AGORA: The private duty marketplace
AGORA: The private duty marketplace
In September, Private Duty Homecare asked if our readers would like to participate in a nationwide movement to raise and unify private duty home care standards, for the benefit of all concerned.
Diane Marks, RN, BSEd, MS, Director of Private Services at Fayette Homecare Inc., responded immediately in the affirmative. She serves, with PDH consulting editor Judith Clinco, on the National Board for Aides Association.
"A lot of our discussion at recent meetings focused on these very issues, and the problems that are plaguing the industry with aide services," she says. "If you have your aide services under the home health side of a Medicare-certified agency, you fall subject to those conditions of participation. If your agency is going to pursue Joint Commission [JCAHO] accreditation, then you also have to fall under those standards. If you have a separate division or company for private duty home care, then you have more latitude because you don’t have to fall under Medicare’s conditions of participation all the time, and certainly not under the JCAHO standards."
Standardized training
Marks would like to see standardized training for aides regardless of where in the country they work. "For example," she says, "there is some training that all of them must have: infection control teaching, orientation, and OSHA stuff. All that can be standardized. We’re finding different levels of aides depending on what and where they are taught. It’s costly to agencies to recruit and orient, only to have the aide quit within the first month."
Improving the industry
In Marks’ agency, which is Medicare-certified, aides have to have formal training. They don’t necessarily have to be certified, but they do have to do a certain number of hours in classroom and clinical work.
"I really think that any efforts at designing a standardized training program would be a tremendous improvement for the entire industry. Maybe we even need to talk about creating another level of worker; someone whose services are between a sitter-companion and an aide. I know that in some states, there are personal care workers who somewhat fit that mold. They don’t need to have the same level of training an aide has. I think we’re going to have to do something like that, because we just can’t find the aides and this problem is nationwide. The thing about standardizing from a national basis is that everybody would be on the same page, including our competitors."
Marks points out that certified private duty home care industry agencies have a public relations problem now, because agencies that are not Medicare-certified provide the same services to the community but at a lower cost because they don’t have to meet certified-agency training requirements.
"They can hire someone who doesn’t have even a GED, and some of these agencies are having their aides do work that is almost at the LPN requirement level. I know that’s probably financially-driven, but that gives us a bad image, as well, because the public doesn’t distinguish between different kinds of private duty agencies. There ought to be something that limits those agencies as to how much they can do, for the safety and well-being of the public. Many times you feel isolated in this business. You can really feel like you’re out there struggling on your own. I share stories with my colleagues at other agencies, but sometimes I really feel isolated. So, if there’s anything to get involved with, I’d be very happy to volunteer."
One format standards designers might want to consider using comes from Sam Kaplan, founder and chairman of the board of U.S. Care Inc., a Santa Monica, CA-based long-term care program manager. Kaplan has designed a set of protocols to evaluate the quality of nursing homes. "Based on those protocols, we give them ratings from A through F, and reimburse them based on the rating. A nursing home that rates a D’ or an F’ is going to get a heck of a lot less reimbursement than a B’ or C’." He notes that there aren’t many A’s’ out there.
He has also just completed protocols on assisted living facilities, which have some of the same definition and lack of standardization problems that private duty home care has.
"Different definitions mean different things in different states," says Kaplan. "You have to set your own criteria and ground rules, if you will." Kaplan acknowledged that private duty home care is a more difficult industry in which to define standards, but adds, "Unless you try it, you won’t know. You can sit around and cogitate about what makes sense and what doesn’t, but until you try and implement it, you don’t know what will happen."
Kaplan’s process for evaluating long-term care nursing homes involves monitoring the facility 24/7. "You’ve got to spend all three shifts there," he says. "You can’t just go in and observe one shift and assume that the second and third shifts are the same quality. You’ve got to talk to patients and their families. Everybody talks about quality, but when you pin them down on how you evaluate and implement it, you get blank stares.
"Nobody wants to take the time and make the effort to establish the protocols, then use those protocols and do long-range evaluating based on those protocols. In long-term care, you’re battling insurance companies. Their major interest is how large they can build their reserves and how long can they maintain those reserves — insurance companies are basically investment trusts."
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