assist themselves post surgically and the elderly. I read in the last AARP that family members are struggling because they cannot afford the care, and/or are not trained. The "help" that the state sends are NOT qualified, but glorified babysitters, and a lot of people fall into that above the poverty threshold level, so no help is available.

Staying at home is the best course to take for post surgery recuperation and for elderly, providing the caretakers know what they are doing.

I know too much inside information about healthcare. Some examples: Did you know that ER docs are forced to work FAST and they are allotted a limited time to spend with patients? They may be penalized during raise time, and some have money taken out of their pay and it's given to the "higher producer". Medicine is all business, insurance reimbursements....Did you know that in nursing homes nurses, CNAs, and other are timed performing nursing duties i.e. 5 minutes to wash a patient. If they don't perform, they are fired. Go ahead and try to give a paraplegic a bath in 5 min! All these facilities are about money and production. The patient suffers.

I do have direct care experience, as I am the only one in the family who stepped up to the plate... I have had surgeries. I have been on the other side as a patient, with my doctor looking for cancer in me....It's an experience that is a must if you will be in the business.

I'm not going to jump into anything, unless I believe in it and can do a good job.

    Bookmark   July 13, 2014 at 10:36AM
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My work is entirely volunteer, since I do not need the paycheck. But it seems that you have little experience in knowing what is already out there in the community and how both for- and non-profits work in these services. Some time with any of the agencies, paid or volunteer, will give you a much larger picture.

For example, we have a start up of ITN here, https://www.itnmontereycounty.org/

And Seniors Helping Seniors

Alliance on Aging which covers several services

Many low-income seniors can qualify for IHSS help.
But there is a huge gap between the low income cut-off for IHSS (about $1000/mo here, it varies by location), and full-pay services. So if your income is $1200 a month, what do you do? Well, you do without, usually.

How about Partners for Transitions?

How about services that provide senior advocacy?

Visiting Angels?

Other senior care agencies (generally $25/hr with 4 hour minimum).

Lots of ideas. What's available where you live?

    Bookmark   July 13, 2014 at 1:48PM
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I agree with Sushipup. I recently asked about what level was needed for my husband who has Alzheimer's to allow me a break. I was told because it would require giving medicine a CMA/CMT would be required. Therefore several of the types of care you would like to have provided are out.

    Bookmark   July 13, 2014 at 3:19PM
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Sishipup- Great links. Thanks.

There are some advocacy groups out there. Most are just there, and don't make much noise or difference. Social services are mostly bilingual, and low quality. We have some rides for Day services and other. We have mostly for profit companion type or Visiting Nurse type agencies. We also have some state and VA help for the elderly. State help is not great. There is an income threshold. The people seem to be unqualified, unreliable...Visiting Nurse is ok, but very expensive.

There is no all around para-nursing type of homecare that I have in mind. Maybe that's all it can be- a dream. Laws and red tape may not allow what is BEST for an elderly to remain at home and independent.

1. I'm not questioning IF I can do it. I am questioning if a homecare business will be a big headache because quality people are hard to find. I cannot run and take over.
2. LIABILITY, and incorporating some grey area medical care is a huge problem in my state.
3. Licensing a business, and liability in my state is different for medical and non-medical.* The distinction here is key.
4. CMAs in my state cannot give meds. The nursing lobbying in CT is interesting. They made sure that the easier stuff is saved for nursing care.The nurses don't want to draw blood, so it's ok for others, including the CMAs to do it. Ironically, you can do a lot of damage here ;)

I do agree that certain aspects of medical care should not be done by non-medical personnel. Things like IV's, monitors, deep tissue or venous injections. Initial wound care (first change). Some meds that require special monitoring. These are NURSES jobs and they charge $220/hr....However, day to day stuff that technically a person could do themselves but are too frail to do it, should be ok to be done by TRAINED personnel, even though they are non-medical (CNAs and HHAs fall into this category). As long as they are shown how by a nurse, doctor...

I have a lot of work to do. I have to check on what exactly my state considers medical; where the lines are drawn. Dealing with my state is no picnic. Getting a hold of a live body in the state of CT is a challenge. Then sifting through the BS jargon is another. You can never get a straight answer. They have the best jobs in the entire US. Trust me on this.

Maifleur- Maybe it's time to change things. APRNs and PAs were not allowed to do much 20 years ago. I know. I worked with them. Now because insurances want to pay less, they are allowed to act like doctors and even write scripts! Maybe its time for a legislative change that trained personnel can give meds, eh? I have seen doctors and nurses make LOTS of meds mistakes in my time, so let's not make them invincible. Quality of care depends on the person giving it.

    Bookmark   July 13, 2014 at 5:21PM
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Hi, dabunch...
I am a Senior care giver, on LOA while I tend to my own mom.

I can't address all of your concerns, but I can help out when it comes to screening prospective employees.

My company not only performs intensive criminal background checks, but financial background checks as well. Desperate people do desperate things and somebody who might not otherwise be inclined to steal might find themselves tempted to do so while handling the finances of a vulnerable client.

As for the "caring" issue- my employer presents prospective employees with numerous "situations" with fictional clients, then quizzes prospects with how they would handle the situation. I even had to role play with my trainer. This really helps in winnowing out empaths from non-empaths.
You can teach someone to shower or bathe a client, but you can't teach empathy.

As for insurances, most of the people I care for are self paying.

I wish you luck in your endeavor!

    Bookmark   July 23, 2014 at 10:27AM
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