By Susan Elise Campbell
According to Syracuse University’s Lerner Center report, nearly one in six New Yorkers is 65 years or older, and no other population group in the state is growing faster. This means there is a growing dependency on the rest of the community for their care as they continue to age.
One industry strongly advocating for aging seniors is in-home health and personal care. The leadership of Home Instead out of Gansevoort and Greater Adirondack Home Aides in Queensbury share a compassion for and commitment to the elderly and disabled in the three counties they serve: Washington, Warren and Saratoga.
As business entities, these agencies couldn’t be more different. Home Instead is part of a privately held corporation with franchises in multiple countries and brand recognition. President and minority owner of the Gansevoort office, Maureen Hopkins, opened the agency in 2000.
Greater Adirondack Home Aides is a non-profit organization dating back to 1965. Charles Nelson is the executive director responsible to a board of directors who has “a little less freedom” than corporate executives do and with shallower pockets, he said.
Since a surge in health care costs follows an aging population, “New York would prefer that people age at home because it doesn’t have to open more skilled nursing facilities,” said Nelson.
These professionals have similar challenges. One is they are constantly looking to hire caregivers. Another is that sometimes they face obstacles by regulatory bodies in the state.
There are two basic kinds of home care, although functions overlap. Personal care, involving non-medical home care, includes safety supervision for people with dementia or mobility issues, meal preparation, assistance paying bills, companionship, and other everyday tasks that help them maintain their independence.
Home health care aides perform important tasks to help a person recover following an illness or operation and are required to be supervised by a RN. They can toilet and bathe their clients and monitor, but not administer, complex medications or medical equipment.
Home Instead offers in-home personal care and companionship at this time. Hopkins said it has applied for a license to perform medical tasks but has been denied “because the state only grants so many licenses per county and says the need has been met in Saratoga.”
“We called the 62 agencies that have the license for Saratoga county,” said Maria Spagnola, home care consultant at Home Instead in Gansevoort.
“At the time of the phone call not even five provided the bathing and other care services we asked about,” Spagnola said. “The rest either didn’t provide any home health care or had no staff.”
Hopkins has already gone back to school and obtained a nursing degree, she said, because as an RN she will supervise her aides as the state health department requires to license them.
“People approach me and say we called your agency and you referred me elsewhere,” Hopkins said. “We take inquiries, usually from adult children looking for care for their parents, and we have to turn them away.”
The agencies she refers those inquiries to are in Albany county, she said.
“But an Albany county agency has a hard time staffing in Saratoga. If the aides live in Albany they’re not going to drive up for a four-hour shift,” she said. “Plus, the agency does not have enough of a presence to supervise them.”
Hopkins said she and Spagnola met with Representative Carrie Woerner at the end of November and “Representative Woerner was interested in helping our cause.”
The next step is to try to appeal by proving to the department of health that there is a “definite need” for more licensing. “We’ve done all the background and are getting documentation together,” Hopkins said.
Licensing applications are already pending in Warren, Washington and Rensselaer counties. She said her agency is very well known in Saratoga and “lots of resources feel the way we do, so they will communicate with the department of health on our behalf.”
“Greater Adirondack Home Aides is fully dedicated to local, community-based health care,” said Nelsen. “That is the commitment the agency was founded on.”
With two RNs on staff, Greater Adirondack provides the full range of in-home care services but their assignments tend to be short-term care for daily activities, such as following an illness or hospitalization.
“Whereas other agencies often will do half-day minimum shifts, we will do smaller cases of only an hour or two a day,” Nelsen said. “Aides supervise a range of daily activities from hand washing and home safety to assisting people with mental health disorders, rehabilitation and restorative care.”
Since personal care is non-medical, it is not covered by any insurance except, at times, Medicaid. Consequently personal care is completely private pay unless clients have long-term care insurance that pays the agency directly.
Greater Adirondack offers a CDPAP program, a client-directed personal care arrangement wherein clients can hire a family member or friend and earn a salary from Medicaid. Greater Adirondack does the administration, paychecks, tax withholding and other payroll services. Only the hiring and firing is up to the client, Nelsen said.
“For example, if my mother got approval from the insurance company for this care, she could hire her neighbor to come in and provide care,” he said. “We would do a background check on the neighbor and then be responsible for worker’s comp, disability, and health insurance, and things of that nature so that she can age in place.”
“These vital programs are less expensive for the state than nursing home placement,” he said. “There are not even enough skilled facilities to take on the populations we are currently serving.”
But programs are changing all the time, Nelsen said. The state is in process of removing this aspect of business from organizations like Greater Adirondack Home Aides.
“It will be interesting to see if the state can do what they want to do,” he said. “Basically they are looking for an opportunity to reduce fraud toward the state and federal government.”
“Medicare and Medicaid fraud usually results in higher health care costs and taxes for everyone,” according to www.medicare.gov.
But such an attempt “misses the boat” in Nelsen’s opinion because it would involve “greater oversight from a bigger distance.”
The corporation winning the bid will not be located in the communities served or will not know their employees, but may potentially save some $500 million through some economies of scale, according to Nelsen.
“Health care costs are going up because the population is aging,” Hopkins said. And more and more personnel will be needed to fill gaps that can keep seniors in the place they call home.
Both Home Instead and Greater Adirondack Home Aides provide access to staff training. Like many in the medical and related fields, Hopkins and Nelsen said staff is not easy to find.
“For the client, it can be intimidating to have someone come into your home, so there is some resistance,” said Spagnola. “With 24 years in service behind us and the right match between client and caregiver, we start building trust right from the first meeting.”
“Trust is a collaboration,” Nelson said. “Caregivers do a humbling and emotional job and we need to value them more as a society.”
Visit the websites www.homeinstead.com/gansevoort and www.greateradirondackhomeaides.org for more information about services and employment opportunities.