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More Americans opt for home health care By
Anna Brunson Johanna McVey braces her leg muscles, and her latex-gloved hands tightly grip Marla's torso as she slowly lowers her into the steamy bathtub. Suddenly, McVey's hands slip, and 40-year-old Marla plops into the water, soaking McVey and the entire bathroom floor. Marla, who is already giggly by nature, cackles uncontrollably at the mess she has caused. McVey decides that from now on, she'll put Marla in the tub before she fills it. It's 7:15 a.m., and it's only been a few minutes since 20-year-old McVey, with bleary eyes, hastily tied up hair, and purple scrubs, tip-toed down the freshly carpeted stairs of Marla's foster family's home to wake her up and help her start the day. Marla has Down Syndrome, and these home visits are a necessary part of her daily routine. People like Marla who have disabilities are turning to companies such as Rocky Mountain Home Care that employ Certified Nurse Aassistants (CNAs) and Registered Nurses (RNs) to provide in-home assistance. But home care isn't just for the disabled. In fact, the Bureau of Labor Statistics says that the number of people insured for home health care has more than doubled in the past two decades to more than 90 percent. Whether for senior assistance, infant care, disease treatment or disability help, home health care is a growing trend that affects everybody. Home care provides independence and versatility and is less expensive than other forms of care, according to the website of First Choice Home Health Specialists, a company based out of Sandy, Utah. The philosophy of home care is to deal with health problems that need to be managed more than they need to be treated and keeping people out of hospitals and nursing homes. McVey is a CNA who has worked at nursing homes, hospitals and outpatient clinics. Now she is an Employee of Rocky Mountain Home Care, and she is a strong supporter of home health care programs. "It's so great to see these people living their lives," she says. "Some of our patients go to day camps; others even have jobs. Because they are able to live in their own homes, there is a sense of independence that they never could have felt in a nursing home." As McVey kneels by the tub, she passes Marla her Herbal Essences shampoo, conditioner, scented shower gel and pouf one by one, telling her each time what to do and what to wash. "When I was working at a nursing home, there would be six or seven patients for each resident," McVey says as she lathers Marla's short, red hair. "Sometimes things would get so busy that little chores like teeth brushing would just have to be skipped for the day. Now, not only do I have time to give patients all the care they need, but I can spend the extra time waiting for them to try to do it themselves." "Home care allows people to stay in their homes longer, which is good because it saves costs, and no one wants to be in a nursing home, but it also provides companionship for people that are living alone," says Suzanne Smith, director of Alpine Home Care in Logan. "Usually, they look forward to their home visits, and it is a big advantage for them." Home care can vary widely, depending on the needs of the patient. It can include visits from nurses who change dressings or administer antibiotics; sessions with physical therapists and specialists; and help from volunteers to do household chores or provide a ride to the doctor. Heritage Brookside Home Care, a company servicing most of Utah, provides 17 different services. McVey has several different patients, and each one gets a personalized regimen. For instance, Marla looks forward to Fridays because that is nail-painting day. As McVey drains the tub, she tells Marla that she is beautiful, and Marla responds by saying "Hubba, hubba, hubba," but her mood begins to dampen after McVey pulls her out of the tub, dries her off, and begins to help her dress. Marla hates every bra that McVey hands her, but after three tries, she finally settles on a sports bra that doesn't feel as tight. McVey dresses her in a pair of khakis and a white sweater that her caretaker set out the night before. It takes two tries to find the right shoes. Providing the favorite choice takes time, but it contributes to the freedom that home visits strive to provide. In addition to independence and tailored care, home care is also becoming more affordable for those who need it. Marla's home care is covered by a private insurance policy that her mother pays for. Her mom had gotten too old to provide constant care for her, so Marla moved into a shared apartment and received daily home care. One of the residents that visited Marla volunteered to let her live with her, her husband and two-year-old son. Throughout this time, the insurance has paid for Marla's continued home care. Medicare or Medicaid programs often cover patients without private insurance policies. More than 90 percent of home care agencies are Medicare and Medicaid certified, says the Bureau of Census. "Basically, Medicare and Medicaid are what we work with most of the time," says Smith. "The patient usually ends up paying a small co-pay or nothing at all." Quietly rocking in her Lazy Boy armchair, Marla eats her breakfast of yogurt while McVey makes the bed and tidies up the room. Before Marla's ride to BRASC day care arrives at 8 a.m., she carefully signs the form McVey gives her to say that she was happy with that day's visit. Marla wiggles her fingers at McVey and says, "Tickle, tickle," and McVey says goodbye. Home care is a success for Marla and many others, but there is also a dark side to the industry. The need for home care keeps growing as people are living longer, but there is a constant lack of certified workers, funding and ideal housing. "There is no question we're facing a future tsunami of [home care] need as the population ages," says Tim Brown, National Association for Home Care spokesman, in the Pittsburgh Post-Gazette. "It comes at a time when there are not an adequate number of people entering the profession." Nursing, says the article, is one of the most underpaid, overworked occupations. Also, with continuing changes to national health care programs, coverage is inconsistent, says the Omaha World-Herald. After Medicare cutbacks from the Balanced Budget Program of 1997, "there were fewer agencies to provide care, but the demand didn't stop," says Kimberle Hall, member of the Association of Home and Community Heath to the Omaha World-Herald. "Some patients went uncovered, and they began to show up in emergency rooms and hospitals instead of receiving in-home services." A new Medicare repayment system is now in place, and industry growth has continued again. Now, more than 10,000 public, non-profit and commercial agencies are in the home care business, says the Omaha World-Herald. McVey says these problems aren't as bad in Cache Valley as they are elsewhere. There are eight home care agencies in the area, and Rocky Mountain Home Care easily covers all of its patients. Smith says that Alpine Home Care has seen a very high demand in Logan for home care, but that the company has not yet had to form a waiting list. Rocky Mountain Home Care pays certified nurses $15 per visit, a highly competitive wage in an area with such a large college population, but unfortunately, even with more years of experience, employees are frozen at that wage. Logan's home care system is still far from perfect. After Marla's visit, McVey travels across town to wake up Frank, a 63-year-old man with severe retardation. Frank shares an apartment with a roommate who is also disabled. McVey sets a paper towel on the couch and places her bag and coat on top of it so she won't pick up any germs. She quickly puts on her latex gloves, which she is always sure to wear at Frank's. Home care employees are not hired to do any deep cleaning, and the apartment is filthy. With only an hour to spend with him, there is nothing she can do about his room. Frank moves around slowly, like a 100-year-old, and he never talks to McVey or shows any sign that he even knows who she is, though she visits several times a week. "He can do everything by himself, but he needs constant prompting," says McVey. "Frank, come over here, please. Frank, wash your hands. Frank, eat your breakfast. But he is able to do and always does what I say. All I have to do is touch up when he shaves." "Sometimes this job is hard for me. It makes me sad to see some patients without a family to take care of them. It's scary to be all by myself when a patient acts up or gets unruly. But, I've always wanted a job working with people, and not like a store, or in the mall or telemarketing. I wanted to make a difference to people. And I make a difference to Frank and Marla." That's why she'll be back at Marla's at 7 a.m. tomorrow. Only this time, she'll wait to fill the bathtub.
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