Helping Them Stay Home

Home health care providers face growing demand as region’s population ages, seeks independent living

BY KRIS BEVILL

The home health care industry is evolving, not unlike other sectors of health care, but in regions like the northern Plains, where much of the population is in the 65 and older age range, home health care providers are uniquely faced with accelerating demand as a growing number of seniors seek out ways to remain living at home as long as possible. This new and growing demand, combined with a region-wide health care worker shortage, means the fairly young home health care industry is often racing to keep up with patient loads and regulations, but providers say they are confident they will continue to meet demand, thanks in part to new methods of care delivery.

Industry Standards

Types of home care providers range widely from non-medical companion organizations to medical caregivers, and organizations can vary greatly in the number of staff employed and services offered. For consumers, this complexity can make choosing a provider overwhelming and the literature provided to assist decision makers is often just as confusing as the process itself.

Recognizing a need for more general information on the topic, the Better Business Bureau of Minnesota and North Dakota hosted a series of meetings with industry members last winter to develop an easily digestible set of consumer tips and industry best practices. Karen Thompson, advertising review manager at the BBB, says the group researched the industry prior to the meetings and found there wasn’t much information readily available for consumers. The BBB felt it was important to provide that service to seniors and their families, and while the industry is already regulated, the group decided it was worthwhile to also compile best practices for the industry.

The resulting set of about two dozen best practices tips was mailed to approximately 1,400 providers in Minnesota and North Dakota, according to Thompson. The BBB has also made the best practices and consumer tips available on its website - bbb.org.

Industry members say the best practices and tips are a good starting point, but add that many providers already abide by similar standards. “I’m hoping we can do better and go beyond those basic best practices,” says Patti Cullen, president and CEO of Care Providers of Minnesota, a nonprofit health care industry association.

Cullen says there are currently about 1,600 home care providers in Minnesota, ranging from individuals providing care for loved ones to large providers. About 300 of Care Providers’ 800 members are home health care providers. The most frequent complaints her group’s home care members receive from clients revolve around the cost of care, staffing shortages and staff turnover, and she notes that staffing issues are likely to continue as demand for home health care only increases in the future. “We’ve got 60,000 seniors turning 65 every year,” Cullen says. “The vast majority of seniors want to stay home and we’re not going to have enough workers to serve all these seniors in small settings.”

Technology to the Rescue

Cullen says there are several initiatives that could help provide more workers for the industry including training for new Americans and older workers, and offering more hands-on opportunities for college students. She also suggests that varying approaches to care will be necessary and useful in meeting demand. Congregate settings allow fewer workers to care for more patients, for example. She also points to technology as a great potential aid in allowing seniors to remain in their home with limited personnel visits.

“There’s no one master solution. I think it’s a series of bits and pieces that we have to cobble together to address it in the future,” she says.

Anne Major, president of Fargo-based Ethos Home Care, agrees that technology can aid the industry greatly in confronting staffing challenges while providing top-notch care to patients.

Ethos was formed last year through a partnership between Fargo’s Bethany Retirement Living, Moorhead, Minn.-based Eventide Senior Living Communities and Alexandria, Minn.-based Knute Nelson with the specific purpose of providing home health care to patients in the Fargo area. Bethany and Eventide had expertise in providing senior care in the area, but neither provider had previously offered in-home care, so the two joined with Knute-Nelson on the new venture, which contributed its years of experience in providing home health care to residents in a 32-county area of Minnesota.

Since launching Ethos last August, the organization has served about 100 patients. Major attributes the small patient load to the fact that the organization wasn’t immediately Medicare approved (it is currently going through the accreditation process) so couldn’t bill for many of its services. She says Ethos also wanted to make sure its staff was thoroughly trained and able to provide the best care possible before ramping up its patient load. “As we take on more employees we’ll take on more patients,” she says.

Ethos currently employs four staff members - two registered nurses, a physical therapist and an occupational therapist. The organization has been advertising for a licensed practical nurse and another registered nurse “for quite awhile,” but finding staff is an ongoing problem. “The hospitals are feeling it, the care centers are all feeling it, and home care is feeling it as well,” Major says.

She’s a strong advocate for incorporating technology into home care not just for the staffing benefits, but for the additional well-being that remote monitoring can provide for families. Technology can be utilized in a variety of ways for senior care. Medication dispensers can send an alarm to caregivers if medicine is not dispensed at the correct time, motion sensors can automatically trigger lights to turn when a person enters a room or steps on the floor as they get out of bed. Major offers another example she’s seen firsthand, where a child was concerned about his parent leaving home and becoming disoriented, so a sensor was enabled to alert the child whenever the parent’s garage door opens or closes.

Knute Nelson utilizes a technology called grandCARE Systems, which uses a touch screen in the patient’s home to control any number of services, all tailored to the individual’s needs. Major says she will “most definitely” incorporate technology at Ethos as it becomes available, adding that while it can be expensive, it is worth the cost. “Sometimes it’s more valuable to pay for peace of mind and know that they’re ok,” she says.

Like elsewhere in the region, South Dakota is struggling to find staffers to meet growing demands from its aging population. However, while Minnesota has a large number of home care options, South Dakota is lacking in providers. A recent check of the South Dakota Department of Health website showed just 24 registered agencies offering services in about 40 locations, in fact.

“Expansion of all types of home health services are important and necessary for South Dakotans, especially in rural areas,” says

Scott Duke, president and CEO of the South Dakota Association of the Healthcare Organizations. “In addition, home- and community-based services are a critical support component to allow people to remain in the community as long as possible.”

An assessment recently commissioned by the state predicts that by 2035, people aged 65 and older will comprise more than 20 percent of the population in all but 10 South Dakota counties. Meanwhile, the number of people aged 18 to 44, prime candidates for the health care workforce, is expected to decline and concentrate in the urban centers of Sioux Falls and Rapid City, further complicating future availability of health care in rural areas.

SDAHO is also looking toward technology to support health care delivery. Tele-health and monitoring systems can reduce the frequency of visits required by health care providers while allowing them to maintain a connection with the patient, the group says.

While the potential benefits are certainly there, the number of providers so far actually utilizing technology to aid in long-term health care is still relatively few. Care givers say the cost of technology is the biggest hindrance to its roll-out.

SDAHO notes that South Dakota providers who use these types of technology often find they are too expensive to maintain. Andrea Jung, president of Elk River, Minn.-based Guardian Angels Elimm Healthcare and Hospice agrees. She says her organization used tele-health in the past, but struggled because there was no funding available to help cover the cost. The organization was eventually forced to stop using tele-health because it was cost prohibitive, although it is now exploring the use of remote monitoring technology developed by Mendota Heights, Minn.based Healthsense.

“I’m really excited about the potential there is for home care,” Jung says. “I think technology is going to be a big impact and change the way we deliver care and how many people we’re reaching. There are so many things going on in this industry that I’m really excited about.” PB

Kris Bevill Editor, Prairie Business 701-306-8561, kbevill@prairiebizmag.com