Home Care is desperately ill in Ohio, especially for those relying on the
State run Core and Core Plus programs, where there are few choices among
mediocre agencies. (Better run agencies with better staffing and better
education are not those who contract with the State programs; these better run
agencies are most-often affiliated with hospital based medical systems.)
The system is broken. Patients are suffering from poorly run programs and
incompetent delivery of care.
The reasons for the deficits of care are numerous. And all
"sides" have their own reasons.
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In a very simplistic list, the "sides" are:
States are answerable to the public and public
opinion about where dollars are spent; the public forgets that most
"patients" had been taxpayers too and since no person
is exempt from sales taxes etc., those who receive help from "the
state" are still taxpayers even when they are unable to work.
Too many of the public today still view any form of Welfare as
disgraceful and that those who receive such help as receiving "hand
outs." Of course, that view changes quickly when they or a
member of their own family must turn to Welfare for help. The
general public needs to remember "there but go I" when voting
on tax levies that support public programs.
Companies are poorly reimbursed by the Ohio
Department of Welfare and there is no pool of properly trained Aides to
hire. Companies have come to expect - and accept - that they have
no choice but to hire whomever applies, rather than waiting for more
qualified candidates. Since the State has made contracts with
these companies for service to be delivered, the companies are under
some pressure to fill the patient schedule with warm bodies, regardless
of the qualifications of those persons.
At the forefront of providing service are Home Health
Aides who lack education/ training and supervision. Many come
through Ohio's Welfare to Work program, which bears more weight on
getting a (any) job rather than matching qualifications to the job.
In a sense, Ohio's Home Care system is nepotism on a grand scale...
Don't train the welfare person who is mandated to get a/any job; funnel
those workers into the Welfare paid Home Care agencies who, because
Welfare reimburses the companies at such low scales, cannot pay these
untrained individuals much more over minimum wage (min. wage is
$5.25/hr; min. salary in home care is 6.00/hr.). This breeds a
financial-"nepotistic" environment. What person wants to
care for an ill person for $6.00 an hour AND do their errands AND
housework, plus bathe the person, empty potty chairs or clean a patient
who has soiled themselves? Many Aides leave after convincing
employers to sign their welfare papers that prove they attempted to get
a job. Over half of the Aides hired leave after a month or less.
Those who stay long term are ones whose generous heart and caring/giving
attitude towards the sick in a little way is a secondary reimbursement
(although it is not financial, but an emotional reimbursement).
All Aides who continue to work for more than 3 months begin to complain
that they not only get paid little, they also do not get raises, paid
days off, sick time, vacation time, or benefits like health insurance.
These workers might be compared to those with the same employment
conditions at fast food joints, preparing food, wiping tables, cleaning
bathrooms, except in home care the service is to an ill person who must
depend on the caregiver and that the service is given in the sanctity
of the ill person's home.
Of course, since the patient is also often a welfare
recipient, the ill person is also part of this sick and financially
nepotistic circle. AND because they are on a welfare provided home care
program the expectation is that they should not complain, despite the
fact that they receive poor care from aides who are poorly trained and
poorly paid.
In the 1980s when Home Care agencies were first being
started, the idealistic picture was one of providing holistic and
complete care in a setting which would have the patient be and remain
the most comfortable, that being their own home. But, in 2005,
Welfare paid Home Care programs have taken that idealistic view of
holistic patient care and mangled the delivery of services so badly that
"home care" for poor folks now resembles that of the worst run
"personal care homes" and "group homes" that existed
in the 1980s (except, now, instead of a group setting, this takes place
in an individual's *HOME*). Without proper training, all
sorts of abuse takes place, from getting an "attitude" when a
patient needs any help, to talking back/spouting off, profanity/name
calling, to outright abuse, theft, and attempts at fraud (lying about
what times they worked, that is, if they show up at all or show up late;
they still want paid for the entire shift. It is ridiculous that a
good 95% also lack the interpersonal skills to deal with ANYone, let
alone someone who is ill. Some cannot follow simple directions within a
person's home. Some cannot read. All these place a huge -
and unnecessary - strain on the patient who needs care.
