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News Roundup: June 24, 2013

Home Care Workers Could Be the New Face of Labor

Published by Home Health Care News
Alyssa Gerace
June 20, 2013

With surging demand for home care workers, unions are sensing an opportunity to get involved by helping workers in the industry to organize—upping their own membership in the process.

But there’s not a clear path to unionizing the sector, writes the Wall Street Journal, as some question whether home health aides qualify to join a union, especially as many are caring for family members and could even be considered self-employed.

As a result, some legislative battles have taken place in a few states either allowing or barring these workers from organizing.

By 2020, the Department of Labor projects the number of home health workers to reach 3.2 million, up almost 70% from 2010′s 1.9 million. The median hourly wage for these workers was $9.70 in 2010, and many lack health care coverage.

“A large percentage of these workers are hired directly by people with disabilities or their families, rather than wing employed by private agencies,” says the WSJ article. In Michigan, for example, a state-commissioned 2011 study revealed that 75% of home care workers there began providing those services to help a family member or friend.

On the one hand, unions and many Democratic lawmakers believe workers receiving public funds—such as Medicaid or Medicare reimbursement—for their labor are technically state employees and have the ability to organize, says the WSJ. But many Republican lawmakers counter with the argument that personal care aides are independent contractors and ineligible for union membership.

In May, Minnesota Democrats passed a bill giving the state’s 15,000 home health care workers along with 7,000 home child care providers the right to organize, while a similar measure in Vermont was recently signed by the state’s Democratic governor permitting the state’s 7,000 home health aides to unionize, reports the WSJ.

Meanwhile, Republicans in other estates have blocked or overturned efforts to allow home health workers to organize, the article continues, citing Wisconsin and Ohio.

Union membership has been declining for years, the home health industry presents a large pool of potential new members. Already, about 25% of home care workers belong to unions across the country, according to Eileen Boris, a professor of history at the University of California at Santa Barbara. She says the unionization of home care workers is comparable to when factory workers unionized in the 1930s and ’40s.

“Home-care workers are the new face of labor,” Boris told the WSJ.

Home-based care: Demand climbs for care of ageing population outside hospital

Published by Financial Times
Rose Jacobs
June 19, 2013


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Carlos Nunez does not have the cure for cancer.
But the chief medical officer of CareFusion, a California-based medical technology company, thinks the next-best option matters, which is why he speaks proudly of a system developed to drain fluid from cancer patients’ lungs.

Rather than requiring them to have periodic surgeries – procedures that can be long and painful – CareFusion’s patients get a catheter placed in their lungs that attaches to a bottle and a vacuum, giving them breathing relief at home.

“Just because a person is dying of cancer, doesn’t mean he has to be at the hospital all the time,” says Dr Nunez.
Nor will that patient usually want to be.

Demographics point to a massive rise in the demand for home-based healthcare over the coming decades as millions of baby boomers begin to feel the impact of ageing and look for ways to receive care on their own terms rather than succumbing to any status quo.

But the desire of individuals to be cared for at home is only one of the forces behind the trend: in the US and Europe – partly because of demographics – governments are facing up to rising healthcare bills, and looking for ways to keep them in check. Home care here holds great promise.

“We are anticipating a much bigger amount of care taking place at people’s homes,” says Candace Imison, acting director of policy at The King’s Fund.
The healthcare think-tank recently outlined 10 priorities for UK authorities with a hold on the country’s health budgets.

Several of these would aim to shift care from clinical settings into the home, including improved “self-management” of medical conditions and improved end-of-life care.
In the US, meanwhile, healthcare laws introduced under President Barack Obama incentivise a shift to home care, while the $74bn home care industry is already growing at an annual rate of about 5 per cent.

“Home care saves patients millions of dollars every year,” says Anna Son, an analyst at market research group IBISWorld, which recently published a report on the approximately 300,000 businesses providing home care in the US.

Ms Imison warns, however, that the full extent of the potential savings is as yet unknown. The US agencies overseeing Medicaid, the federal health insurance programme for low-income individuals and families, estimate three people can be cared for at home for what it costs to care for one person in hospital.

But that ratio might grow as home-care systems advance. Traditional models have been highly staff-intensive, for example, while many policy makers and industry experts count on technology fundamentally changing the way the best home care models work. That could range from more devices such as the lung-drainage systems Dr Nunez describes, to teleconferencing, to automated in-home medicine dispensers that not only offer up the appropriate pills at the appropriate times of day, but report back to a doctor or care worker about whether a patient has, in fact, taken those tablets.

Corporate R&D teams are eager to provide these sorts of devices, and Dr Nunez predicts the investment will gather pace as regulators respond in kind, accepting that they need to oversee new types of technologies, for new uses.

The US Food and Drug Administration recently contacted the makers of UChek, a smartphone app that analyses urine samples through photos, asking why the company had not sought agency approval.

But technology will invariably only go so far in facilitating the home care shift, and Thea Stein, chief executive of the Carers’ Trust in the UK, worries that family members will bear the brunt of a cost-savings push.

“The family carer has to be seen as the unpaid member of the healthcare team,” she says. “If not, you are likely to lead to serious levels of stress and strain; carers will collapse, and that will lead to a whole load of other costs to the system. So it’s not just a moral duty – it’s financially the right thing to do.”

Moreover, she points out, while home care can save patients and carers cumbersome hospital and clinic visits, it can also lead to greater alienation.
“One of the things we hear most often from carers, is how terribly isolated they feel.”

Ms Imison at the King’s Fund agrees that the key to the success of home care depends on the people supplying it, and she argues that considerable thought and investment needs to go into retraining large portions of the medical workforce to care for people in their homes rather than in hospital.

Even then, she says, by 2025, there could be a 35 per cent gap between demand for social care workers in the UK and supply.

But, here, demographics may help, Ms Imison says: “There is a role here for volunteers and the older generation themselves – we think the fit baby boomers will help the unfit.”
It may seem an optimistic view. But Dr Nunez argues that creative solutions will be necessary, particularly as developed-world diseases such as diabetes add to the strain.
“We’re entering a brave new world,” he says. “And if we’re going to save both lives and money, we need to be nimble.”

CMS to Hold Home Health, Hospice and DME Forum

Published by Home Health Care News
Jason Oliva
June 19, 2013

Next week, the Centers for Medicare & Medicaid Services (CMS) will hold an open door forum (ODF) to address the concerns of three unique healthcare areas relating to home health.

The next Home Health, Hospice & Durable Medical Equipment (DME) Open Door Forum is scheduled for Wednesday, June 16, 2013 from 2:00pm—3:00pm, ET.

Topics of discussion include issues related to Home Health Prospective Payment System (PPS), the newly proposed competitive bidding program for DME and the Medicare Hospice benefit.

CMS intends that combining all three discussion topics under one forum will be particularly useful for many participants.

“We continue to hold Special ODFs when individual policy issues require special attention,” writes CMS.

Timely announcements and clarifications regarding important rule making, agency program initiatives and other related areas are also included in the CMS forums.