Aging-in-place trend boosts Treasure Valley home-care firms

The Valley's market for health and personal assistance is only going to get busier.

adutton@idahostatesman.comMay 14, 2013 

  • NATIONAL DEBATE OVER HOME-CARE EMPLOYEE PAY

    Home-care workers in Idaho have among the lowest earnings in the country, with wages averaging about $20,000 to $23,000 per year as of May 2012.

    Idaho is one of 29 states without a minimum-wage guarantee for home-care workers, according to the U.S. Department of Labor.

    The Obama administration aims to add wage guarantees and overtime pay requirements to federal labor laws, which have special exemptions for certain home-care jobs.

    Home-care advocates welcome the proposal. But state Medicaid directors and some Republican politicians don't like it, according to Kaiser Health News.

    A letter from the National Association of Medicaid Directors warned the Office of Management and Budget to think about "the unintended consequences, cost-effectiveness and alternatives to this complicated and burdensome rule," according to Kaiser Health News.

    The owners of home-care agencies are leery, too.

    Medicaid pays a break-even rate, at best, for Medicaid-eligible patients, who make up about 20 percent of Progressive Nursing Services owner Karen Young's clients.

    "It makes it very difficult for an employer to be able to provide a fair wage and be able to even offer the essential benefits of insurance and pay Social Security taxes," she says.

    Still, she will continue serving people on Medicaid, she says.

Karen Young was a nurse for premature infants in the late 1980s, when an Idaho family's unmet needs persuaded her to start a business in an industry with explosive growth.

Young was working in Utah. One baby's family needed to return to Idaho, so Young came up to arrange care for the infant. She discovered "there were three other children living in the hospitals because nobody did home care."

She opened Progressive Nursing Services in Boise in 1990 to help premature babies on ventilators and other pediatric patients to stay in their homes. Four years later, Progressive landed a contract with the Boise Veterans Affairs Medical Center to provide in-home care to veterans. Her business has grown steadily since then. She now has about 300 clients and 150 employees working 20 to 40 hours per week on average.

"There are more seniors and more people becoming in need of assistance," she says. "There are excellent job opportunities."

Idaho has nearly 20,000 people working as home health aides, personal care aides and nursing assistants, according to the U.S. Bureau of Labor Statistics. Most of them are in the Treasure Valley.

Expect that number to rise. The bureau projected national job growth of 70 percent for home health and personal care aides between 2010 and 2020, making them the two fastest-growing occupations. That's five times the average growth rate for all jobs.

Personal and home-health aides also earn lower wages than all other Top 30 fastest-growing occupations, according to the bureau.

Idaho has 84 home-health agencies, according to the Department of Health and Welfare. They are overseen by the Bureau of Facility Standards and must meet certain requirements to be allowed to take Medicaid and Medicare.

The demand is driven by a wave of seniors who want to grow old in their homes, and by their children who cannot provide around-the-clock care but can't imagine sending their parents to nursing homes.

Life's Doors in Boise offers a trio of home services - home health care, in-home personal care and hospice. Community liaison Alan Greenhalgh says the company and its industry are preparing for baby boomers. That includes Vietnam War veterans who are "a whole different ball game" because of mental health and substance abuse, and in some cases, specific disorders related to chemical warfare, he says.

"We're definitely looking into the future of what we need to do to better serve what's coming," he says.

Young and other agencies - most of them smaller or part of regional and national companies - employ part-time workers who usually don't need much training.

"You might have a young mother that has children that go to school during the day," Young says. "That mother might not have a lot of formal education, (but) she can take a job and make $10 to $12 an hour just by going to someone's house."

Young expects to have more private-pay customers in the future, with more adult children willing to pay out of pocket to have their parents cared for at home. About 20 percent of her clients are on Medicaid.

Medicare doesn't cover most care in a senior's home. It might cover select services for a short time - a bath aide while someone heals from hip replacement surgery, for example - but most people pay out of pocket for their services, Young says.

Private insurance may cover some home care, without housekeeping and other personal care services that are offered by most agencies. There's also long-term care insurance, though agencies say most clients don't use it.

Progressive bills $150 per visit to deliver intermittent skilled services, including doctor-ordered therapy or nursing; $49 for certified nursing assistant care; and $250 a day for a live-in caregiver. The company charges $18 to $20 per hour, with a two-hour minimum, for caregiver services like bathing, personal care, shopping, housekeeping and companion services.

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Audrey Dutton: 377-6448

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