Quality Care No Matter Where
The real cost of in home nursing
Freedom means a person should be able to live where they want and choose what they want to do and when they want to do it. Simple enough description but for many it is a fight, and one they are in danger of losing.
For Lewiston resident Bill Rybarczyk, these are the solutions he looks for every day. Mr Rybarczyk, requires 24 hour nurse care to live in his own home. He is the employer. He cannot rely on family members as they can only help in an emergency. These nurses need to attend to medical issues like operating and monitoring a ventilator, being able to do tracheostomy care and suction. It is increasingly hard to find nurses trained and able to perform such tasks. Add to that a difficulty in finding qualified nurses for the night shift.
When he can find the nurses, he is quite willing to train them, provide them with an orientation, and time shadowing a previous nurse before working on their own. If they are respectful and a good listener he can help them pick it up quickly. And he can offer a good work environment. He is easy to get along with and this kind of work provides a lot of time to study or read, as part of the time you are just monitoring. Working in his private home is a pleasant setting with a pool, gardens and horses. Modern, clean and comfortable, not at all like an institutional setting.
Independence to do as he chooses is important. Mr. Rybarczyk, likes to watch
sports and news programs, enjoys going places and visiting with friends. With help from a nurse he can take the Lewiston transit bus to medical appointments and more. But without their assistance, he remains at home. Or worse, return to a nursing home. In a nursing facility you don’t get to choose when and what you want to eat, when to bathe, when to wake up or go to sleep. Even choosing to spend time outside when you want. He is in control of his care. And being in your own home saves the taxpayer money. On average a nursing home costs over $87,235 per year compared to home care of $21,840.
Mr. Rybarczyk, knows the struggle of finding nursing staff first hand, he has recently returned home from a nursing facility. A handsome, mature gentleman, he has been healthy since April and is eager to get on with things he likes to do. That requires a staff of nurses to handle all the shifts and provide coverage in an emergency. If a caregiver misses a shift, he needs to be able to call someone who is already on staff and trained, or the previous nurse has to stay until one can be found. It’s critical for a person to meet his or her schedule, as you can’t just take sick leave day without finding someone to provide coverage.
Finding these in-home caregivers is a nationwide problem. “These are desperate times,” said Steve Corr, Program Manager of 1st Choice Personal Assistant Services. “Sometimes you end up reusing the same staff over and over and people burn out. That leaves our customers vulnerable.” Some in-home nursing providers have provided special incentives such as retention bonuses. Yet even these perks are not enough to overcome the hardships of a profession that can impose demands, from suctioning tracheostomies and dressing wounds to heavy lifting when moving the person from wheelchair to bed.
The shortage started after 2010, when the post recession job market started recovering. “From 2007-2010, we saw an average of 30 applicants on the registry for work,” said Mr. Corr. “Now we have been averaging 7-10.” This tight job market can be blamed on historically low wages for the home care sector. “We need to professionalize the industry, raise wages and provide benefits.”
Possible solutions to this problem:
- Raise the reimbursement rates for Medicaid. This needs to be done at a federal and state level, so take home pay is comparable to hospital or nursing home work.
- Unionize home care workers
- Start cooperatives such as Minnesota and Wisconsin are developing.
The passage of the federal minimum wage protection and overtime pay for home health workers in 2013 was expected to help, but has actually lowered the availability of workers. If Medicaid doesn’t allow for payment at higher wages or cover overtime costs or benefit costs, it actually reduces the amount of hours a company can hire home health care workers. Add to that the cost of providing health care without reimbursement and hours are cut even more.
This is a growth industry with increasingly more Medicaid expenditures going to home based services as opposed to the more expensive institutional care.
Luckily, Disability Action Center NW provides beginning wages for nurses that are pretty good, but it is still hard to compete with what hospitals pay. And nurse turnover is still an issue. About half Mr. Rybarczyk, staff turns over slowly, the other half turn over rapidly as those are LPN’s going to school. So he is always looking to hire.
But for some this will be a perfect fit. Working one on one allows for better interaction. Interested on this kind of work? Please contact Disability Action Center NW to start your application process.