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In Ohio, for example, there is no regulation of Home Care
Aides in home care, except by their employers (who sadly, also do too little
training or supervision).
CHANGES NEEDED:
(1) EVALUATIONS: Patients should do individual
evaluations on every employee who walks through their door (of course, this
would be done anonymously!) HHA's would receive feedback from the
evaluations as a grouped response from all patients they had cared for during
every 3 month time period. In this way, HHA's strengths and weaknesses
would be identified clearly to the employer, with specific examples from
patient's comments (re-worded, of course). In-services can be
developed using any number ratio of previous patient responses to HHAs numbers,
especially in-services on particularly troubling areas such as home/patient
safety, body mechanics/transfers, and communication skills. Additional
in-services could address in a group setting the weaknesses of one or a few
employees, without ever pointing to any specific employee.
(2) Re-Initiate bi-monthly supervisory visits which used to
be required by insurance payers like Medicare.
One thing that would greatly improve care is, obviously, a review of the
current system of payment and an increase of wages to Home Care Workers.
This is a legislative issue, since the programs are managed by the State.
Second, Home Health Aides need more Staff Supervision. In the 1980s,
supervisory visits were done every two weeks, and immediately if a patient made
any type of complaint. Now, supervisory visits are ONLY done once every 60
days, and NO visits are made immediately if there is a complaint. This
schedule does nothing to offer guidance or training to the Aides, or provide
remedial intervention when there is a complaint.
Third, Patients need a way to offer evaluations and satisfaction feedback about
all Home Health Aides, which is currently not done. Patient evaluations
could measure specific tasks and actions of an Aide. This would give
needed feedback to companies, who in turn could use the evaluations to set up
in-services that address particular care issues. If a company has a
predetermined schedule of general in-services, this is less helpful than
in-service programs that cover the deficits among a group of Care workers.
Patients should do individual evaluations on every employee who walks through
their door (of course, this would be done anonymously!) HHA's would
receive feedback from the evaluations as a grouped response from all patients
they had cared for during every 3 month time period. In this way, HHA's
strengths and weaknesses would be identified clearly to the employer,
with specific examples from patient's comments (re-worded, of course), and
relayed to the worker. In-services can be developed using any number
ratio of previous patient responses to HHAs numbers, especially in-services on
particularly troubling areas such as home/patient safety, body
mechanics/transfers, and communication skills. Additional in-services
could address in a group setting the weaknesses of one or a few employees,
without ever pointing to any specific employee.
Some questions that should be on the evaluation that patients
would complete:
1. Does this worker arrive on time for each shift?
2. If not, what reasons are given?
3. Does this worker take breaks within a 4 hour shift? (By
law, breaks are only allowed if a shift is longer than 4 hours)
4. Does this worker show any negative responses to your
requests of help? (examples: making faces, negative remarks, refusal to provide
needed help, disappearing for long periods of time)
5. Does this worker use good home safety? (problems may
be: leaving paper or plastic on kitchen stove; leaving laundry thrown down a
flight of stairs; blocking doorways & pathways)
6. Does this worker use good lifting techniques and body
mechanics? Have you felt un-safe because of how they have helped you at
any time?
7. Does this worker do all tasks given to them?
8. Does your worker sit too much, when you need them to be
doing tasks instead?
9. Does this worker call off frequently? at the last
minute?
10. Have you been assisted with personal care at LEAST every
week? (bath, shower, washing hair etc.)
11. Has this worker ever written wrong days or hours on the
sheet you sign, or have they ever asked you to lie on paperwork?
12. Does this worker respect your home and belongings?
The rest of the evaluation could be a numerical scale of
satisfaction-dissatisfaction, and should include ways to measure communication
skills, etc.
CONCLUSIONS:
Unless these programs make changes, patients will continue to suffer or
receive inadequate care. Currently, patients have no voice in the
design and delivery of State-run programs. Patient-supplied evaluations
will greatly assist in making changes to the present care delivery system.
Home Health Aide workers must receive pay and benefits that reflect the work
they do for patients confined to their homes. Companies must insist on
hiring only qualified workers. All applicants for home care work should
have minimum requirements and testing before being hired.
